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Relinquishing control? Supervisor co-regulation may disrupt students’ self-regulated learning during simulation-based training

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Abstract

When uncertain, medical trainees often seek to co-regulate their learning with supervisors and peers. Evidence suggests they may enact self-regulated learning (SRL) strategies differently when engaged in self- versus co-regulated learning (Co-RL). We compared the impacts of SRL and Co-RL on trainees’ acquisition, retention, and preparation for future learning (PFL) of cardiac auscultation skills during simulation-based training. In our two-arm, prospective, non-inferiority trial, we randomly assigned first- and second-year medical students to the SRL (N = 16) or Co-RL conditions (N = 16). Across two learning sessions separated by two-weeks, participants practiced and were assessed in diagnosing simulated cardiac murmurs. We examined diagnostic accuracy and learning trace data across sessions, and conducted semi-structured interviews to explore participants’ understandings of their underlying choices and learning strategies. SRL participants’ outcomes were non-inferior to Co-RL participants on the immediate post-test and retention test, but not on the PFL assessment (i.e., inconclusive). Analyzing interview transcripts (N = 31) generated three themes: perceived utility of initial learning supports for future learning; SRL strategies and sequencing of murmurs; and perceived control over learning across sessions. Co-RL participants regularly described relinquishing control of learning to supervisors and regaining it when on their own. For some trainees, Co-RL seemed to interfere with their situated and future SRL. We posit that transient clinical training sessions, typical in simulation-based and workplace-based settings, may not allow the ideal processes of Co-RL to unfold between supervisor and trainee. Future research must examine how supervisors and trainees can share accountability to develop the shared mental models that underlie effective Co-RL.

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Acknowledgements

The authors wish to thank the study participants, the University of Toronto, Temerty Faculty of Medicine MD Program, and Drs. Maria Mylopoulos and Carol-Anne Moulton for supporting this work. Dr. Lorello dedicates this work in acknowledgement of the late Dr. Brian Kavanagh for his support during his residency and Clinician-Investigator Program years.

Funding

Dr. Ryan Brydges is generously funded by the Professorship in Technology-Enabled Education, at St. Michael’s Hospital, Unity Health Toronto.

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Authors and Affiliations

  1. Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada

    Gianni R. Lorello

  2. Department of Anesthesia and Pain Management, University Health Network – Toronto Western Hospital, Toronto, ON, Canada

    Gianni R. Lorello

  3. Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada

    Gianni R. Lorello

  4. Wilson Centre for Research in Education, University Health Network, Toronto, ON, Canada

    Gianni R. Lorello & Ryan Brydges

  5. Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Room 5-086, 209 Victoria St., Toronto, ON, M5B 1T8, Canada

    Kathryn Hodwitz & Ryan Brydges

  6. Michael S Gordon Center for Simulation and Innovation in Medical Education, University of Miami Miller School of Medicine, Miami, FL, USA

    S. Barry Issenberg

  7. Allan Waters Family Simulation Centre, Unity Health Toronto, Toronto, ON, Canada

    Ryan Brydges

  8. Department of Medicine, University of Toronto, Toronto, ON, Canada

    Ryan Brydges

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  1. Gianni R. Lorello
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  2. Kathryn Hodwitz
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  4. Ryan Brydges
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Contributions

GL and RB conceptualized this study. GL led in collecting the data. BI supported content development and simulator logistics. GL, KH, and RB analyzed and interpreted the data. GL, KH and RB drafted the paper and all authors critically reviewed it and approved the final version to be published.

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Correspondence to Ryan Brydges.

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Lorello, G.R., Hodwitz, K., Issenberg, S.B. et al. Relinquishing control? Supervisor co-regulation may disrupt students’ self-regulated learning during simulation-based training. Adv in Health Sci Educ 29, 9–25 (2024). https://doi.org/10.1007/s10459-023-10244-9

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