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The aim of the present empirical study was to explore students' self-regulated learning behaviours in vocational education and training and to describe the micro processes associated with planning, monitoring and evaluating during practical learning tasks. The 18 participants were well-performing students from upper secondary vocational education. We collected data from observations, interviews and self-reports to gain detailed insights into students' behaviours and thoughts during practical task performance. The results reveal that most of the students planned their time and resources, but did not develop elaborate plans to regulate their learning behaviours. They monitored their work carefully and adjusted when necessary. When evaluating, students focussed more on work outcomes than learning processes. The results also showed that the students' actual behaviours corresponded with self-reports on internal regulation, with three students overestimating their internal regulation. This study sheds light on an underexplored context and population regarding self-regulated learning. Though the well-performing vocational students engaged in self-regulation, their self-regulating behaviours were led by a combination of hands-on activities and evolving work outcomes. Thus, it was the emerging performance and experiences that triggered their learning. Although self-regulated learning behaviours in vocational education and training were present, we conclude that instructional support needs to be developed and empirically tested to actively facilitate and foster vocational students' learning by doing and reflection.

In vocational education, workplace simulations (WPS) have been implemented to ensure a better connection between the educational setting and the labour market. Moreover, WPS are supposed to motivate students and promote self-directed learning. So far, however, not much is known about the way students experience these WPS. The aim of the present exploratory case study was to investigate students' perceptions and preparedness for WPS and explore what factors they perceive to be relevant for their learning in these simulations. Forty students from three different pre-vocational secondary schools participated. Semi-structured group interviews were conducted and thematic analysis was used to examine the qualitative data. The results revealed that authentic WPS can increase student motivation and engagement. Learner characteristics regarded as relevant in WPS were motivation, responsibility, independence and discipline. For students, the presence and guidance of the teacher played an essential role in their working and learning effectively. They felt limited in making choices to direct their own learning. Assessment criteria were not transparent enough for students. Concluding, we found that students perceived factors closely related to self-regulated and self-directed learning to be relevant for their learning; however, these learning activities and processes have not yet been sufficiently promoted and supported in the investigated vocational schools. The study highlights design dilemmas for vocational practice and offers indications in how to match both learning environmental characteristics and teacher support tailored to learners' needs.

This study examined physicians' motivation to engage in work-related learning and its contribution to expertise development beyond work experience. Based on deliberate practice theory, semi-structured interviews were conducted with 17 residents and 28 experienced physicians in internal medicine, focusing on the activities they engaged in during work that might contribute to professional development and the goals underlying this behavior. Learning motivation was also measured using a goal orientation questionnaire. Expertise was measured by a case test derived from the Medical Knowledge Self Assessment Program (MKSAP). The interviews showed that participants' learning was largely embedded in everyday work; most of their learning activities were inherent to the job rather than motivated by competence improvement goals. The problems encountered in patient care played a key role in prompting learning. Role, work experience and work situation affected the type of activities engaged in, as well as the intensity of practice. Deliberate engagement in work-related learning activities was related neither to goal orientations nor to case test performance, except activities by the experienced physicians to keep up-to-date. Work experience, in contrast, showed a clear positive relationship with the performance of residents. Two main conclusions can be drawn from this study: (1) patient care induced relevant learning activities aimed at performance improvement for the patient's sake; (2) deliberate investments in learning can be enhanced to promote expertise development. Self-regulated learning by physicians needs to be strengthened and the organization for which they work should facilitate and encourage learning in daily practice.

Purpose: This study aims to investigate quality of feedback as offered by supervisor-assessors with varying levels of assessor expertise following assessment of performance in residency training in a health care setting. It furthermore investigates if and how different levels of assessor expertise influence feedback characteristics. Design/methodology/approach: Experienced (n = 18) and non-experienced (n = 16) supervisor-assessors with different levels of assessor expertise in general practice (GP) watched two videotapes, each presenting a trainee in a "real-life" patient encounter. After watching each videotape, participants documented performance ratings, wrote down narrative feedback comments and verbalized their feedback. Deductive content analysis of feedback protocols was used to explore quality of feedback. Between-group differences were assessed using qualitative-based quantitative analysis of feedback data. Findings: Overall, specificity and usefulness of both written and verbal feedback was limited. Differences in assessor expertise did not seem to affect feedback quality. Research limitations/implications: Results of the study are limited to a specific setting (GP) and assessment context. Further study in other settings and larger sample sizes may contribute to better understanding of the relation between assessor characteristics and feedback quality. Practical implications: Findings suggest that even with supervisor-assessors with varying levels of assessor expertise who are trained in performance assessment and the provision of performance feedback, high-quality feedback is not self-evident; coaching "on the job" of feedback providers and continuous evaluation of feedback processes in performance management systems is crucial. Instruments should facilitate provision of meaningful feedback in writing. Originality/value: The paper investigates quality of feedback immediately following assessment of performance, and links feedback quality to assessor expertise. Findings can contribute to improvement of performance management systems and assessments for developmental purposes. (Contains 2 tables and 2 figures.)

Medical professionals need to keep on learning as part of their everyday work to deliver high-quality health care. Although the importance of physicians' learning is widely recognized, few studies have investigated how they learn in the workplace. Based on insights from deliberate practice research, this study examined the activities physicians engage in during their work that might further their professional development. As deliberate practice requires a focused effort to improve performance, the study also examined the goals underlying this behaviour. Semi-structured interviews were conducted with 50 internal medicine physicians: 19 residents, 18 internists working at a university hospital, and 13 working at a non-university hospital. The results showed that learning in medical practice was very much embedded in clinical work. Most relevant learning activities were directly related to patient care rather than motivated by competence improvement goals. Advice and feedback were sought when necessary to provide this care. Performance standards were tied to patients' conditions. The patients encountered and the discussions with colleagues about patients were valued most for professional development, while teaching and updating activities were also valued in this respect. In conclusion, physicians' learning is largely guided by practical experience rather than deliberately sought. When professionals interact in diagnosing and treating patients to achieve high-quality care, their experiences contribute to expertise development. However, much could be gained from managing learning opportunities more explicitly. We offer suggestions for increasing the focus on learning in medical practice and further research. (Contains 2 tables.)

Background: Worked examples are very effective for novice learners. They typically present a written-out ideal (didactical) solution for learners to study. Aims: This study used worked examples of patient history taking in physiotherapy that presented a "non"-didactical solution (i.e., based on actual performance). The effects of model expertise (i.e., worked example based on advanced, third-year student model or expert physiotherapist model) in relation to students' expertise (i.e., first- or second-year) were investigated. Sample: One hundred and thirty-four physiotherapy students (61 first-year and 73 second-year). Methods: Design was 2x2 factorial with factors "Student Expertise" (first-year vs. second-year) and "Model Expertise" (expert vs. advanced student). Within expertise levels, students were randomly assigned to the Expert Example or the Advanced Student Example condition. All students studied two examples (content depending on their assigned condition) and then completed a retention and test task. They rated their invested mental effort after each example and test task. Results: Second-year students invested less mental effort in studying the examples, and in performing the retention and transfer tasks than first-year students. They also performed better on the retention test, but not on the transfer test. In contrast to our hypothesis, there was no interaction between student expertise and model expertise: all students who had studied the Expert examples performed better on the transfer test than students who had studied Advanced Student Examples. Conclusions: This study suggests that when worked examples are based on actual performance, rather than an ideal procedure, expert models are to be preferred over advanced student models.

Medical Education 2011: : 280-288 Real-patient contacts in problem-based undergraduate medical education are promoted as a good way to introduce biomedical and (in)formal clinical knowledge early in the curriculum and thereby to foster the development of coherent and integrated knowledge networks. There are concerns, however, that such contacts may cause students to focus on clinical knowledge to the neglect of biomedical knowledge, and that group discussions may be dominated by teachers. We examined these concerns by addressing the following questions in the context of group sessions in which students prepare for and report on real-patient contacts. To what extent are biomedical and (in)formal clinical knowledge addressed? To what extent are these knowledge types addressed by students or tutors? Are connections made between biomedical and clinical knowledge? We videotaped and transcribed six preparation and six reporting group sessions (two preparation and two reporting phases for each of three groups) held with students in Year 3 of the problem-based curriculum at Maastricht University. During this year, real patients rather than paper patients are used. Qualitative analysis software was used to code propositions in the transcriptions in order to identify different kinds of knowledge and different functions of biomedical knowledge. Formal clinical knowledge was the subject of 40.7% and 34.8% of propositions during the preparation and reporting phases, respectively. The corresponding percentages for biomedical knowledge were 15.0% and 28.0%. Tutors accounted for 63.4% of propositions during the preparation phase, and students for 80.1% during the reporting phase. Nearly all biomedical knowledge was related to clinical knowledge. It appears that pre-clinical patient encounters can stimulate students to pay attention to both clinical and biomedical knowledge and to how they are connected. Tutor dominance was evident only during the preparation phase. Further research is needed to investigate whether pre-clinical patient contacts promote the development of coherent and integrated knowledge networks. [ABSTRACT FROM AUTHOR]

Background This study was directed at illuminating a well known phenomenon in the medical expertise literature, the ‘intermediate effect’ in clinical case recall. This robust phenomenon consists of the finding that medical students of intermediate levels of expertise outperform both experts and novices in clinical case recall after diagnosing cases. It deals in particular with the findings of OME researchers who have reported a monotonically increasing recall with level of expertise. Purpose To address possible causes for this anomaly in medical expertise and to experimentally demonstrate how data elaboration can cause expertise effects in clinical case recall. Method Expert nephrologists, intermediate level students and novices were presented with 6 medical cases under 3 different conditions: laboratory data cases without special instructions, laboratory data cases with instructions to elaborate, and cases with laboratory data and a relevant clinical context. Results Only when participants were required to elaborate on each of the information units presented to them did case recall show an expertise effect. If laboratory data are framed within the context of a patient's history and physical examination data, the ‘intermediate effect’ appears. Conclusions The instructions used in the elaboration condition seem to have induced a deeper, more detailed, analysis of the patient case. It is therefore interesting to note that these instructions only affected the recall of the experts and had no effect on the novices' or intermediates' recall. We might conclude from this that expertise effects in clinical case recall are only produced when the normal processing of patient information is disrupted. [ABSTRACT FROM AUTHOR]

Based on cognitive psychological research, a number of theoretical frameworks have been put forward to describe the structure of experts’ medical knowledge and to explain experts’ case-processing. To provide evidence for the theory of knowledge encapsulation, which states that medical knowledge constitutes of interlinked biomedical and clinical knowledge. Fourth-year medical students, clerks and medical experts evaluated six case descriptions, consisting of laboratory data either with or without a clinical context. For each case description, the participants were required to study the case, to formulate a diagnosis, and to write down everything they could remember of the case. When the laboratory data were not embedded within a clinical context, medical experts’ case-processing increased and their diagnostic accuracy became worse. Furthermore, laboratory data recall of medical experts was more elaborate in cases where the laboratory data were presented without a clinical context. Similar results were obtained for students and clerks. The findings are only partially consistent with a prediction made by the theory of knowledge encapsulation. Further research, using a different paradigm than the traditionally used method of free recall, is required to unearth whether medical experts use qualitatively different knowledge structures than novices while solving cases. [ABSTRACT FROM AUTHOR]