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

Mary A Andrews; Catherine A Okuliar; Sean A Whelton; Allison O Windels; Stacy R Kruse; Manesh G Nachnani; Deborah A Topol; Elexis C McBee; Michael T Stein; Raj C Singaraju; Sam W Gao; David S Oliver; Jed P Mangal; Jeffrey S LaRochelle; William F Kelly; Kent J DeZee; H Carrie Chen; Anthony R Artino Jr; Paul A Hemmer; Ting Dong; Timothy J Cleary; Steven J Durning

doi:10.5334/pme.833

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

Perspect Med Educ. 2023 Oct 13;12(1):385-398. doi: 10.5334/pme.833. eCollection 2023.

Authors

Mary A Andrews¹, Catherine A Okuliar², Sean A Whelton², Allison O Windels², Stacy R Kruse², Manesh G Nachnani², Deborah A Topol², Elexis C McBee¹, Michael T Stein¹, Raj C Singaraju¹, Sam W Gao¹, David S Oliver¹, Jed P Mangal¹, Jeffrey S LaRochelle³, William F Kelly¹, Kent J DeZee¹, H Carrie Chen⁴, Anthony R Artino Jr⁵, Paul A Hemmer¹, Ting Dong⁶, Timothy J Cleary⁷, Steven J Durning⁶

Affiliations

¹ Department of Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, Maryland, USA.
² Department of Medicine, Georgetown University School of Medicine, Washington, District of Columbia, USA.
³ Department of Medical Education, University of Central Florida College of Medicine, Orlando, Florida, USA.
⁴ Department of Pediatrics, Georgetown University School of Medicine, Washington, District of Columbia, USA.
⁵ Department of Health, Human Function, and Rehabilitation Sciences, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia, USA.
⁶ Center for Health Professions Education, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, Maryland, USA.
⁷ Department of School Psychology, Graduate School of Applied and Professional Psychology, Rutgers, The State University of New Jersey, Piscatawy, New Jersey, USA.

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.

MeSH terms

Education, Medical*
Education, Medical, Undergraduate* / methods
Educational Measurement / methods
Humans
Learning
Students, Medical* / psychology

Grants and funding

This work was supported by the Stemmler Fund of the National Board of Medical Examiners under Grant 1718-1224.