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Directed self‐regulated learning versus instructor‐regulated learning in simulation training
Author(s) -
Brydges Ryan,
Nair Parvathy,
Ma Irene,
Shanks David,
Hatala Rose
Publication year - 2012
Publication title -
medical education
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.776
H-Index - 138
eISSN - 1365-2923
pISSN - 0308-0110
DOI - 10.1111/j.1365-2923.2012.04268.x
Subject(s) - checklist , analysis of variance , test (biology) , repeated measures design , psychology , correlation , confidence interval , pearson product moment correlation coefficient , medicine , physical therapy , statistics , mathematics , paleontology , geometry , cognitive psychology , biology
Medical Education 2012: 46: 648–656 Objectives Simulation training offers opportunities for unsupervised, self‐regulated learning, yet little evidence is available to indicate the efficacy of this approach in the learning of procedural skills. We evaluated the effectiveness of directed self‐regulated learning (DSRL) and instructor‐regulated learning (IRL), respectively, for teaching lumbar puncture (LP) using simulation. Methods We randomly assigned internal medicine residents in postgraduate year 1 to either DSRL (‘directed’ to progress from easy to difficult LP simulators during self‐regulated learning) or IRL (in groups of four led by an instructor). All participants practised for up to 50 minutes and completed a pre‐test, post‐test and delayed (by 3 months) retention test on the simulator. Pairs of blinded trained experts independently rated all videotaped performances using a validated global rating scale and a modified version of a validated checklist. Participants provided measures of LP experience and self‐reported confidence. We analysed the pre–post ( n = 42) and pre–post–retention performance scores ( n = 23) using two separate repeated‐measures analyses of variance ( anova s) and computed Pearson correlation coefficients between participants’ confidence and performance scores. Results Inter‐rater agreement was strong for both performance measures (intra‐class correlation coefficient > 0.81). The groups achieved similar pre‐test and post‐test scores (p > 0.05) and scores in both groups improved significantly from the pre‐ to the post‐test (p < 0.05). On retention, a significant interaction ( F 2,42 = 3.92, p = 0.03) suggests the DSRL group maintained its post‐test performance, whereas that in the IRL group dropped significantly (p < 0.05). Correlations between self‐reported confidence and post‐test performance were positive and significant for the DSRL group, and negative and non‐significant for the IRL group. Conclusions Both IRL and DSRL led to improved LP performance immediately after practice. Whereas the IRL group’s skills declined after 3 months, the DSRL group’s performance was maintained, suggesting a potential long‐term benefit of this training. Participants in the DSRL group also developed a more accurate relationship between confidence and competence following practice. Further research is needed to clarify the mechanisms of self‐regulated learning and its role in simulation contexts.