Page 124 - Medical students’ self-regulated learning in clinical contexts

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I have come to the conclusion there is no such thing as the clinical context. Instead many clinical contexts exist, however when undergraduate medical students de- scribe the clinical contexts in which they learn, many similari es can be found. An important one is that a clinical context is not sta c, but rather something exible and one that can be interpreted di erently by individuals. Chapter 2 for instance, provided insight in how some students deemed structured learning ac vi es (e.g. daily plenary educa onal mee ngs) to be suppor ve to their SRL because it aided their goal se ng. Other students however, perceived structured learning ac vi es as a lack in autonomy to engage in SRL. Addi onally, as we discussed in chapter 4, context and individuals both have an in uence on SRL and the e ects of both indi- vidual and context, are intertwined. This results in a clinical context that is personal, social, ever changing and has a signi cant in uence on students’ SRL. Therefore, it is very di cult to study the e ect of a single contextual factor on students’ SRL and the en re process should be regarded holis cally.
Rela onships in a clinical context
One of the most important elements of the clinical context in uencing students’ SRL resul ng from our studies was the social aspect, or rela onships with others. Rela onships with others in a clinical context were a ected by two important fac- tors: students’ social network and rou nes of clinical departments that enabled or hindered crea ng and maintaining rela onships. Social interac ons have proved to be important in uences throughout the research described in this thesis. Chapters 2 and 5 provided us with the insight that students’ SRL strategies very frequently in- volved asking or answering ques ons. Likewise, students frequently discussed learn- ing goals and proac vely asked for feedback in their SRL strategies. Who students asked for feedback and discussed their learning goals with depended on their social network in a clinical context.
A signi cant nding presented in this thesis is how the social network of students in a clinical context expands and changes, as I have described in chapter 3. Students who were new or feel insecure about their role in a clinical context have a rela vely limit- ed social context and their SRL was therefore in uenced by a rela vely small number of people. Consequently, the vagaries of a single resident, peer, or consultant could have a major impact on students’ SRL and could make learning thrive or diminish. More experienced students on the other hand had a much larger social network in a clinical context and the in uence a single person had on their SRL is smaller. These students were able to navigate and understand the clinical community and all of its members and knew what their role in the process of pa ent care could be. Sub-