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

Authors

Mary A. Andrews, Department of Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, Maryland, USA.
Catherine A. Okuliar, Department of Medicine, Georgetown University School of Medicine, Washington, District of Columbia, USA.
Sean A. Whelton, Department of Medicine, Georgetown University School of Medicine, Washington, District of Columbia, USA.
Allison O. Windels, Department of Medicine, Georgetown University School of Medicine, Washington, District of Columbia, USA.
Stacy R. Kruse, Department of Medicine, Georgetown University School of Medicine, Washington, District of Columbia, USA.
Manesh G. Nachnani, Department of Medicine, Georgetown University School of Medicine, Washington, District of Columbia, USA.
Deborah A. Topol, Department of Medicine, Georgetown University School of Medicine, Washington, District of Columbia, USA.
Elexis C. McBee, Department of Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, Maryland, USA.
Michael T. Stein, Department of Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, Maryland, USA.
Raj C. Singaraju, Department of Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, Maryland, USA.
Sam W. Gao, Department of Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, Maryland, USA.
David S. Oliver, Department of Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, Maryland, USA.
Jed P. Mangal, Department of Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, Maryland, USA.
Jeffrey S. LaRochelle, Department of Medical Education, University of Central Florida College of Medicine, Orlando, Florida, USA.
William F. Kelly, Department of Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, Maryland, USA.
Kent J. DeZee, Department of Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, Maryland, USA.
H Carrie Chen, Department of Pediatrics, Georgetown University School of Medicine, Washington, District of Columbia, USA.
Anthony R. Artino, Department of Health, Human Function, and Rehabilitation Sciences, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia, USA.
Paul A. Hemmer, Department of Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, Maryland, USA.
Ting Dong, Center for Health Professions Education, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, Maryland, USA.
Timothy J. Cleary, Department of School Psychology, Graduate School of Applied and Professional Psychology, Rutgers, The State University of New Jersey, Piscatawy, New Jersey, USA.
Steven J. Durning, Center for Health Professions Education, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, Maryland, USA.

Document Type

Journal Article

Publication Date

1-1-2023

Journal

Perspectives on medical education

Volume

12

Issue

1

DOI

10.5334/pme.833

Abstract

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.

APA Citation

Andrews, Mary A.; Okuliar, Catherine A.; Whelton, Sean A.; Windels, Allison O.; Kruse, Stacy R.; Nachnani, Manesh G.; Topol, Deborah A.; McBee, Elexis C.; Stein, Michael T.; Singaraju, Raj C.; Gao, Sam W.; Oliver, David S.; Mangal, Jed P.; LaRochelle, Jeffrey S.; Kelly, William F.; DeZee, Kent J.; Chen, H Carrie; Artino, Anthony R.; Hemmer, Paul A.; Dong, Ting; Cleary, Timothy J.; and Durning, Steven J., "Using Self-Regulated Learning Microanalysis to Examine Regulatory Processes in Clerkship Students Engaged in Practice Questions" (2023). GW Authored Works. Paper 3605.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/3605

Department

Health, Human Function, and Rehabilitation Sciences