SpringerLink
Log in

The Relationship Between Self-Regulated Learning Competency and Clinical Reasoning Tendency in Medical Students

  • Original Research
  • Published:
Medical Science Educator Aims and scope Submit manuscript

Abstract

Self-regulated learning (SRL) is essential to professional learning and practice across disciplines. However, the literature provides limited insights into how medical educators could leverage the SRL framework to support trainees’ strategic processes in clinical reasoning activities. In this study, we investigated the relationship between SRL competency and clinical reasoning tendency as 64 medical students diagnosed a virtual patient in a computer-simulated environment. We further examined whether students with different profiles of SRL competency and clinical reasoning tendency differed in their behavioral patterns and performance. The results suggested that SRL competency positively predicted clinical reasoning tendency. Enhancing medical students’ SRL competency, especially their self-reflection skills, could increase the tendency toward relying on an analytic approach to clinical reasoning. Moreover, we identified two groups of students (i.e., analytic SRL learners, and non-analytic, low SRL learners) using K-means clustering analysis. The two groups of students differed in their behavioral patterns in clinical reasoning, as revealed by lag sequential analysis. Furthermore, analytic SRL learners ordered more relevant lab tests than non-analytic low SRL learners in clinical reasoning. This study has methodological and practical implications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Thailand)

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Availability of Data and Material

The data and material generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.

References

  1. Artino AR, Cleary TJ, Dong T, Hemmer PA, Durning SJ. Exploring clinical reasoning in novices: a self-regulated learning microanalytic assessment approach. Med Educ. 2014;48(3):280–91.

    Article  Google Scholar 

  2. Brydges R, Butler D. A reflective analysis of medical education research on self-regulation in learning and practice. Med Educ. 2012;46(1):71–9.

    Article  Google Scholar 

  3. Lajoie SP, Zheng J, Li S, Jarrell A, Gube M. Examining the interplay of affect and self regulation in the context of clinical reasoning. Learn Instruct. 2019;101219. https://doi.org/10.1016/j.learninstruc.2019.101219.

  4. Winne PH. Cognition and metacognition within self-regulated learning. In P. A. Alexander, D. H. Schunk, & J. A. Greene (Eds.), Handbook of self-regulation of learning and performance (2nd ed.). 2017;36–48. Routledge. https://doi.org/10.4324/9781315697048-3.

  5. Zimmerman BJ. Attaining self-regulation: a social cognitive perspective. In M. Boekaerts, P. Paul R, & M. Zeidner (Eds.), Handbook of self-regulation (1st ed.). US: Academic Press. 2000;13–39. https://doi.org/10.1016/B978-012109890-2/50031-7.

  6. Zheng J, Li S, Lajoie SP. The role of achievement goals and self-regulated learning behaviors in clinical reasoning. Technol Knowl Learn. 2020;25(3):541–56. https://doi.org/10.1007/s10758-019-09420-x.

    Article  Google Scholar 

  7. Cleary TJ, Durning SJ, Artino AR. Microanalytic assessment of self-regulated learning during clinical reasoning tasks: recent developments and next steps. Acad Med. 2016;91(11):1516–21.

    Article  Google Scholar 

  8. Zheng J, Li S, Lajoie SP. Diagnosing virtual patients in a technology-rich learning environment: a sequential mining of students’ efficiency and behavioral patterns. Educ Inf Technol. 2021. https://doi.org/10.1007/s10639-021-10772-0.

    Article  Google Scholar 

  9. Azevedo R, Gašević D. Analyzing multimodal multichannel data about self-regulated learning with advanced learning technologies: issues and challenges. Comput Hum Behav. 2019;96:207–10. https://doi.org/10.1016/j.chb.2019.03.025.

    Article  Google Scholar 

  10. Greene JA, Azevedo R. A theoretical review of Winne and Hadwin’s model of self-regulated learning: new perspectives and directions. Rev Educ Res. 2007;77(3):334–72.

    Article  Google Scholar 

  11. Pintrich PR. A conceptual framework for assessing motivation and self-regulated learning in college students. Educ Psychol Rev. 2004;16(4):385–407. https://doi.org/10.1007/s10648-004-0006-x.

    Article  Google Scholar 

  12. Marcum JA. An integrated model of clinical reasoning: dual-process theory of cognition and metacognition. J Eval Clin Pract. 2012;18(5):954–61.

    Article  Google Scholar 

  13. Elstein AS, Shulman LS, Sprafka SA. Medical problem solving: A ten-year retrospective. Eval Health Prof. 1990;13(1):5–36.

    Article  Google Scholar 

  14. Eva KW. What every teacher needs to know about clinical reasoning. Med Educ. 2005;39(1):98–106. https://doi.org/10.1111/j.1365-2929.2004.01972.x.

    Article  Google Scholar 

  15. Wigton RS. Use of linear models to analyze physicians’ decisions. Med Decis Making. 1988;8(4):241–52.

    Article  Google Scholar 

  16. Coderre S, Mandin H, Harasym PH, Fick GH. Diagnostic reasoning strategies and diagnostic success. Med Educ. 2003;37(8):695–703.

    Article  Google Scholar 

  17. Turner JR, Gellman M. Encyclopedia of behavioral medicine. Springer Science+Business Media. 2013. https://doi.org/10.1007/978-1-4419-1005-9.

  18. Lajoie SP. Student modeling for individuals and groups: the BioWorld and HOWARD platforms. Int J Artif Intell Educ. 2020;1–16. https://doi.org/10.1007/s40593-020-00219-x.

  19. Pintrich PR, Smith DAF, Garcia T, Mckeachie WJ. Reliability and predictive validity of the motivated strategies for learning questionnaire (MSLQ). Educ Psychol Measur. 1993;53(3):801–13. https://doi.org/10.1177/0013164493053003024.

    Article  Google Scholar 

  20. Schraw G, Dennison RS. Metacognitive awareness inventory. Contemp Educ Psychol. 1994;19:460–75.

    Article  Google Scholar 

  21. Bakeman R, Quera V, Gnisci A. Observer agreement for timed-event sequential data: a comparison of time-based and event-based algorithms. Behav Res Methods. 2009;41(1):137–47. https://doi.org/10.3758/BRM.41.1.137.

    Article  Google Scholar 

  22. Bakeman R, Quera V. Analyzing interaction: sequential analysis with SDIS and GSEQ. Cambridge University Press. 1995.

  23. Li S, Zheng J, Lajoie SP. Temporal structures and sequential patterns of self-regulated learning behaviors in problem solving with an intelligent tutoring system. Educ Technol Soc. 2022;25(4):1–14.

    Google Scholar 

  24. Kline T. Psychological testing: A practical approach to design and evaluation. Sage. 2005.

  25. Hu L, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Modeling. 1995;6(1):1–55.

    Article  Google Scholar 

  26. Browne MW, Cudeck R. Single sample cross-validation indices for covariance structures. Multivar Behav Res. 1989;24(4):445–55.

    Article  Google Scholar 

  27. Bakeman R, Quera V. Sequential analysis and observational methods for the behavioral sciences. Cambridge University Press. 2011.

  28. Barrows HS, Feltovich PJ. The clinical reasoning process. Med Educ. 1987;21(2):86–91. https://doi.org/10.1111/j.1365-2923.1987.tb00671.x.

    Article  Google Scholar 

Download references

Acknowledgements

The authors are indebted to the Peking University Health Science Center and the School of Basic Medical Sciences for assistance and suggestions.

Funding

This work is supported by the Social Sciences and Humanities Research Council of Canada (SSHRC) under grant number of 895–2011-1006, the Fonds de Recherche du Québec—Société et Culture (FRQSC), and the China Medical Board (CMB) under grant number of 22–457. Any opinions, findings, and conclusions or recommendations expressed in this paper, however, are those of the authors and do not necessarily reflect the views of the SSHRC, FRQSC, and CMB.

Author information

Authors and Affiliations

  1. College of Health/College of Education, Lehigh University, Bethlehem, PA, USA

    Shan Li

  2. College of Education, Lehigh University, Bethlehem, PA, USA

    Juan Zheng

  3. Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada

    Susanne P. Lajoie

  4. Department of Respiratory and Critical Medicine, Peking University First Hospital, Bei**g, China

    Haichao Li

  5. Office of Education, Peking University School of Basic Medical Sciences, Bei**g, China

    Dan Pu

  6. Institute of Medical Education/National Center for Health Professions Education Development, Peking University, Haidian District, 38 Xueyuan road, Bei**g, 100191, China

    Hongbin Wu

Authors
  1. Shan Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Juan Zheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Susanne P. Lajoie
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Haichao Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dan Pu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hongbin Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SL and HW conceived and designed the study. SL, JZ, and HW performed the empirical analyses, drafted the initial paper, and revised the paper. HW acquired the data. SP, HL, and DP revised the paper and provided the comments for the study. All authors read the final manuscript and approved its submission.

Corresponding author

Correspondence to Hongbin Wu.

Ethics declarations

Ethics Approval

The research was conducted in accordance with the journal’s ethical guidelines. The authors declare that the work described was original research that has not been published previously and is not under consideration for publication elsewhere.

Consent to Participate

Written informed consent was obtained from all individual participants included in the study.

Consent for Publication

All authors approved the final manuscript and the submission to this journal.

Competing Interests

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Appendix The Measurement of SRL Competency and Clinical Reasoning Tendency

Appendix The Measurement of SRL Competency and Clinical Reasoning Tendency

Construct

Items

SRL competency

Forethought

I ask myself questions about the material at the beginning of the task

I think about what I really need to learn before I begin a task

I set specific goals before I start a task

I try to find relationships between what I am learning and what I already know

Performance

I go over my notes to confirm or disconfirm my solutions

I organize materials to help me understand the logic of the problem

I periodically review to help me understand important relationships

I find myself analyzing the usefulness of strategies while I study

I ask myself periodically if I am meeting my goals

Self-reflection

I ask myself if there is an easier way to do things after I finish a task

I ask myself how well I accomplish my goals once I’m finished

I ask myself if I have considered all options when solving a problem

Clinical reasoning tendency

Reasoning

I tend to form all hypotheses before confirming them

I consider several alternatives to a problem based on what I already know

I consider all possibilities before coming up with a solution

I systematically find arguments to support my idea

Non-analytic reasoning

I use my personal experience to solve the problem

I come up with a final solution without many reasoning processes

I use mental shortcuts to solve the problem

I made intuitive judgments

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Li, S., Zheng, J., Lajoie, S.P. et al. The Relationship Between Self-Regulated Learning Competency and Clinical Reasoning Tendency in Medical Students. Med.Sci.Educ. 33, 1335–1345 (2023). https://doi.org/10.1007/s40670-023-01909-6

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40670-023-01909-6

Keywords

Search

Navigation