Page 56 - Medical students’ self-regulated learning in clinical contexts

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explained they rarely had contact with consultants. Besides goal se ng, consultants and nurses played an important role in crea ng a safe learning environment, a posi ve atmosphere and engaging students in the team. This facilitated novice students SRL strategies because this permi ed them to make mistakes, ask ques ons, create learning opportuni es, and seek feedback. Novice students also learned by observing others such as consultants and nurses. This role model func on is exempli ed in the quote by Megan. Pa ents’ in uence was limited to a ec ng learning opportuni es because a pa ents’ problem determined the content of learning opportuni es. Ques ons from pa ents and their families, similar to ques ons from consultants and nurses, could also ini ate reac ve on-the-spot learning.
Megan [about nurses]: “They won’t teach me how a disease works [....] but I think they can show you how to treat pa ents [...] You also look at the,.... at other students, well at everyone, also residents and consultants. Everyone treats pa ents di erently, so you can decide for yourself what you believe is good and bad [...] Some mes it is good to see something not go very well, to make you realize: this did not go well, and some mes you think: yes, I would like to be able to do this”.
Experienced students in clerkships
If novice students can be characterized as pinballs in a pinball machine, experienced students can be thought of as snowballs rolling downhill. These students explained a clear trajectory in their learning, becoming more powerful whilst rolling, and that only signi cant obstacles could deviate them from their path. The Pictor chart of Laci ( gure 2) illustrates this visually. The proximity of the arrows to herself portrays how important she perceived many others, such as physician assistants and nurses, to be bene cial to her SRL. Laci’s Pictor chart is also more structured then Marlon’s and symbolizes how she understood the clinical context and felt like a true member of the clinical team. She discussed having strategies to use all people in her Pictor chart to bene t her learning. Because of these strategies, the in uence a single person had on her SRL in general was smaller than for novice students. Experienced students o en had a clear objec ve of what kind of doctor they wanted to become. They did not need peers to help with goal se ng, but were more dependent on the help of consultants to assist them in crea ng adequate learning opportuni es. This is illustrated in Laci’s Pictor chart - compared to Marlon’s chart, as the distance between the arrow represen ng peers and her own is larger, while the arrows represen ng consultants are closer to her own and consultants of other special es