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Objective Practice-Based Learning and Improvement is a Core Competency for surgical residents. Self-regulated learning (SRL) skills are an important component of this competency, yet are rarely taught in surgical training. Before we can teach SRL skills to residents we must understand the attributes that are essential. The purpose of this study was to develop a framework for SRL for surgical trainees. Design This mixed-methods study design utilized a two-round modified-Delphi approach to develop consensus among experts in surgical education regarding SRL in surgical training. Round One included SRL constructs derived from educational, professional, and medical literature. Based upon quantitative data and thematic coding of comments, these constructs were adapted for applicability in the context of surgical residency and reorganized using a constant comparative approach. Revised constructs and groupings were presented to the expert panel in Round Two. Further survey rounds were not needed as all items in Round Two reached the predetermined consensus level of 70%. Setting The Delphi panel was a purposeful sample of nationally recognized experts in surgical education, including members of the Association for Surgical Education and the Association for Program Directors in Surgery. Participants Thirty-eight of 42 experts (90.5%) responded to Round One, representing 29 academic and community medical systems nationally. The response rate for Round Two was 92%, 35 of the 38 Round One participants. Results In Round One, the SRL constructs were all viewed as important with median scores ranging from 50 to 99.5, on a 100-point scale. Two hundred and ninety-one comments were coded and used to refine SRL definitions into 7 domains for Round Two, which included self-awareness, task analysis, situation awareness, strategic planning, progress evaluation, learning and performance management, and goal attainment and refinement. All Round Two items reached greater than 70% agreement, and received 51 free response comments. Several key themes emerged: clinical prioritization over learning, learner's limited control, value and reliance on external resources, low use of metacognition, and complex goal orientation. Incorporation of common themes generated a novel multi-stage framework of SRL in surgical education. Conclusions Surgical residency represents a unique learning context, in which the ideal learner is one who understands their learning environment and utilizes available resources to optimize their own learning. Experts in surgical education believe SRL skills are important in training, and a novel framework of SRL is necessary to support a learner-centered model within the demanding environment of surgical training.

Background: Ultrasound education has been provided to students in medical schools within and beyond the United States. A formal experiment with use of personal handheld ultrasound equipment by all first-year medical students has not been reported. Employing insonation (an application of ultrasound) at the personal leisure by medical school freshmen enables self-directed learning throughout the academic year. Methods: We describe a peer-led ultrasound curriculum with handheld devices. The students’ perceptions were gathered through quarterly Likert-style questionnaires, and the differences in the categories were tested using Analysis of Variance. Results: The response rate was 58.5% for the first survey (n = 32), 56% (n = 30) for the second survey, and 62.3% (n = 33) for the final survey, respectively, with an average response rate of 58.9%. At the baseline survey, overall agreement was observed for enhancement on performance (62.5%) and interpretation (56.3) of ultrasounds, understanding (68.8%) and learning of anatomy (61.3%), ease (78.1%), comfort (59.4%) and benefit of incorporation of insonation in the medical school curricula (all p-values < 0.001). Neutral response (38.7%) or disagreement (38.7%) was observed when assessing the effect of the integration in medical curriculum on specialty choice (p < 0.01). These trends remained constant over follow-up with the exception that the perceived benefit for integration of insonation into the longitudinal curricula (p < 0.05) increased significantly over time. Majority of disagreement was observed regarding current access to the personal ultrasound devices (38.7%) (p < 0.001). Conclusions: The introduction of insonation through personal handheld ultrasound devices in the first-year medical school curriculum was received enthusiastically by students, with the majority of respondents finding the devices both easy to use and a valuable aid to improving their understanding of the three-dimensional anatomy.

BACKGROUND The implementation of optical diagnosis (OD) of diminutive colorectal lesions in clinical practice has been hampered by differences in performance between community and academic settings. One possible cause is the lack of a standardized learning tool. Since the factors related to better learning are not well described, strong evidence upon which a consistent learning tool could be designed is lacking. We hypothesized that a self-designed learning program may be enough to achieve competency in OD of diminutive lesions of the colon. AIM To assess the accuracy of OD of diminutive lesions in real colonoscopies after application of a self-administered learning program. METHODS This was a single-endoscopist prospective pilot study, in which an experienced endoscopist followed a self-designed, self-administered learning program in OD of colorectal lesions. An assessment phase divided in two halves with a 6-mo period in between without performance of OD was developed in a population-based colorectal cancer screening program. The accomplishment of the Preservation and Incorporation of Valuable Endoscopic Innovations criteria and performance measures were calculated overall and in the two halves of the assessment phase, assessing their response to the 6-mo stopping period. The evolution of performance through blocks of 50 lesions was also assessed. RESULTS Overall, 152 patients and 522 lesions (

Given the rapid pace at which modern radiology is evolving and the associated paradigm shifts in health care delivery, it is critical that radiologists adapt and constantly update the skills and knowledge required to practice safe, patient-centered care. The Association of University Radiologists-Radiology Research Alliance Lifelong Learning Task Force convened to explore the current status and future directions of lifelong learning in radiology and summarized its finding in this article. We review the various learning platforms and resources available to radiologists in their self-motivated and self-directed pursuit of lifelong learning. We also discuss the challenges and perceived barriers to lifelong learning and strategies to mitigate those barriers and optimize learning outcomes.

Purpose: Self-directed learning (SDL) has been increasingly emphasized within medical education. However, little is known about the SDL resources medical students use. This study aimed to identify patterns in medical students’ SDL behaviors, their SDL resource choices, factors motivating these choices, and the potential impact of the coronavirus disease 2019 (COVID-19) pandemic on these variables.Methods: An online cross-sectional survey comprising multiple-choice, ranked, and free-text response questions were disseminated to medical students across all 41 UK medical schools between April and July 2020. Independent study hours and sources of study materials prior to and during the COVID-19 pandemic were compared. Motivational factors guiding resource choices and awareness of Free Open Access Meducation were also investigated.Results: The target sample was 75 students per medical school across a total of 41 medical schools within the United Kingdom (3,075 total students), and 1,564 responses were analyzed. University-provided information comprised the most commonly used component of independent study time, but a minority of total independent study time. Independent study time increased as a result of the COVID-19 pandemic (P

Research shows that when students arrive at university they are often not prepared for independent learning. New students enter a period of transition during their first year, which is often characterised by emotional destabilisation, as they move towards becoming more self-regulating in their new learning environment. In this small-scale qualitative study, data from an in-depth pair interview were triangulated with data from a questionnaire, to explore participants' experiences of self-regulated learning in the first year of a Dental Surgery course. Five threshold concepts relating to learning in transition emerged from the analysis of the data. These concepts were as follows: learning how to learn using a range of self-chosen sources instead of a single textbook, learning how to organise incoming information without guidance, distinguishing between main ideas and detail during revision, coping with a heavy workload, and knowing what to expect from examinations and coursework. Strong emotions (feeling confused, overwhelmed and scared) were associated with negotiating these threshold concepts. However, the study illustrates how the participants adopted new cognitive and metacognitive strategies to become more self-regulating over time. The findings of the study suggest that lecturers, tutors, study advisers and peers all have an important role to play in explicitly guiding first-year students as they grapple with troublesome threshold concepts relating to self-regulated learning. Furthermore, structural changes to the content-heavy, lecture-based curricula often associated with first-year Medical and Dental courses would help ease students' transition to independent learning, which may make an impact on student attainment.

An ever-changing and challenging patient care environment requires nurses and midwives to embrace the concept of lifelong learning through a self-directed learning (SDL) approach. This study aims to evaluate nurses and midwives' readiness towards self-directed learning (SDRL) in Brunei Darussalam. A cross sectional descriptive study was conducted. Using a non-proportional quota sampling method, 700 questionnaires were distributed among nurses and midwives working in four District Government Hospitals in Brunei. Fisher's Self Directed Learning Readiness Scale was used to explore readiness towards SDL among nurses and midwives. In total, 616 completed questionnaires were returned (representing a response rate of 88%). Results indicated a high level of readiness towards self-directed learning among the participants with a total mean SDLR score of 158.44 ± 16.00. In overall comparison, the mean score of domains were: self-management (49.21), desire for learning (50.12) and self-control (59.10). This national hospital survey concludes that graduateness, workplace, age and marital status determine readiness towards self-directed learning among nurses and midwives in Brunei. Future research should focus on a theoretical framework for SDL models and the impact of these models on quality nursing practice.

Background. This research investigated the possibility of integrating simulation in plastic surgery residency training. The problem addressed was the lack of knowledge about using simulation as a teaching method to enhance the training of plastic surgeons. There was a lack of empirical evidence regarding learning outcomes that could be mastered by simulation-based education and training and their specific cognitive levels. Objectives. To identify and describe: ( i ) learning outcomes for plastic surgery education and training for which simulation might be an important (essential and useful) training method; and ( ii ) simulation modalities, linked to specific cognitive levels, to establish the influence of simulation on plastic surgery education and training. The objectives entail determining the importance of simulation in plastic surgery training and identifying simulation modalities most suited to attain specific outcomes. Methods. Data were collected by means of a Delphi survey to obtain consensus from an expert panel comprising 9 plastic surgeons, supplemented by semi-structured interviews conducted with 8 national and international role players in simulation and postgraduate education. Results. Learning outcomes, levels of training, possible simulation modalities, cognitive levels and descriptive verbs and phrases were described, as these pertain to learning. Participants agreed that simulation in medical education can be used to enhance postgraduate plastic surgery training, with special reference to specific outcomes and cognitive levels. Participants made recommendations for the planning and support of the implementation, aimed at ensuring the quality of training. Conclusion. The objectives set were achieved and the results of the study serve as encouragement and guidance in the striving for the enhancement of postgraduate plastic surgery education and training, and in other medical disciplines.

Self-directed lifelong learning is an important competency for nursing students to meet their professional development, yet it can be challenging for some students to acquire self-directed learning skills in a clinical context. A framework based on Hiemstra and Brockett’s “Person, Process, Context” model was developed to promote nurses' self-directed lifelong learning. The implication stems from our expectation that the framework can accelerate the development of interpersonal and intellectual skills valuable to a nursing student’s lifelong learning process.

Psychologists and educators have long pointed to myriad benefits of self-directed learning. Yet evidence of its efficacy in real-world domains is mixed and it remains unclear how it is constrained by basic perceptual and cognitive processes. Previous work suggests that, in particular, self-directed learning is affected by the way that people generate hypotheses as they learn. This study examines how biased hypothesis generation affects the learning of categorical rules, a basic building block of concept learning, through self-directed selection of training data. In both perceptual and abstract category learning tasks, participants' hypotheses regarding an unknown classification boundary were influenced by how features were represented. This bias had persistent effects on their ability to learn the underlying categorical relationship despite their opportunity to control the selection of training items. The results demonstrate that self-directed control can be beneficial for both perceptual and abstract category learning, but that the ability to discover rules of a particular form depends on how the learning environment guides the generation of new hypotheses. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Problem Medical student participation in research enhances appreciation of the scientific literature and the conduct of investigation, and may lead to an interest in academic medicine. Independent medical student research offers frequently overlooked opportunities to develop and assess professional practice abilities, including project design and implementation, interprofessional team communication, and time management. These skills, useful to physicians, are often challenging for medical students to master as they transition into clinical careers. To address this challenge, we designed and embedded interventional modalities into a highly mentored and longitudinal scholarly concentration component of the curriculum. Intervention The Embark scholarly concentration program incorporates traditional research training with the development of professional practice skills essential for transitioning to clinical practice. The program includes individualized and just-in-time components enabling student access to information and feedback specific to their projects and development of professional practice skills. Context The Embark program is a required longitudinal component of the Oakland University William Beaumont School of Medicine undergraduate medical curriculum. The Embark program consists of courses that inform and facilitate a required longitudinal independent research project. Outcome A retrospective evaluation of the Embark program's success with development of professional practice skills through the lens of both faculty and student perceptions included analysis of project records and course evaluation feedback. Evaluation of individual student development of transitional skill ability is possible through both quantitative and qualitative analysis of data collected from student project records. More than 80% of course evaluation commentary on strengths of the program addressed activities related to professional practice skills. To systematize the evaluation of these data sources, we have piloted a framework, iSAIL, designed to assess student development in these skills during the planning and conduct of a research project. Lessons learned By developing professional practice skills in the context of a scholarly concentration program, medical students can build a foundation for future engagement in research while they develop skills to overcome challenges that they are likely to encounter in their clinical careers. Modalities designed to evaluate individualized student development of professional practice skills through research participation define program successes and may lead to the identification of additional resources needed by students. By offering medical students opportunities to develop professional practice skills within the protected environment of an independent research project, this scholarly concentration program provides a valuable opportunity to influence the early development of skills necessary throughout their clinical careers.

It is an axiom of research into cost and value in education that the way to deliver low cost education is to save on faculty cost, as this makes up the majority of the costs in most educational programmes. Thus, any savings that can be made to faculty costs will make a significant contribution to reducing overall cost. But this may not be the case with all programmes, or with all methods of learning. In particular, it may not be the case with self-directed learning. The cost of self-directed learning can be divided up into cost categories just like any other form of learning. As such, it will be made up of faculty cost, learner costs, infrastructure and facility costs, content costs and technology costs. However, in postgraduate education, these costs are largely the same as those that account for clinical care, as postgraduate learners learn as they work. To get maximum value from self-directed learning that will support clinical decisions, learners will need to have access to excellent clinical decision support resources that will facilitate self-directed learning.

This study explored to understand the lived experiences of a group of pre-registration nursing students' in a United Kingdom Higher Education setting, in the context of increasing responsibility for self-direction throughout the learning process. Care is underpinned by evidence, knowledge and problem solving skills, predicated on enhanced student capability to ensure self-direction in learning. A hermeneutic phenomenological approach framed within an interpretative paradigm enabled exploration to seek out individual and collective perceptions of the learning process. Four over-arching themes were identified: Divergent perceptions of self-directed learning, Adult learning needs and transition, Motivation and Understanding responsibility. Students appeared very dependent and, paradoxically, demanded both variety and consistency from educators in assisting them to develop as they progressed through the course. Within these themes, anxiety and vulnerability were shared motifs in students' experiences. Clear expectations of responsibilities and roles in learning is key to supporting students from the beginning of the undergraduate programme. Teacher and student interaction is important in developing and enabling critical engagement in learning with clear directions and guidelines.

Introduction Existing scholarly curricula often underemphasize basic research skills and do not address the individual learning needs of residents, whose level of prior exposure to research concepts varies widely. A supplemental educational experience was developed to address educational gaps in a family medicine residency curriculum, including systematic exploration and interpretation of the medical literature, development and exploration of clinically pertinent questions, and development of residents' written communication skills. Methods A 2-week, online, self-directed research curriculum was developed. The five-module curriculum included (I) Research Methods and Data Analysis, (II) Article Review, (III) Board Review, (IV) Literature Search, and (V) Literature Review and Proposal. Two years after implementation, residents who completed the curriculum were surveyed to assess the overall rotation and its success in meeting learning objectives. Results Eighteen residents completed the new rotation and demonstrated objectives through assignment completion and review. Additionally, residents reported improved skills on all objectives and were satisfied with the new curriculum and its self-led, online format. Those planning to do research after graduation were more likely to report several benefits from the rotation, including learning more about data analyses and being more likely to complete a future scholarly project. Discussion An online, self-directed curriculum can provide a feasible and effective educational approach to efficient use of faculty and resident time, allowing time to be focused on resident-specific knowledge gaps and learning needs, rather than presenting all learning material uniformly. The online, accessible format aligned with residents' existing reliance on the internet as a primary information source.

Background For effective self-directed life-long learning physicians need to engage in feedback-seeking, which means fostering such behavior during training. Self-determination theory (SDT) posits that intrinsic motivation is fostered when the environment optimizes the individual’s experience of autonomy, relatedness, and competence. Educational settings meeting these psychological needs may foster intrinsic motivation in trainees, enhance their desire for feedback, and promote feedback-seeking. We sought to examine residents’ feedback-seeking behaviors through the lens of SDT and explore the association with intrinsic motivation and career choice. Methods We used a mixed-methods approach with an explanatory sequential design. Residents participated in simulation training, completed an inventory of intrinsic motivation (IMI) and responded to sequential opportunities for performance feedback requiring different levels of effort. We compared IMI scores and career choice between groups with different effort. We interviewed high-effort feedback-seekers and conducted thematic analysis of interview data. Results Thirty-four of 35 residents completed the survey (97%). Of those completing the study, 12 engaged in low-effort feedback-seeking only, 10 indicated intent for high-effort feedback-seeking and 10 actually engaged in higher effort to get feedback. Groups did not differ in mean IMI scores. Among high-effort feedback-seekers more residents were interested in critical care–related fields compared to the other groups. We identified 5 themes around autonomy, relatedness, and competence clarifying residents’ reasons for feedback-seeking. Conclusions Our findings suggest that among residents, the relationship between motivation and feedback-seeking is complex and cannot be predicted by IMI score. Career plans and relationships with feedback providers impact feedback-seeking, which can inform educational interventions. Electronic supplementary material The online version of this article (10.1186/s12909-018-1253-8) contains supplementary material, which is available to authorized users.

Professional nursing values are important concepts in developing the identity of nursing professional among nursing students. Self-directed learning as an ability can drive motivation to enhance professional nursing values and merits examination. This study aimed to examine the associations between self-directed learning and professional nursing values in nursing students. A cross-sectional descriptive design was employed with a sample of 800 nursing students. The measurement tools were the Self-Rating Scale of Self-Directed Learning and Korean version of the Nurses Professional Values Scale-Revised. Path analysis was used to evaluate relationships among self-directed learning, professional nursing values, and general participant characteristics. Self-directed learning had significantly positive effects on professional nursing values. Male nursing students were more likely to have higher levels of self-directed learning. Our findings suggest that self-directed learning can be an effective pedagogical method to instill and reinforce professional nursing values in nursing students. In addition, nursing educators should consider sex differences in the learning styles of nursing students.

The objective of our research is to find out if gamification increases motivation for self-directed learning (SDL) of human anatomy among year 1 medical students, and more importantly, their academic grades (n = 120). At the NUS Yong Loo Lin School of Medicine, anatomy teaching has traditionally been delivered via didactic means. To encourage more active learning, suitable games (non-digital) and the script concordance test were utilized to enhance the process. The flipped classroom approach was also introduced to further trigger active learning. In addition, the use of mobile apps (digital) was also initiated as supplements for SDL. Feedback was collected based on the previously validated PRO-SDL scale. Results from the research yielded inconclusive evidence to support enhanced motivation among our students due to gamification (P0.05). However, it did help to encourage active participation for a "fun learning" experience supported by numerous positive comments. More importantly, the participant's continuous assessment (CA1, CA2, and CA3) and objective specific practical exam results were better than the cohort's average (P0.05), suggesting that enhanced meta-cognition, and factual recall had taken place. While it is positive, there are some caveats to note with gamification, first and foremost, that it is tutor dependent. Taken together, gamification could represent a new paradigm for anatomy education, and also an opportune time to change the prevailing culture in the healthcare and education industry. Clin. Anat. 31:997-1005, 2018. © 2018 Wiley Periodicals, Inc.

Background Self-directed learning (SDL) is defined as learning on one’s own initiative, with the learner having primary responsibility for planning, implementing, and evaluating the effort. Medical education institutions promote SDL, since physicians need to be self-directed learners to maintain lifelong learning in the ever-changing world of medicine and to obtain essential knowledge for professional growth. The purpose of the study was to measure the self-directed learning readiness of medical students across the training years, to determine the perceptions of students and faculty on factors that promote and deter SDL and to identify the role of culture and curriculum on SDL at the Christian Medical College, Vellore, India. Methods Guglielmino’s SDL Readiness Scale (SDLRS) was administered in 2015 to six student cohorts (452 students) at admission, end of 1st, 2nd, 3rd and 4th year of training, and at the beginning of internship in the undergraduate medicine (MBBS) program. Analysis of variance (ANOVA) was used to compare SDL scores between years of training. 5 student focus groups and 7 interviews with instructors captured perceptions of self-direction. Transcripts were coded and analyzed thematically. Results The overall mean SDLRS score was 212.91. There was no significant effect of gender and age on SDLR scores. There was a significant drop in SDLRS scores on comparing students at admission with students at subsequent years of training. Qualitative analysis showed the prominent role of culture and curriculum on SDL readiness. Conclusions Given the importance of SDL in medicine, the current curriculum may require an increase in learning activities that promote SDL. Strategies to change the learning environment that facilitates SDL have to be considered.

Background The importance of self-directed learning (SDL) and collaborative learning has been emphasized in medical education. This study examined if there were changes in the pattern of SDL and group cohesion from the time of admission to medical school under the criterion-referenced grading system, increased group activities, and interaction of medical education curriculum. Second, it was examined whether group cohesion influences self-directed learning. Methods The participants were 106 medical students (71 males, 35 females) who enrolled in Yonsei University College of Medicine in Seoul, South Korea in March 2014. They were asked to complete a Korean version of the self-directed learning readiness scale (SDLRS) and group cohesion scale (GCS) at the end of each semester for three years. A repeated measures ANOVA and a correlation and regression analysis were conducted. Results All the participants completed the questionnaires. There were differences in the SDLRS scores over the three years. A significant increase was observed one year after admission followed by stable scores until the third year. There was a significant increase in GCS scores as students progressed through medical school years. Positive relationships were found between SDLRS and GCS scores, and the regression model predicted 32% variance. Conclusions SDLRS and GCS increased as medical school years progressed. In addition, GCS is a significant factor in fostering SDLRS. Medical schools should develop various curriculum activities that enhance group cohesion among medical students, which would in turn promote SDL.

Outside the US, FLS certification is not required and its teaching methods are not well standardized. Even if the FLS was designed as “stand alone” training system, most of Academic Institution offer support to residents during training. We present the first systematic application of FLS in Italy. Our aim was to evaluate the role of mentoring/coaching on FLS training in terms of the passing rate and global performance in the search for resource optimization. Sixty residents in general surgery, obstetrics & gynecology, and urology were selected to be enrolled in a randomized controlled trial, practicing FLS with the goal of passing a simulated final exam. The control group practiced exclusively with video material from SAGES, whereas the interventional group was supported by a mentor. Forty-six subjects met the requirements and completed the trial. For the other 14 subjects no results are available for comparison. One subject for each group failed the exam, resulting in a passing rate of 95.7%, with no obvious differences between groups. Subgroup analysis did not reveal any difference between the groups for FLS tasks. We confirm that methods other than video instruction and deliberate FLS practice are not essential to pass the final exam. Based on these results, we suggest the introduction of the FLS system even where a trained tutor is not available. This trial is the first single institution application of the FLS in Italy and one of the few experiences outside the US. Trial Number: NCT02486575 ( https://www.clinicaltrials.gov ).

We compared the effects of the effects of self-instructions in the form of prose or song lyrics in the acquisition of gross motor tasks in 4 third-grade children. We taught participants 4 pairs of gross motor tasks, with one task in each pair taught with prose self-instructions and the other taught with song lyric self-instructions. Both self-instruction procedures were effective for teaching tasks; however, acquisition was quicker with song lyric self-instruction for 4 task pairs, acquisition was quicker with prose self-instruction for 3 task pairs; and similar for 1 task pair. Participants were then able to select their preferred method of self-instruction for a novel, applied skill. Two participants selected song-lyric self-instructions and 2 participants selected prose self-instructions.

To construct the study platform for meridians and acupoints by analyzing the status and current problems of teachingTotally two hundred and five 2014 grade bachelor candidates from four classes of the department of acupuncture-moxibustion and tuina were selected from Hunan Junior College of TCM. They were randomized into an observation group (102 cases) and a control group (103 cases). in the observation group, the flipped classroom was performed by adopting the study platform of meridians and acupoints. Additionally, the team cooperation learning and overall assessment were conducted. In the control group, the traditional teaching system was adopted, in which, the mode of "teacher's demonstration-to-discussion in group-to-teachers' assessment" and the operation check at the end of the semester were applied. The learning effect and the self-learning ability were evaluated at the end of semester in the two groups. The satisfaction survey was conducted in the observation group.In the observation group, the drawing of meridian running course and locating the acupoints, as well as the self-learning ability were better than those in the control group, indicating the significant differences (allThe study platform of learning

Purpose Self-directed learning (SDL) is part of residency training, which residents desire guidance in implementing. To characterize SDL within the clinical context, this study explored residents' perceptions of faculty members' role in promoting and supporting resident SDL. Method Using a constructivist grounded theory approach, the authors conducted seven focus groups with 46 internal medicine residents at the Mayo Clinic Internal Medicine Residency Program from October 2014 to January 2015. Focus group transcripts were deidentified and processed through open coding and analytic memo writing. Guided by a previously developed SDL model, data were analyzed regarding faculty member involvement in resident SDL. Themes were organized and patterns were discussed at team meetings, with constant comparison with new data. Trustworthiness was established using two member-check sessions. Results The authors identified themes within the categories of faculty guidance for SDL, SDL versus other-directed learning (ODL), and faculty archetypes for supporting SDL. Clinical teachers play a key role in facilitating resident SDL and can provide guidance at each step in the SDL process. Residents discussed the distinction between SDL and ODL, highlighting the integrated nature of learning and interplay between the two approaches to learning. Residents identified themes relating to three archetypal approaches faculty implement to support resident SDL in the clinical environment (directed, collaborative, and role model SDL), with benefits and challenges of each approach. Conclusions This study underscores the importance of external guidance for resident SDL and expands on approaches faculty members can use to support SDL in the clinical context.

“Boxed warnings” (BW), sometimes referred to as “black box warnings,” are the most serious level of warning provided by the Food and Drug Administration (FDA). We aimed to assess physician awareness and knowledge of BW, and to gain a better understanding of where physicians obtain information about serious adverse drug reactions for commonly prescribed medications. A cross-sectional survey instrument was administered to emergency medicine (EM) and pediatrician (Peds) attending and resident physicians. The main outcome measures were physician performance in identifying medications with and without black box warnings and the content of the warnings. The survey response rate was 81/198 (41 %). Respondents correctly identified medications with BW only 36.3 % of the time, but were able to correctly identify medications without such warnings 83.8 % of the time. Attending physicians were better able to identify medications with or without BW when compared with residents (p

Background Modern healthcare institutions are continuously changing, and Self-Directed Learning (SDL) abilities are considered a prerequisite for both nursing students and nurses in order to be proactive about these demanding challenges. To date, no systematic reviews of existing instruments aimed at detecting and critically evaluating SDL abilities have been published. Therefore, the aims of this review are: 1) identify the instruments for assessment of SDL abilities among nursing students and nurses; 2) critically evaluate the methodological studies quality; and 3) compare the psychometric properties of the available instruments. Methods A psychometric-systematic-review was performed. CDSR, CINAHL, ERIC, MEDLINE, PROSPERO, SCOPUS databases were searched without restrictions in time and setting. All primary studies involving nursing students or nurses, written in English and aimed at validating SDL assessment tools, were included. Studies retrieved were evaluated according to the COnsensus-based-Standards for the selection of health Measurement-INstruments (COSMIN) panel. Study inclusion, data extraction and quality assessment were performed by researchers independently. Results Eleven studies were included and four tools based on Knowles’s theory have emerged: 1) the Self-Directed Learning Readiness Scale; 2) the Self-Directed Learning Readiness Scale for Nursing Education; 3) the Self-Rating Scale of Self-Directed Learning, and 4) the Self-Directed Learning Instrument. A few psychometric properties have been considered in each study, from two to four out of the ten required. The quality of the methodologies used was in general, from fair to poor with the exception of one instrument (the Self-Directed-Learning-Instrument). The psychometric proprieties that emerged across the tools were good in general: the Cronbach α was from 0.73 to 0.91; structural validities have also reported good indexes both in the explorative and in the confirmative factor analyses. Conclusions On the basis of the findings, the Self-Directed-Learning-Instrument can be recommended for the assessment of SDL abilities among nursing students and nurses, given the excellent methodology quality adopted in estimating the psychometric properties. However, rigorous study designs aimed at estimating psychometric properties of tools in wide samples of nursing students and nurses across different stages of professional life, from undergraduate education to professional maturity, in different cultural, educational, and work settings, are strongly recommended.

Background We sought to determine whether a self-training program on a high-fidelity flexible bronchoscopy (FB) simulator would allow residents who were novices in bronchoscopy to acquire competencies similar to those of experienced bronchoscopists as concerns the visualization of the bronchial tree and the identification of its anatomical elements. Methods We performed a prospective cohort study, categorizing bronchoscopists into three groups according to their experience level: novice (Group A, no FBs performed, n = 8), moderate (Group B, 30 ≤ FBs performed ≤200, n = 17) or high (Group C, > 200 FBs performed, n = 9). All were initially evaluated on their ability to perform on a high-fidelity FB simulator a complete visualization/identification of the bronchial tree in the least amount of time possible. The residents in Group A then completed a simulation-based self-training program and underwent a final evaluation thereafter. Results The median total procedure time for Group A fell from 561 s (IQR = 134) in the initial evaluation to 216 s (IQR = 257) in the final evaluation (P = 0.002). The visualization and identification scores for Group A also improved significantly in the final evaluation. Resultantly, the overall performance score for Group A climbed from 5.9% (IQR = 5.1) before self-training to 25.5% (IQR = 26.3) after (P = 0.002), thus becoming comparable to the overall performance scores of Group B (25.3%, IQR = 13.8) and Group C (22.2%, IQR = 5.5). Conclusions Novice bronchoscopists who self-train on a high-fidelity simulator acquire basic competencies similar to those of moderately or even highly experienced bronchoscopists. High-fidelity simulation should be rapidly integrated within the learning curriculum and replace traditional, in-patient learning methods. Electronic supplementary material The online version of this article (10.1186/s12909-018-1304-1) contains supplementary material, which is available to authorized users.

Background Sex and gender influence health and disease outcomes, therefore, doctors should be able to deliver gender-sensitive care. To train gender-sensitive doctors, relevant sex and gender differences have to be included in medical education. In order to develop appealing, relevant, and effective education for undergraduate medical students, education should be tailored to students’ level and anticipated on their ideas and assumptions. Therefore, we wanted to answer the following research questions: 1. What do aspiring medical students want to learn about gender medicine?; 2. How would they like to learn about gender medicine?; and 3. What are their ideas and assumptions about sex and gender differences in health and disease? Methods We performed an explorative thematic document analysis of educational assignments made by successful applicants (n = 50) during the selection procedure of their entry into medical school. To test aspirants’ capacity for self-directed learning, students were asked to formulate their own study plan after they watched a video that resembled a future practical experience (a consultation with a patient). As the content of this video was gender-sensitive, the assignments of the successful applicants gave us the unique opportunity to examine aspiring medical students’ views about gender medicine. Results Aspiring medical students were eager to start their training to become gender-sensitive doctors. They believed in better care for all patients and thought doctors should obtain gender competences during their medical training. Students preferred to start with acquiring basic biomedical knowledge about differences between men and women and continue their training by developing gender-sensitive communication skills in (simulated) practical settings. Students differed in their interpretation of the gender-sensitive video, some generalized potential differences to all men and all women. Teachers were considered as important role models in learning about gender medicine. Conclusions We advise medical schools to teach gender medicine from the beginning of medical school, by focusing on sex differences first and adding gender related themes later on in the curriculum. As students may interpret gender-sensitive information differently, structurally embedding reflection on gender medicine with gender competent teachers is necessary.

Background: Students should be encouraged to become reflexive and develop autonomous, lifelong learning habits. Therefore, teachers should focus on learning strategies which stimulate autonomous learning. Aim: To assess the impact of a self-directed teaching methodology on the academic performance of medical students in cellular biology and biochemistry. Materials and Methods: During 2013, 85 students received a traditional teaching methodology and during 2014, 85 students received a self-directed learning methodology. The grades obtained and the number of failures in the courses of cellular biology and biochemistry were compared in both groups. Results: The percentages of students approved at the end of the courses during 2013 and 2014 were 64 and 96% respectively (p < 0.01). The grades obtained by the 2014 students were also significantly higher than those obtained by 2013 students. Conclusions: This study confirms that academic performance improves with a self-directed teaching approach.

The nature and characteristics of self-directed learning (SDL) by physicians has been transformed with the growth in digital, social, and mobile technologies (DSMTs). Although these technologies present opportunities for greater "just-in-time" information seeking, there are issues for ensuring effective and efficient usage to compliment one's repertoire for continuous learning. The purpose of this study was to explore the SDL experiences of rural physicians and the potential of DSMTs for supporting their continuing professional development (CPD).Semistructured interviews were conducted with a purposive sample of rural physicians. Interview data were transcribed verbatim and analyzed using NVivo analytical software and thematic analysis.Fourteen (N = 14) interviews were conducted and key thematic categories that emerged included key triggers, methods of undertaking SDL, barriers, and supports. Methods and resources for undertaking SDL have evolved considerably, and rural physicians report greater usage of mobile phones, tablets, and laptop computers for updating their knowledge and skills and in responding to patient questions/problems. Mobile technologies, and some social media, can serve as "triggers" in instigating SDL and a greater usage of DSMTs, particularly at "point of care," may result in higher levels of SDL. Social media is met with some scrutiny and ambivalence, mainly because of the "credibility" of information and risks associated with digital professionalism.DSMTs are growing in popularity as a key resource to support SDL for rural physicians. Mobile technologies are enabling greater "point-of-care" learning and more efficient information seeking. Effective use of DSMTs for SDL has implications for enhancing just-in-time learning and quality of care. Increasing use of DSMTs and their new effect on SDL raises the need for reflection on conceptualizations of the SDL process. The "digital age" has implications for our CPD credit systems and the roles of CPD providers in supporting SDL using DSMTs.

Background Self-directed learning (SDL) is expected of health science graduates; it is thus a learning outcome in many pre-certification programs. Previous research identified age, gender, discipline and prior education as associated with variations in students’ self-directed learning readiness (SDLR). Studies in other fields also propose personality as influential. Method This study investigated relationships between SDLR and age, gender, discipline, previous education, and personality traits. The Self-Directed Learning Readiness Scale and the 50-item ‘big five’ personality trait inventory were administered to 584 first-year undergraduate students (n = 312 female) enrolled in a first-session undergraduate interprofessional health sciences subject. Results Students were from health promotion, health services management, therapeutic recreation, sports and exercise science, occupational therapy, physiotherapy, and podiatry. Four hundred and seven responses (n = 230 females) were complete. SDLR was significantly higher in females and students in occupational therapy and physiotherapy. SDLR increased with age and higher levels of previous education. It was also significantly associated with ‘big five’ personality trait scores. Regression analysis revealed 52.9% of variance was accounted for by personality factors, discipline and prior experience of tertiary education. Conclusion Demographic, discipline and personality factors are associated with SDLR in the first year of study. Teachers need to be alert to individual student variation in SDLR.

Objective The Council on Medical Student Education in Pediatrics and Association of Pediatric Program Directors developed a Pediatric Subinternship (CAPS) curriculum for use with an individualized learning plan (ILP). The authors determined which learning objectives (LOs) pediatric subinterns selected when provided the CAPS curriculum, summarized students' self-reported progress, and determined feasibility of ILPs in subinternship. Methods Students from 10 medical schools completed a standardized ILP during pediatric subinternship. Students listed ≥3 LOs using CAPS curriculum as a guide and self-assessed their progress. Students reviewed ILPs with faculty preceptors; preceptors completed questionnaires on time and effort spent. Authors mapped student LOs to CAPS curriculum objectives and grouped in Accreditation Council for Graduate Medical Education competency domains. Results Two hundred four students documented 850 LOs. Authors mapped student LOs to 61 of the 69 CAPS objectives (88%). Students most commonly chose Patient Care LOs, with the top 3 related to oral presentations, time management, and management plans. Student LOs not in CAPS addressed nutrition, child development, test interpretation, and cost. No students chose LOs related to health disparities, shared decision making, informed consent, or patient safety. Students self-reported significant progress on most LOs (73%). Faculty met with students ≥1 time and 93% met for a total of ≤1 hour. According to faculty, students required little or no help completing ILPs. Conclusions Students chose a wide range of LOs when provided the CAPS curriculum. Revision to include additional student-identified LOs would enhance CAPS curriculum's comprehensiveness. Using this curriculum with an ILP during subinternship is feasible, but gaps between educator-identified and student-identified objectives require further exploration.

Strong reading habits are key to developing the medical expertise and the critical appraisal skills necessary for practice. At our institution, medicine spans 4 years with years 1 and 2 largely bei...

Purpose Different from the basic core part of the clinical interviewing and physical examination (PE) skills course in basic, head-to-toe, and thorax systems, learners need structural feedback for the development of the complex skills in cluster part including abdominal, neuromuscular and musculoskeletal systems. It aimed to evaluate the effects of replacing Dreyfus scale, which having elements of continuous professional development, with Likert scale in the feedback in cluster part of training in Taiwan. Methods Instructors and final-year medical students of class 2015-2016 comprised the regular cohort, whereas those of class 2017-2018 formed the intervention cohort. In the intervention cohort, Dreyfus scale-based feedback rather than Likert scale based feedback was used in the cluster part of the course in National Yang-Ming university, Taiwan. Results Among the regular cohort, poor pre-trained standardized patients (SPs) rated class climate, low grouped students satisfaction with the instructors and course, and low grouped student self-assessed readiness were noted in the cluster part than those in the core part. In comparison with regular cohort, greater improvement of post-cluster part end-of-course group objective structured clinical examination (GOSCE) scores was noted in intervention cohort. In other word, the implementation of Dreyfus scale-based feedback in the cluster part improved the deficit in this part of the course among the intervention cohort. Conclusion The implementation of Dreyfus scale-based feedback helped instructors to create a good class climate in the cluster parts of clinical interviewing plus PE skills course in our study. Simultaneously, this new intervention achieved the goal of medical students competency in interviewing, PE and self-directed learning (SDL) skills.

Although self-regulated learning (SRL) is considered a fundamental skill that must be developed in physician training, many programs of SRL utilize learning goals that are generated only at the beginning of learning experiences or are widely spaced apart in time. These goals are often not formally shared with those actually working with the learner in the clinical setting.We developed a program of written, student-generated weekly learning goals in which students focused on processes of becoming better doctors for their patients. These goals were shared at the beginning of each week with students' clinical teams for feedback and incorporation into the work.The weekly learning goals program was developed and implemented as part of a required 3rd-year neurology clerkship. At the end of each 4-week clerkship, students were asked to evaluate the program through an anonymous electronic survey utilizing quantitative and open-ended qualitative questions.Seventy-six of 82 students completed the evaluation survey (93% response rate). Eighty-six percent reported that the weekly learning goals increased their awareness of their thoughts and actions. Seventy-eight percent reported that the learning goals helped to improve their clinical performance to some degree, and 57% reported that the learning goals increased their focus on patient care. Students described a greater sense of focus on self-assessment and accountability from their goals. Students often commented that engagement from attendings and residents regarding their goals was a key element for successful learning from their goals.Student-generated weekly learning goals on a neurology clerkship appear to be an effective method to operationalize SRL. For most students, the frequency of the goals allowed for close self-monitoring, and the act of sharing goals with the team opened a new avenue for dialogue between students and their supervisors.

Students should be encouraged to become reflexive and develop autonomous, lifelong learning habits. Therefore, teachers should focus on learning strategies which stimulate autonomous learning.To assess the impact of a self-directed teaching methodology on the academic performance of medical students in cellular biology and biochemistry.During 2013, 85 students received a traditional teaching methodology and during 2014, 85 students received a self-directed learning methodology. The grades obtained and the number of failures in the courses of cellular biology and biochemistry were compared in both groups.The percentages of students approved at the end of the courses during 2013 and 2014 were 64 and 96% respectively (p0.01). The grades obtained by the 2014 students were also significantly higher than those obtained by 2013 students.This study confirms that academic performance improves with a self-directed teaching approach.

Background Evaluation of two different self-educational methods (video assisted learning versus video assisted learning plus a nodal point operation primer) on learning laparoscopic suturing and intracorporal knotting. Methods Randomized controlled trial at the laparoscopic surgical training center, University of Tubingen with 45 surgical novices first year medical students being pretested for dexterity. After self-educational training for 90 min with either method (Group A: video assisted learning, Group B: video assisted learning plus a nodal point operation primer) participants had to perform five laparoscopic intracorporal knots. Assessed were number of knots completed (maximum of five knots counted, knot integrity, technical proficiency and knotting time per knot. Primary outcome measure is a composed knot score combining knot integrity, technical proficiency and knotting time. Results Group B (n = 23) achieved a significantly higher composed knot score than Group A (n = 22) (53.3 ± 8.4 versus 46.5 ± 13.6 points respectively, p = 0.016). Median knotting time per completed knot was significantly different between Group B and Group A (308 s [100–1221] versus 394 s [138–1397] respectively, p = 0.001). Concerning number of completed knots there was a trend towards more knots achieved in Group B (4.2 ± 1.2 versus 3.55 ± 1.4 respectively, p = 0.075) . Conclusions The use of a nodal point operation primer highlighting essential key steps of a procedure augment the success of learning laparoscopic skills as suturing and intracorporal knotting. (UIN researchregistry3866, March 22, 2018). Electronic supplementary material The online version of this article (10.1186/s12909-018-1193-3) contains supplementary material, which is available to authorized users.

The widespread growth of higher education is increasing the heterogeneity of university students in terms of socioeconomic characteristics, academic story and cultural background. Medical schools are not an exception of this phenomenon.To compare the academic background and self-directed learning behavior of students who entered to a public medial school between 2010 and 2014.A non-probabilistic sample of 527 medical students aged between 17 and 29 years (60% men), was studied. Their academic information was collected from the University data base; they answered the Self-directed learning readiness scale of Fisher.Students from the 2014 cohort had higher high school grades than their counterparts. The scores in mathematics of the Scholarship Aptitude Test (SAT) were higher in the cohorts of 2010 and 2011. Those of the sciences test were superior in the 2013 cohort. The 2014 cohort had the lower general score of self-directed learning behaviors.The lower SAT and self-directed learning scores of the students entering medical school in 2014, indicate the progressive increase in the heterogeneity of Medical students.