Page 127 - Medical students’ self-regulated learning in clinical contexts

In chapter 3 we found how ‘experienced’ students had managed to se le in a clinical context. Regarded from an Iden ty Development point of view, these students had reached the Iden ty Achievement status. Likewise, ‘novice’ students can be regarded to be in Marcia’s Moratorium status, because they are in an ac ve struggle of manag- ing themselves in a new context. Lastly, some ‘novice’ students, enrolled in clerkships for a long me did not appear to make the transi on to ‘experienced’. This may be understood because these students are in the Foreclosure status of iden ty develop- ment. They have accepted not to be able to nd their way in a clinical context and rather just do what they are told. This also shows resemblance to the ‘acquiescing to a lack of learning opportuni es’ approach to SRL as described by Woods et al.9 This theore cal re ec on gives addi onal theore cal support to the recent call for increasing the a en on for iden ty development in medical educa on.5
Situated learning theory and transi oning into an experienced student
Why iden ty development is such an important issue in SRL can also be understood using Situated Learning Theory.10,11 This theory describes that learners learn in the workplace through legi mate par cipa on in the periphery of a community of prac- ce. This means that it is vital for students to think, act and feel like physicians, be- cause it enables them to become legi mate members of a clinical community of prac ce and collaborate in daily ac vi es.5 Therefore, placing a students’ profession- al iden ty forma on more at the core of medical educa on, as suggested by various authors,5,12,13 might also bene t students’ engagement in SRL in a clinical context.
In all studies presented in this thesis, students reported learning most from par ci- pa ng in real clinical ac vi es, similar as in Situated Learning theory. From a Situated Learning perspec ve, the transi on from novice to experienced student relies on an adequate understanding of a clinical community of prac ce and developing an iden- ty as a physician in a clinical context. This makes a stronger case for longer clinical placements, because longer exposure facilitates students’ understanding of a clinical community of prac ce, and consequently what a student’s role in a team might be.
Situated Learning theory explains how learning happens through legi mate pe- ripheral par cipa on in a community of prac ce.10,11 Novice students in chapter 3 explained learning from a small number of people. They acted in the periphery of a clinical community of prac ce. Novice students reported a feeling of illegi macy when their SRL was hindered, when they felt they were of li le added value, or even a nuisance to the clinical team.14 Experienced students on the other hand, reported feeling like a real member of the clinical team. They could quickly establish their le-
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Chapter 6 General Discussion