Nurses' self-regulated learning in clinical wards: Important insights for nurse educators from a multi-method research study.

Central in nurse education curricula stands the preparation of future nurses to work in quickly evolving, dynamic, clinical wards. Learning in the flow of work plays a pivotal role in initial nurse education, but also during continuous professional development. To drive their ongoing development, nurses need competency in self-regulation of learning (SRL). Despite the importance of SRL in the clinical workplace for all (future) healthcare professionals, research on self-regulated workplace learning (SRwpL) of nurses and future nurses in clinical wards is underdeveloped. This study aims to enhance the conceptual understanding of SRwpL strategies and practices in clinical nursing wards and to offer insights for designing effective educational interventions supporting the facilitation and development of (future) nurses' SRwpL in the clinical ward. A multi-actor, multi-method perspective was adopted to qualitatively investigate SRwpL strategies nurses engaged in. Nurses were observed and interviewed, but also professionals responsible for ongoing development in clinical wards (the ward's head nurses and learning counselors) were interviewed. The data collection took place before the COVID pandemic. Results reveal self-regulatory strategies conditional for SRwpL in addition to strategies initiating, progressing, and evaluating the learning process. Head nurses and learning counselors report a lack of these conditional strategies and little variation, and sporadic engagement in all other self-regulatory strategies. To enhance (future) nurses' SRwpL, we suggest that clinical supervisors from educational institutions could exert a lasting influence by not only educating student nurses, but also fostering further professional development of counselors and head nurses to scaffold the SRwpL processes of future nurses in clinical wards.

The process of slowing down in clinical reasoning during ultrasound consultations.

OBJECTIVES: In clinical reasoning, clinicians need to switch between automatic and effortful reasoning to solve both routine and non-routine problems. This requires the ability to recognise when a problem is non-routine and adapt one's reasoning mode accordingly, that is to 'slow down' the reasoning process. In the current study, we explored the process of these transitions between automatic and effortful reasoning by radiologists who performed ultrasound examinations during consultations at the polyclinic. METHODS: Manifestations of slowing down in clinical reasoning were explored in 41 out-patient consultations performed by five radiologists. Interviews before and after the consultations were combined with observations during the consultations to obtain proactively planned triggers, slowing down manifestations and situationally responsive initiators. Transcripts of the interviews and field notes of the observations were coded. The constant comparative method was used to classify slowing down manifestations. RESULTS: In thirteen of the 41 consultations, slowing down moments were observed. Four manifestations of slowing down were identified: shifting, checking, searching and focusing. These manifestations mainly differed in how long radiologists maintained effortful reasoning, varying from very short periods (shifting and checking) to sustained periods (searching and focusing). Unexpected patient statements and ambiguous ultrasound images initiated the slowing down moments. DISCUSSION: The results from this study contribute to understanding how clinicians transition from automatic to effortful reasoning. Also, this study revealed two sources of initiators of this transition in radiologists' consultations: statements made by the patient and conflicting or ambiguous visual information, in this case from ultrasound images. Natural variations in patient statements and visual information can be used as input of what might be meaningful variation in the domain of radiology education to support expertise development.

Self-regulated learning in the clinical context: a systematic review.

OBJECTIVES: Research has suggested beneficial effects of self-regulated learning (SRL) for medical students' and residents' workplace-based learning. Ideally, learners go through a cyclic process of setting learning goals, choosing learning strategies and assessing progress towards goals. A clear overview of medical students' and residents' successful key strategies, influential factors and effective interventions to stimulate SRL in the workplace is missing. This systematic review aims to provide an overview of and a theoretical base for effective SRL strategies of medical students and residents for their learning in the clinical context. METHODS: This systematic review was conducted according to the guidelines of the Association for Medical Education in Europe. We systematically searched PubMed, EMBASE, Web of Science, PsycINFO, ERIC and the Cochrane Library from January 1992 to July 2016. Qualitative and quantitative studies were included. Two reviewers independently performed the review process and assessed the methodological quality of included studies. A total of 3341 publications were initially identified and 18 were included in the review. RESULTS: We found diversity in the use of SRL strategies by medical students and residents, which is linked to individual (goal setting), contextual (time pressure, patient care and supervision) and social (supervisors and peers) factors. Three types of intervention were identified (coaching, learning plans and supportive tools). However, all interventions focused on goal setting and monitoring and none on supporting self-evaluation. CONCLUSIONS: Self-regulated learning in the clinical environment is a complex process that results from an interaction between person and context. Future research should focus on unravelling the process of SRL in the clinical context and specifically on how medical students and residents assess their progress towards goals.

Measuring students' self-regulated learning in professional education: bridging the gap between event and aptitude measurements.

Self-regulated learning has benefits for students' academic performance in school, but also for expertise development during their professional career. This study examined the validity of an instrument to measure student teachers' regulation of their learning to teach across multiple and different kinds of learning events in the context of a postgraduate professional teacher education programme. Based on an analysis of the literature, we developed a log with structured questions that could be used as a multiple-event instrument to determine the quality of student teachers' regulation of learning by combining data from multiple learning experiences. The findings showed that this structured version of the instrument measured student teachers' regulation of their learning in a valid and reliable way. Furthermore, with the aid of the Structured Learning Report individual differences in student teachers' regulation of learning could be discerned. Together the findings indicate that a multiple-event instrument can be used to measure regulation of learning in multiple contexts for various learning experiences at the same time, without the necessity of relying on students' ability to rate themselves across all these different experiences. In this way, this instrument can make an important contribution to bridging the gap between two dominant approaches to measure SRL, the traditional aptitude and event measurement approach.

The nature of student teachers' regulation of learning in teacher education.

BACKGROUND: Self-regulated learning (SRL) has mainly been conceptualized to involve student learning within academic settings. In teacher education, where learning from theory and practice is combined, student teachers also need to regulate their learning. Hence, there is an urgent need to extend SRL theories to the domain of teacher learning and to obtain scientific knowledge on the nature of student teachers' SRL to enable support of these processes in teacher education. AIMS: This study was aimed at exploring the nature of student teachers' regulation of learning across various theoretical and practical contexts in teacher education. SAMPLE: Twenty-eight students from a post-graduate academic teacher education institute participated in this study. METHOD: For the measurement of student teachers' regulation activities, an open question log, called Learning Report, was developed. Content analysis and multiple correspondence analyses of 133 Learning Reports were used to identify qualitative differences in regulation activities and the underlying structure in the data. RESULTS: The analyses resulted in the identification and description of the variety and frequency of student teachers' regulation activities. The relations among the regulation activities were described by an underlying structure of two dimensions: passive versus active regulation of learning and prospective versus retrospective regulation of learning. Active regulation dominated in practice schools, passive regulation at the university. CONCLUSIONS: It is argued that for learning to teach, a different conceptualization of SRL is needed, focusing less on setting initial learning goals and more on retrospective aspects of SRL. Building blocks for such a conceptualization are offered.