Using multiple self-regulated learning measures to understand medical students' biomedical science learning

Validation of the motivated strategies for learning questionnaire and instructional materials motivation survey

PURPOSE

To validate the Motivated Strategies for Learning Questionnaire (MSLQ), which measures learner motivations; and the Instructional Materials Motivation Survey (IMMS), which measures the motivational properties of educational activities.

METHODS

Participants (333 pharmacists, physicians, and advanced practice providers) completed the MSLQ, IMMS, Congruence-Personalization Questionnaire (CPQ), and a knowledge test immediately following an online learning module (April 2021). We randomly divided data for split-sample analysis using confirmatory factor analysis (CFA), exploratory factor analysis (EFA), and the multitrait-multimethod matrix.

RESULTS

Cronbach alpha was ≥0.70 for most domains. CFA using sample 1 demonstrated suboptimal fit for both instruments, including 3 negatively-worded IMMS items with particularly low loadings. Revised IMMS (RIMMS) scores (which omit negatively-worded items) demonstrated better fit. Guided by EFA, we identified a novel 3-domain, 11-item 'MSLQ-Short Form-Revised' (MSLQ-SFR, with domains: Interest, Self-efficacy, and Attribution) and the 4-domain, 12-item RIMMS as the best models. CFA using sample 2 confirmed good fit. Correlations among MSLQ-SFR, RIMMS, and CPQ scores aligned with predictions; correlations with knowledge scores were small.

CONCLUSIONS

Original MSLQ and IMMS scores show poor model fit, with negatively-worded items notably divergent. Revised, shorter models-the MSLQ-SFR and RIMMS-show satisfactory model fit (internal structure) and relations with other variables.

Should we add patients in concordance of judgment learning tool panels? - An analysis between patients and primary care physicians

INTRODUCTION

The Concordance of Judgment Learning Tool (CJLT) has been developed for distance asynchronous learning of professionalism in health sciences education. The learning of professionalism is induced by a student's comparison of their own responses with those of the panel members. Whilst CJLT programs typically include same profession experts in their panels, we believe that they could also include patients. Accordingly, we conducted a study aimed at comparing CJLT response patterns between two groups of primary care physicians (PCPs) and patients.

METHODS

We conducted a mixed prospective study of responses to a CJLT program based on a group of PCPs and a group of patients: an analysis of the response patterns of the two groups and a qualitative analysis of justifications.

RESULTS

A total of 110 participants were included in the study: 70 patients and 40 PCPs. We found a significant difference in response patterns between the PCP and patient groups for nine of the fifteen questions (60%). The qualitative analysis of justifications between groups allowed us to comprehend patients' views on the professionalism of PCPs.

CONCLUSIONS

Including patients in CJLT panels can enrich the feedback offered to students in these online training programs.

Relinquishing control? Supervisor co-regulation may disrupt students' self-regulated learning during simulation-based training

When uncertain, medical trainees often seek to co-regulate their learning with supervisors and peers. Evidence suggests they may enact self-regulated learning (SRL) strategies differently when engaged in self- versus co-regulated learning (Co-RL). We compared the impacts of SRL and Co-RL on trainees' acquisition, retention, and preparation for future learning (PFL) of cardiac auscultation skills during simulation-based training. In our two-arm, prospective, non-inferiority trial, we randomly assigned first- and second-year medical students to the SRL (N = 16) or Co-RL conditions (N = 16). Across two learning sessions separated by two-weeks, participants practiced and were assessed in diagnosing simulated cardiac murmurs. We examined diagnostic accuracy and learning trace data across sessions, and conducted semi-structured interviews to explore participants' understandings of their underlying choices and learning strategies. SRL participants' outcomes were non-inferior to Co-RL participants on the immediate post-test and retention test, but not on the PFL assessment (i.e., inconclusive). Analyzing interview transcripts (N = 31) generated three themes: perceived utility of initial learning supports for future learning; SRL strategies and sequencing of murmurs; and perceived control over learning across sessions. Co-RL participants regularly described relinquishing control of learning to supervisors and regaining it when on their own. For some trainees, Co-RL seemed to interfere with their situated and future SRL. We posit that transient clinical training sessions, typical in simulation-based and workplace-based settings, may not allow the ideal processes of Co-RL to unfold between supervisor and trainee. Future research must examine how supervisors and trainees can share accountability to develop the shared mental models that underlie effective Co-RL.

The potential of structured learning diaries for combining the development and assessment of self-regulated learning

Structured Self-Regulated Learning (SSRL) diaries have the potential for combining the development and assessment of a student's SRL processes over time. The aim of this study was to evaluate the extent to which an SSRL diary can develop SRL and provide a reliable longitudinal assessment of SRL development in academically low-achieving undergraduate medical students. We conducted a quasi-experimental study with low-achieving medical students at Tehran University of Medical Sciences. The intervention was a weekly SSRL diary, with 21 items in two parts (before and after studying) that was integrated with weekly explicit SRL training. A repeated measures ANOVA was performed to assess the participants' SRL development across time. We conducted generalizability theory analysis in two designs; the first was to assess the reliability of the total diary score in assessing low-achieving medical students' SRL and the second was to assess the efficacy of the four-week intervention results in improving the low-achieving medical students' SRL. Each participant (n = 20) completed four SSRL diaries. There were significant positive changes during the intervention in the students' measures of total SRL, time estimation of study, time spent on study, concentration, elaboration, organization, self-monitoring, and self-evaluation. The absolute and relative generalizability coefficients for the first design, which indicates the reliability of the students' SRL scores, were 0.71 and 0.77. The absolute and relative generalizability coefficients for the second design, which presents the reliability of the improvement of students' SRL across time were 0.79 and 0.87. The results of this study suggest that SSRL diaries combined with explicit training can provide an effective and reliable method for combining the development and assessment of SRL in low-achieving medical students' SRL over time.

From self-regulation to co-regulation: refining learning presence in a community of inquiry in interprofessional education

INTRODUCTION

Online interprofessional education is a collaborative process that emphasizes both individual reflection and shared discourses. A useful analytical tool for understanding the complex dynamics of online collaborative learning is the community of inquiry (CoI) framework, which originally held that there are three types of presence in such learning: teaching, cognitive, and social. However, it was later revised to include learning presence, which is characterized by self-regulated learning. Our study aims to refine the construct of learning presence through a clearer understanding of how self- and co-regulation jointly influence learning outcomes.

METHODS

We surveyed 110 people involved with an online interprofessional medical-education curriculum at a university in Hong Kong. Path analysis was adopted to explore the relationships among 1) the three original presences of CoI; 2) learning presence (i.e., for this purpose, a combination of self-regulation and co-regulation); and 3) two learning outcomes: perceived progress and learner satisfaction.

RESULTS

The results of path analysis indicated that teaching presence had a significant indirect effect, through co-regulation, on perceived progress. In terms of direct relationships, co-regulation significantly and positively influenced both self-regulation and cognitive presence; and social presence had both positive influence on learners' satisfaction and perceived progress.

DISCUSSION

This study's findings suggest the important role of co-regulation in supporting self-regulation, especially in online collaborative-learning environments. Learners' self-regulation skills are shaped by their social interactions and regulatory activities with others. This further implies that health-professions educators and instructional designers should create learning activities that facilitate the development of co-regulatory skills, as a means of improving learning outcomes. As self-regulation is an important skill for health professions learners' lifelong learning, and because their future workplaces will be interdisciplinary in nature, it is critical to provide interactive and collaborative learning environments that will promote co-regulation and self-regulation.

Achievement Emotions of Medical Students: Do They Predict Self-regulated Learning and Burnout in an Online Learning Environment?

BACKGROUND

Achievement emotions have been proven as important indicators of students' academic performance in traditional classrooms and beyond. In the online learning contexts, previous studies have indicated that achievement emotions would affect students' adoption of self-regulated learning strategies and further predict their learning outcomes. However, the pathway regarding how different positive and negative achievement emotions might affect students' burnout through self-regulated learning among medical students in online learning environments remains unclear. In this study, the aim is to investigate how achievement emotions and self-regulated learning predict burnout among medical students in online education.

METHODS

This study involved 282 medical students who had attended online courses due to the sudden shift of learning mode caused by the COVID-19 pandemic in 2022. Confirmatory factor analysis was performed to examine the hypothesized factor structure, and structural equation modelling was conducted to test the hypothesized relationships among factors.

RESULTS

The results of structural equation modelling revealed that medical students' self-efficacy positively predicted their enjoyment (β = .57) and online self-regulated learning (β = .54). Learning-related boredom inhibited students' adoption of online self-regulated learning strategies (β = -.24), and it was positively associated with their burnout (β = .54). Learning-related anxiety was a positive predictor of online self-regulated learning (β = .38).

DISCUSSIONS

The results of this study suggest that achievement emotions experienced by medical students had a significant impact on their online self-regulated learning and burnout. Specifically, the experience of learning-related boredom was detrimental to the adoption of self-regulated learning strategies and increased the likelihood of burnout. However, learning-related anxiety, despite being a negative achievement emotion, was positively associated with students' online self-regulated learning. These findings have important implications for online teaching and learning, particularly in the post-pandemic era.

Using Self-Regulated Learning Microanalysis to Examine Regulatory Processes in Clerkship Students Engaged in Practice Questions

Introduction

Self-regulated learning is a cyclical process of forethought, performance, and self-reflection that has been used as an assessment tool in medical education. No prior studies have evaluated SRL processes for answering multiple-choice questions (MCQs) and most evaluated one or two iterations of a non-MCQ task. SRL assessment during MCQs may elucidate reasons why learners are successful or not on these questions that are encountered repeatedly during medical education.

Methods

Internal medicine clerkship students at three institutions participated in a SRL microanalytic protocol that targeted strategic planning, metacognitive monitoring, causal attributions, and adaptive inferences across seven MCQs. Responses were transcribed and coded according to previously published methods for microanalytic protocols.

Results

Forty-four students participated. In the forethought phase, students commonly endorsed prioritizing relevant features as their diagnostic strategy (n = 20, 45%) but few mentioned higher-order diagnostic reasoning processes such as integrating clinical information (n = 5, 11%) or comparing/contrasting diagnoses (n = 0, 0%). However, in the performance phase, students' metacognitive processes included high frequencies of integration (n = 38, 86%) and comparing/contrasting (n = 24, 55%). In the self-reflection phase, 93% (n = 41) of students faulted their management reasoning and 84% (n = 37) made negative references to their abilities. Less than 10% (n = 4) of students indicated that they would adapt their diagnostic reasoning process for these questions.

Discussion

This study describes in detail student self-regulatory processes during MCQs. We found that students engaged in higher-order diagnostic reasoning processes but were not explicit about it and seldom reflected critically on these processes after selecting an incorrect answer. Self-reflections focused almost exclusively on management reasoning and negative references to abilities which may decrease self-efficacy. Encouraging students to identify and evaluate diagnostic reasoning processes and make attributions to controllable factors may improve performance.

How self-regulated learning influences undergraduate medical students to conduct student-centred learning: a scoping review protocol

INTRODUCTION

Self-regulated learning is one of the influencing factors in successful learning. There is a need to understand the factors influencing self-regulated learning in undergraduate medical students in implementing a student-centred learning curriculum. This scoping review aims to systematically identify and map undergraduate medical students' self-regulated learning during student-centred learning implementation and to learn the tools used to measure it.

METHODS AND ANALYSIS

The scoping review will use Arksey and O'Malley's proposed five-stage framework guideline. A search for published literature between 2012 and 2022 in the five electronic databases of EBSCOHost, Science Direct, Scopus, ProQuest and PubMed will be conducted using keywords to identify relevant studies. Articles will be limited to the English language. Mendeley software will eliminate duplicates, and results will be exported into abstracts for two stages of the screening process: title and abstract reviews and full-text reviews. The selection process of eligible literature will be reported using the Preferred Reporting Items of Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist recommendations. Studies using qualitative and quantitative data from all world regions will be considered. To be included, studies should examine medical students' self-regulated learning in a student-centred learning approach curriculum. A data chart will capture relevant information from all the included studies. As a scoping review, no assessment of the studies' quality and risk of bias will be made. Results will be presented in tabular form and a narrative report.

ETHICS AND DISSEMINATION

No Ethics Committee or Institutional Board approval is required. The findings of this study will be disseminated through peer-reviewed publications, conference presentations and professional networks.

Medical education environment perception and learning engagement in undergraduate nursing students: The mediating effect of self-regulated learning ability

AIM

To investigate the interrelationships of medical education environment perception, learning engagement and self-regulated learning ability among Chinese undergraduate nursing students.

BACKGROUND

After the outbreak of COVID-19, great changes have taken place in the medical education environment, many offline teaching and academic activities have been replaced by online activities. Students' learning engagement influences the efficiency of online learning. However, the mediating effect of self-regulated learning (SRL) ability between medical education environment perception and learning engagement is unclear.

DESIGN

This study involved a cross-sectional descriptive correlational research.

METHODS

A total of 228 undergraduatenursing students who were attending online learning were included in this study.This investigation adopted Dundee Ready Educational Environment Measure scale (DREEM), Motivated Strategies for Learning Questionnaire (MSLQ) and Utrecht Work Engagement Scale-Student scale (UWES-S) to respectively know about the levels of medical education environment perception, self-regulating and learning engagement. The structural equation model and bootstrap method were used to clarify the association and interaction among the three variables.

RESULTS

The scores of nursing students' medical education environment perception, SRL ability and learning engagement were 135.64 ± 15.12, 161.39 ± 22.57 and 68.01 ± 11.77, respectively. Perception of medical education environment directly affects learning engagement (β = 0.556, P < 0.001). SRL ability partially mediated the effect of medical environment perception on learning engagement (x2/df = 1.427, RMSEA = 0.043, GFI = 0.962, NFI = 0.954, TLI = 0.980, CFI = 0.986), and the variance was 30.8 %.

CONCLUSION

SRL ability plays a mediating role between medical education environment perception and learning engagement. Nursing educators should continuously optimize the online education environment, such as designing intelligent teaching platform or software, adopting interactive teaching methods, strengthening professional value education and encouraging peer learning, so as to meet the requirements of nursing students' learning engagement in the new medical education environment.

Self-regulated learning processes across different physiotherapy clinical procedural skills and time intervals: A SRL microanalysis study

PURPOSE OF THE STUDY

The performance of a clinical procedural skill by an individual student is associated with their use of Self-Regulated Learning (SRL) processes. However, previous research has not identified if an individual student has a similarity in their use of SRL processes across different clinical procedural skill tasks and at a time interval. The aim of this pilot study was to explore the similarity in the use of SRL processes by individual students across different clinical procedural skill tasks and at a time interval.

METHODS

SRL-microanalysis was used to collect within-subject data on undergraduate physiotherapy students' use of the two key SRL processes (planning and monitoring) during their performance of different goniometry clinical procedural skills tasks and also at a fourth month interval.

RESULTS

An individual student's use of key SRL processes across different clinical procedural skill tasks and at a time interval was similar. Also, this similarity was identified for students with initial successful and unsuccessful performances.

CONCLUSION

Our findings have implications for the future wider practical implementation of SRL microanalysis to inform personalised SRL feedback for developing the clinical procedural skills of individual students. Further research with a greater number of students and across a wider range of clinical procedural skills will be required to confirm our findings, and also its effectiveness on feedback and future performance.

Developing low-achieving medical students' self-regulated learning using a combined learning diary and explicit training intervention

INTRODUCTION

The development of self-regulated learning (SRL) is an essential educational component of remediation for low-achieving students. The aim of this study was to design, implement, and evaluate a longitudinal SRL intervention combining both a structured learning diary and explicit SRL training in a cohort of low-achieving undergraduate medical students.

MATERIALS AND METHODS

A mixed methods quasi-experimental study was conducted, with a pretest-posttest study in the intervention group and comparison of the GPA and course grade of the intervention group with a historical comparison group. A questionnaire and focus group explored the participants' perceptions about the intervention.

RESULTS

The SRL scores (total and rehearsal, organization, critical thinking, metacognitive regulation, time management and environment management) and course grade of participants were significantly improved in the intervention group. The course grade of participants was significantly higher than the comparison group but the GPA was not significantly different. Overall, the participants were positive about the intervention.

CONCLUSIONS

This study was the first in medical education to evaluate the effectiveness and user acceptability of an SRL intervention that combined a structured learning diary and explicit SRL training in low-achieving medical students. Further research is recommended in different contexts and with larger number of students.

Assessing Learner Engagement and the Impact on Academic Performance within a Virtual Learning Environment

BACKGROUND

The objective of this pilot study was to examine student engagement with weekly self-paced learning materials in a virtual therapeutics course, and how sub-factors in the Motivated Strategies for Learning Questionnaire (MSLQ) may have influenced academic performance.

METHODS

Students within a diabetes module of a therapeutics course were provided with weekly asynchronous optional self-directed learning activities. Student submissions, on-time rates, self-reported weekly study time, and exam performance were collected. Students completed the MSLQ at the completion of the study. Data was evaluated using various correlation analyses to determine the predictive ability of the MSLQ and its 5 subscales.

RESULTS

In total, 173 students completed the study. Students' self-efficacy score on the MSLQ subscale and case submission on-time rate have the strongest positive correlation with the exam score, while the test anxiety as reported on the MSLQ test anxiety subscale had the strongest negative correlation with the exam score.

CONCLUSIONS

Study results proved the MSLQ to be an effective predictive tool in students' self-regulation skills. Results can be used to develop intentional interventions aimed at improving self-regulation skills while providing opportunities to enhance student learning.

Motivational Design for Web-Based Instruction in Health Professions Education: Protocol for a Systematic Review and Directed Content Analysis

BACKGROUND

Web-based instruction plays an essential role in health professions education (HPE) by facilitating learners' interactions with educational content, teachers, peers, and patients when they would not be feasible in person. Within the unsupervised settings where web-based instruction is often delivered, learners must effectively self-regulate their learning to be successful. Effective self-regulation places heavy demands on learners' motivation, so effective web-based instruction must be designed to instigate and maintain learners' motivation to learn. Models of motivational design integrate theories of motivation with design strategies intended to create the conditions for motivated engagement. Teachers can use such models to develop their procedural and conceptual knowledge in ways that help them design motivating instruction in messy real-world contexts. Studies such as randomized controlled trials (RCTs) and other quasi-experimental designs that compare different motivational design strategies play a critical role in advancing models of motivational design. Synthesizing the evidence from those studies can identify effective strategies and help teachers and researchers understand the mechanisms governing why strategies work, for whom, and under what circumstances.

OBJECTIVE

The planned review aims to analyze how studies comparing motivational design strategies for web-based instruction in HPE support and advance models of motivational design by (1) controlling for established risks to internal validity, (2) leveraging authentic educational contexts to afford ecological validity, (3) drawing on established theories of motivation, (4) investigating a wide breadth of motivational constructs, and (5) analyzing mediators and moderators of strategy effects.

METHODS

The planned review will use database searching, registry searching, and hand searching to identify studies comparing motivational design strategies for web-based instruction, delivered to learners in HPE. Studies will be considered from 1990 onward. Two team members will independently screen studies and extract data from the included studies. During extraction, we will record information on the design characteristics of the studies, the theories of motivation they are informed by, the motivational constructs they target, and the mediators and moderators they consider.

RESULTS

We have executed our database and registry searches and have begun screening titles and abstracts.

CONCLUSIONS

By appraising the characteristics of studies that have focused on the motivational design of web-based instruction in HPE, the planned review will produce recommendations that will ensure impactful programs of future research in this crucial educational space.

TRIAL REGISTRATION

PROSPERO CRD42022359521; https://tinyurl.com/57chuzf6.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/42681.

Capturing Sequences of Learners' Self-Regulatory Interactions With Instructional Material During Game-Based Learning Using Auto-Recurrence Quantification Analysis

Undergraduate students (N = 82) learned about microbiology with Crystal Island, a game-based learning environment (GBLE), which required participants to interact with instructional materials (i.e., books and research articles, non-player character [NPC] dialogue, posters) spread throughout the game. Participants were randomly assigned to one of two conditions: full agency, where they had complete control over their actions, and partial agency, where they were required to complete an ordered play-through of Crystal Island. As participants learned with Crystal Island, log-file and eye-tracking time series data were collected to pinpoint instances when participants interacted with instructional materials. Hierarchical linear growth models indicated relationships between eye gaze dwell time and (1) the type of representation a learner gathered information from (i.e., large sections of text, poster, or dialogue); (2) the ability of the learner to distinguish relevant from irrelevant information; (3) learning gains; and (4) agency. Auto-recurrence quantification analysis (aRQA) revealed the degree to which repetitive sequences of interactions with instructional material were random or predictable. Through hierarchical modeling, analyses suggested that greater dwell times and learning gains were associated with more predictable sequences of interaction with instructional materials. Results from hierarchical clustering found that participants with restricted agency and more recurrent action sequences had greater learning gains. Implications are provided for how learning unfolds over learners' time in game using a non-linear dynamical systems analysis and the extent to which it can be supported within GBLEs to design advanced learning technologies to scaffold self-regulation during game play.

How to conceptualise self-regulated learning: Implications for measurement

When is self‐regulated learning not entirely self‐regulated? The authors argue SRL is socially embedded and we need better measurement of its reciprocal relationship with co‐regulated learning.

Self-regulated learning: the effect on medical student learning outcomes in a flipped classroom environment

BACKGROUND

The flipped-classroom model is increasingly being adopted in competency-based medical education. However, it poses a major challenge to students who have not mastered self-regulated learning strategies. This study explores which self-regulated learning skills affect student learning performance in the first 2 years of medical school at a university in the midwestern United States.

METHODS

Survey data were used to assess how 146 first- and second-year medical students' use of self-regulated learning strategies affected their performance on standardized tests.

RESULTS

Based on the results of regression analysis and content analysis, it was found that the use of peer learning and help-seeking positively affected the performance of first- and second-year students, respectively; whereas the use of rehearsal had a negative effect on student learning outcomes.

CONCLUSIONS

The study findings imply that during the transition period from traditional lecture-intensive learning to flipped-classroom learning, promoting peer learning and help-seeking could significantly improve students' academic achievement.