Center for Evidence-Based Education, Academic Medical Center (AMC-UvA), University of Amsterdam, Amsterdam, The Netherlands.
Center for Research and Innovation in Medical Education, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Med Educ. 2018 Jan;52(1):34-44. doi: 10.1111/medu.13463. Epub 2017 Oct 6.
WHERE DO WE STAND NOW?: In the 30 years that have passed since The Edinburgh Declaration on Medical Education, we have made tremendous progress in research on fostering 'self-directed and independent study' as propagated in this declaration, of which one prime example is research carried out on problem-based learning. However, a large portion of medical education happens outside of classrooms, in authentic clinical contexts. Therefore, this article discusses recent developments in research regarding fostering active learning in clinical contexts.
SELF-REGULATED, LIFELONG LEARNING IN MEDICAL EDUCATION: Clinical contexts are much more complex and flexible than classrooms, and therefore require a modified approach when fostering active learning. Recent efforts have been increasingly focused on understanding the more complex subject of supporting active learning in clinical contexts. One way of doing this is by using theory regarding self-regulated learning (SRL), as well as situated learning, workplace affordances, self-determination theory and achievement goal theory. Combining these different perspectives provides a holistic view of active learning in clinical contexts. ENTRY TO PRACTICE, VOCATIONAL TRAINING AND CONTINUING PROFESSIONAL DEVELOPMENT: Research on SRL in clinical contexts has mostly focused on the undergraduate setting, showing that active learning in clinical contexts requires not only proficiency in metacognition and SRL, but also in reactive, opportunistic learning. These studies have also made us aware of the large influence one's social environment has on SRL, the importance of professional relationships for learners, and the role of identity development in learning in clinical contexts. Additionally, research regarding postgraduate lifelong learning also highlights the importance of learners interacting about learning in clinical contexts, as well as the difficulties that clinical contexts may pose for lifelong learning. However, stimulating self-regulated learning in undergraduate medical education may also make postgraduate lifelong learning easier for learners in clinical contexts.
未加标签：我们现在处于什么位置？：自《爱丁堡医学教育宣言》发表以来的 30 年里，我们在培养该宣言所倡导的“自主和独立学习”的研究方面取得了巨大进展，其中一个主要例子是基于问题的学习研究。然而，大部分医学教育发生在课堂之外，在真实的临床环境中。因此，本文讨论了最近在促进临床环境中主动学习的研究方面的进展。
医学教育中的自我调节、终身学习：临床环境比课堂复杂灵活得多，因此在促进主动学习时需要采用一种改进的方法。最近的努力越来越集中在理解支持临床环境中主动学习的更复杂的课题上。一种方法是使用关于自我调节学习（SRL）的理论，以及情境学习、工作场所的促进因素、自我决定理论和成就目标理论。将这些不同的观点结合起来，可以提供一个临床环境中主动学习的整体视角。
进入实践、职业培训和持续专业发展：临床环境中 SRL 的研究主要集中在本科阶段，表明临床环境中的主动学习不仅需要元认知和 SRL 的熟练程度，还需要反应性、机会性学习。这些研究还使我们意识到社会环境对 SRL 的巨大影响、专业关系对学习者的重要性以及身份发展在临床环境中学习的作用。此外，关于研究生终身学习的研究也强调了学习者在临床环境中相互交流学习的重要性，以及临床环境对终身学习可能带来的困难。然而，在本科医学教育中激发自我调节学习也可能使临床环境中的研究生终身学习更容易。
