Day Leora Branfield, Butler Deborah, Kuper Ayelet, Shah Rupal, Stroud Lynfa, Ginsburg Shiphra, Tavares Walter, Brydges Ryan
Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Department of Medicine, Women's College Hospital, Toronto, ON, Canada.
Med Educ. 2025 May;59(5):519-530. doi: 10.1111/medu.15549. Epub 2024 Oct 10.
BACKGROUND/OBJECTIVE: In implementing competence-based medical education (CBME), some Canadian residency programmes recruit clinicians to function as Academic Advisors (AAs). AAs are expected to help monitor residents' progress, coach them longitudinally, and serve as sources of co-regulated learning (Co-RL) to support their developing self-regulated learning (SRL) abilities. Implementing the AA role is optional, meaning each residency programme must decide whether and how to implement it, which could generate uncertainty and heterogeneity in how effectively AAs will "monitor and advise" residents. We sought to clarify how AA-resident dyads collaboratively interpret assessment data from multiple sources, co-create learning goals and action plans and attempt to enhance residents' SRL skills.
Shortly after each of their six meetings during two years of Internal Medicine residency, we conducted individual, brief interviews with AAs (N = 10) and residents (N = 10). We analysed transcripts using an abductive framework with theory-based and evidence-based sensitizing concepts.
We collected 49 residents and 36 AA 'meeting debriefs', which produced rich data on how dyads variably engaged in SRL and Co-RL. Residents and AAs adopted "learning stances" that oriented their perceptions and approaches to Co-RL. Their stances did not always align within dyads. We found unique patterns in how stances evolved or devolved over time, and in how these changes impacted dyads' Co-RL processes. While some dyads evolved to engage in proactive co-regulation, most stayed consistent or oscillated reactively in their relationships, with little apparent Co-RL focused on helping residents to develop clinical competencies through SRL. We catalogued multiple influential sources of regulation of learning.
The conceptually ideal form of Co-RL was not consistently achieved in this well-intended implementation of AA-resident dyads. To better translate 'coaching over time' from intention to practice, we recommend that residency programmes use Co-RL principles to refine CBME processes, including refining assessment tools, resident orientation sessions and faculty development practices.
背景/目的：在实施基于能力的医学教育（CBME）过程中，加拿大的一些住院医师培训项目招募临床医生担任学术顾问（AA）。预计学术顾问将帮助监测住院医师的进展，对他们进行长期指导，并作为共同调节学习（Co-RL）的资源，以支持他们发展自我调节学习（SRL）能力。实施学术顾问这一角色是可选择的，这意味着每个住院医师培训项目必须决定是否以及如何实施，这可能导致学术顾问在“监测和指导”住院医师方面的有效性产生不确定性和异质性。我们试图阐明学术顾问 - 住院医师二元组如何协作解读来自多个来源的评估数据，共同制定学习目标和行动计划，并尝试提高住院医师的自我调节学习技能。
在内科住院医师培训的两年中，每次六次会议结束后不久，我们对10名学术顾问和10名住院医师进行了简短的个人访谈。我们使用具有基于理论和基于证据的敏感概念的溯因框架分析访谈记录。
我们收集了49名住院医师和36份学术顾问的“会议总结”，这些资料提供了关于二元组如何以不同方式参与自我调节学习和共同调节学习的丰富数据。住院医师和学术顾问采取了“学习立场”，这些立场影响了他们对共同调节学习的认知和方法。他们的立场在二元组中并不总是一致的。我们发现了立场如何随时间演变或退化，以及这些变化如何影响二元组的共同调节学习过程的独特模式。虽然一些二元组逐渐发展为积极的共同调节，但大多数在他们的关系中保持一致或反应性地波动，几乎没有明显的共同调节学习专注于通过自我调节学习帮助住院医师发展临床能力。我们梳理了学习调节的多个影响因素。
在这个精心设计的学术顾问 - 住院医师二元组实施过程中，共同调节学习的概念上的理想形式并未始终实现。为了更好地将“长期指导”从意图转化为实践方法，我们建议住院医师培训项目使用共同调节学习原则来完善基于能力的医学教育过程，包括完善评估工具、住院医师入职培训课程和教师发展实践。
