Department of Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, Maryland, USA.
Department of Medicine, Georgetown University School of Medicine, Washington, District of Columbia, USA.
Perspect Med Educ. 2023 Oct 13;12(1):385-398. doi: 10.5334/pme.833. eCollection 2023.
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.
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.
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.
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.
自我调节学习是一个前瞻性、表现和自我反思的循环过程，已被用作医学教育中的评估工具。以前没有研究评估过 SRL 过程在回答多项选择题（MCQs）中的应用，大多数研究评估了一个或两个非 MCQ 任务的迭代。在 MCQs 中进行 SRL 评估可以阐明学习者在这些问题上成功或不成功的原因，这些问题在医学教育中会反复遇到。
三个机构的内科实习学生参与了一项 SRL 微观分析方案，该方案针对战略规划、元认知监测、因果归因和自适应推理，跨越了七个 MCQs。根据之前发表的微观分析方案方法，对回答进行了转录和编码。
共有 44 名学生参与。在预想阶段，学生通常支持将相关特征作为他们的诊断策略（n = 20，45%），但很少提及更高阶的诊断推理过程，如整合临床信息（n = 5，11%）或比较/对比诊断（n = 0，0%）。然而，在表现阶段，学生的元认知过程包括高度的整合（n = 38，86%）和比较/对比（n = 24，55%）。在自我反思阶段，93%（n = 41）的学生对他们的管理推理提出了批评，84%（n = 37）对他们的能力做出了负面评价。不到 10%（n = 4）的学生表示他们会为这些问题调整他们的诊断推理过程。
本研究详细描述了学生在 MCQs 中的自我调节过程。我们发现，学生进行了更高阶的诊断推理过程，但没有明确说明，并且很少在选择错误答案后对这些过程进行批判性反思。自我反思几乎完全集中在管理推理和对能力的负面评价上，这可能会降低自我效能感。鼓励学生识别和评估诊断推理过程，并对可控因素做出归因，可能会提高表现。
