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GP supervisors’ experience in supporting self-regulated learning: a balancing act

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Abstract

Self-regulated learning is essential for professional development and lifelong learning. As self-regulated learning has many inaccuracies, the need to support self-regulated learning has been recommended. Supervisors can provide such support. In a prior study trainees reported on the variation in received supervisor support. This study aims at exploring supervisors’ perspectives. The aim is to explore how supervisors experience self-regulated learning of postgraduate general practitioners (GP) trainees and their role in this, and what helps and hinders them in supervising. In a qualitative study using a phenomenological approach, we interviewed 20 supervisors of first- and third-year postgraduate GP trainees. Supervisors recognised trainee activity in self-regulated learning and adapted their coaching style to trainee needs, occasionally causing conflicting emotions. Supervisors’ beliefs regarding their role, trainees’ role and the usefulness of educational interventions influenced their support. Supervisors experienced a relation between patient safety, self-regulated learning and trainee capability to learn. Supervisor training was helpful to exchange experience and obtain advice. Supervisors found colleagues helpful in sharing supervision tasks or in calibrating judgments of trainees. Busy practice occasionally hindered the supervisory process. In conclusion, supervisors adapt their coaching to trainees’ self-regulated learning, sometimes causing conflicting emotions. Patient safety and entrustment are key aspects of the supervisory process. Supervisors’ beliefs about their role and trainees’ role influence their support. Supervisor training is important to increase awareness of these beliefs and the influence on their behaviour, and to improve the use of educational instruments. The results align with findings from other (medical) education, thereby illustrating its relevance.

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References

  • Artino, A. R, Jr, & Jones, K. D. (2013). AM last page: Self-regulated learning—a dynamic, cyclical perspective. Academic Medicine, 88(7), 1048.

    Article  Google Scholar 

  • Barry, C. A., Britten, N., Barber, N., Bradley, C., & Stevenson, F. (1999). Using reflexivity to optimize teamwork in qualitative research. Qualitative Health Research, 9(1), 26–44.

    Article  Google Scholar 

  • Bergman, E., de Feijter, J., Frambach, J., Godefrooij, M., Slootweg, I., Stalmeijer, R., et al. (2012). AM last page: A guide to research paradigms relevant to medical education. Academic Medicine, 87(4), 545.

    Article  Google Scholar 

  • Billett, S. (2004). Workplace participatory practices. Conceptualising workplaces as learning environments. Journal of Workplace Learning, 16(6), 312–324.

    Article  Google Scholar 

  • Bjork, R. A., Dunlosky, J., & Kornell, N. (2013). Self-regulated learning: Beliefs, techniques, and illusions. Annual Review of Psychology, 64, 417–444.

    Article  Google Scholar 

  • Boekaerts, M. (1997). Self-regulated learning: A new concept embraced by researchers, policy makers, educators, teachers, and students. Learning and Instruction, 7(2), 161–186.

    Article  Google Scholar 

  • Boendermaker, P. M., Schuling, J., Meyboom-De Jong, B. M., Zwierstra, R. P., & Metz, J. C. (2000). What are the characteristics of the competent general practitioner trainer? Family Practice, 17(6), 547–553.

    Article  Google Scholar 

  • Brydges, R., & Butler, D. (2012). A reflective analysis of medical education research on self-regulation in learning and practice. Medical Education, 46(1), 71–79.

    Article  Google Scholar 

  • Brydges, R., Dubrowski, A., & Regehr, G. (2010). A new concept of unsupervised learning: Directed self-guided learning in the health professions. Academic Medicine, 85(10 Suppl), S49–S55.

    Article  Google Scholar 

  • Bunniss, S., & Kelly, D. R. (2010). Research paradigms in medical education research. Medical Education, 44(4), 358–366.

    Article  Google Scholar 

  • Butler, D. L., & Brydges, R. (2013). Learning in the health professions: What does self-regulation have to do with it? Medical Education, 47(11), 1057–1059.

    Article  Google Scholar 

  • Creswell, J. W. (1998). Qualitative inquiry and research design. Choosing among five traditions. Thousend Oaks, London, New Delhi: SAGE Publications.

    Google Scholar 

  • Davis, D. A., Mazmanian, P. E., Fordis, M., Van Harrison, R., Thorpe, K. E., & Perrier, L. (2006). Accuracy of physician self-assessment compared with observed measures of competence: A systematic review. JAMA, 296(9), 1094–1102.

    Article  Google Scholar 

  • De Kleijn, R.A.M. (2013). Master’s Theses Supervision: Feedback, interpersonal relationships and adaptivity. Dissertation, Utrecht University, Utrecht.

  • Dowling, M. (2007). From Husserl to van Manen. A review of different phenomenological approaches. International Journal of Nursing Studies, 44(1), 131–142.

    Article  Google Scholar 

  • Durning, S. J., & Artino, A. R. (2011). Situativity theory: A perspective on how participants and the environment can interact: AMEE Guide no. 52. Medical Teacher, 33(3), 188–199.

    Article  Google Scholar 

  • Durning, S. J., Cleary, T. J., Sandars, J., Hemmer, P., Kokotailo, P., & Artino, A. R. (2011). Perspective: Viewing “strugglers” through a different lens: How a self-regulated learning perspective can help medical educators with assessment and remediation. Academic Medicine, 86(4), 488–495.

    Article  Google Scholar 

  • Eva, K. W., & Regehr, G. (2008). “I’ll never play professional football” and other fallacies of self-assessment. The Journal of Continuing Education in the Health Professions, 28(1), 14–19.

    Article  Google Scholar 

  • Frambach, J. M., van der Vleuten, C. P., & Durning, S. J. (2013). AM last page. Quality criteria in qualitative and quantitative research. Academic Medicine, 88(4), 552.

    Google Scholar 

  • Gibson, W., & Brown, A. (2009). Working with qualitative data. Los Angeles, CA: Sage.

    Google Scholar 

  • Giorgi, B. (2006). Can an empirical psychology Be Drawn from Husserl’s phenomenology? In P. D. Ashworth & M. C. Chung (Eds.), Phenomenology and psychological science, historical and philosophical perspectives (pp. 69–88). New York: Springer Science + Business Media LLC.

    Chapter  Google Scholar 

  • Gordon, M. J. (1991). A review of the validity and accuracy of self-assessments in health professions training. Academic Medicine, 66(12), 762–769.

    Article  Google Scholar 

  • Govaerts, M. J., Van der Vleuten, C. P. M., Schuwirth, L. W., & Muijtjens, A. M. (2007). Broadening perspectives on clinical performance assessment: Rethinking the nature of in-training assessment. Advances in Health Sciences Education: Theory and Practice, 12(2), 239–260.

    Article  Google Scholar 

  • Grow, G. O. (1991). Teaching learners to be self-directed. Adult Education Quarterly, 41(3), 125–149.

    Article  Google Scholar 

  • Hauer, K. E., Ten Cate, O., Boscardin, C., Irby, D. M., Iobst, W., & O’Sullivan, P. S. (2014). Understanding trust as an essential element of trainee supervision and learning in the workplace. Advances in Health Sciences Education: Theory and Practice, 19(3), 435–456.

    Google Scholar 

  • Hodges, B., Regehr, G., & Martin, D. (2001). Difficulties in recognizing one’s own incompetence: Novice physicians who are unskilled and unaware of it. Academic Medicine, 76(10 Suppl), S87–S89.

    Article  Google Scholar 

  • Hutchins, E., & Klausen, T. (1996). Distributed cognition in an airline cockpit. In Y. Engeström & D. Middleton (Eds.), Cognition and communication at work (pp. 15–34). New York, NY: Cambridge University Press.

    Chapter  Google Scholar 

  • Kennedy, T. J., Lingard, L., Baker, G. R., Kitchen, L., & Regehr, G. (2007). Clinical oversight: Conceptualizing the relationship between supervision and safety. Journal of General Internal Medicine, 22(8), 1080–1085.

    Article  Google Scholar 

  • Kilminster, S., Cottrell, D., Grant, J., & Jolly, B. (2007). AMEE Guide No. 27: Effective educational and clinical supervision. Medical Teacher, 29(1), 2–19.

    Article  Google Scholar 

  • King, N. (2004). Using templates in the thematic analysis of text. In C. Cassell & G. Symon (Eds.), Essential guide tot qualitative methods in organizational research (pp. 256–270). London: Sage.

    Chapter  Google Scholar 

  • King, N. (2012). Template Analysis Retrieved April 2012, August–December 2012, from http://hhs.hud.ac.uk/w2/research/template_analysis/.

  • King, N., Carroll, C., Newton, P., & Dornan, T. (2002). “You can’t cure it so you have to endure it”: The experience of adaptation to diabetic renal disease. Qualitative Health Research, 12(3), 329–346.

    Article  Google Scholar 

  • Kolb, D. A. (1984). Experiential learning. Experience as a source of learning and understanding. Englewood Cliff: Prentice Hall.

    Google Scholar 

  • Korthagen, F. A. J. (2004). In search of the essence of a good teacher: Towards a more holistic approach in teacher education. Teaching and Teacher Education, 20(1), 77–97.

    Article  Google Scholar 

  • Korthagen, F. A. J. (2009). Professional learning from within. Studying Teacher Education, 5(2), 195–199.

    Article  Google Scholar 

  • Kramer, A. W., Zuithoff, P., Jansen, J. J., Tan, L. H., Grol, R. P., & Van der Vleuten, C. (2007). Growth of self-perceived clinical competence in postgraduate training for general practice and its relation to potentially influencing factors. Advances in Health Sciences Education: Theory and Practice, 12(2), 135–145.

    Article  Google Scholar 

  • Kruger, J., & Dunning, D. (1999). Unskilled and unaware of it: How difficulties in recognizing one’s own incompetence lead to inflated self-assessments. Journal of Personality and Social Psychology, 77(6), 1121–1134.

    Article  Google Scholar 

  • Lave, J., & Wenger, E. (1991). Situated learning: Legitimate peripheral participation. New York: Cambridge University Press.

    Book  Google Scholar 

  • Mann, K. V. (2011). Theoretical perspectives in medical education: Past experience and future possibilities. Medical Education, 45(1), 60–68.

    Article  Google Scholar 

  • Mann, K. V., Holmes, D. B., Hayes, V. M., Burge, F. I., & Viscount, P. W. (2001). Community family medicine teachers’ perceptions of their teaching role. Medical Education, 35(3), 278–285.

    Article  Google Scholar 

  • Miles, M. B., & Huberman, A. M. (1994). Qualitative data analysis: An expanded sourcebook (2nd ed.). Thousand Oakes, CA: SAGE Publications.

    Google Scholar 

  • Pimmer, C., Pachler, N., & Genewein, U. (2013). Reframing clinical workplace learning using the theory of distributed cognition. Academic Medicine, 88(9), 1239–1245.

    Article  Google Scholar 

  • Puustinen, M., & Pulkkinen, L. (2001). Models of self-regulated learning: A review. Scandinavian Journal of Educational Research, 45(3), 269–286.

    Article  Google Scholar 

  • Regehr, G., & Eva, K. (2006). Self-assessment, self-direction, and the self-regulating professional. Clinical Orthopaedics and Related Research, 449, 34–38.

    Google Scholar 

  • Sagasser, M. H., Kramer, A. W. M., & Van der Vleuten, C. P. M. (2012). How do postgraduate GP trainees regulate their learning and what helps and hinders them? A qualitative study. BMC Medical Education, 12, 67.

    Article  Google Scholar 

  • Sandars, J., & Cleary, T. J. (2011). Self-regulation theory: Applications to medical education: AMEE Guide No. 58. Medical Teacher, 33(11), 875–886.

    Article  Google Scholar 

  • Sargeant, J., Mann, K., Van der Vleuten, C., & Metsemakers, J. (2008). “Directed” self-assessment: Practice and feedback within a social context. The Journal of Continuing Education in the Health Professions, 28(1), 47–54.

    Article  Google Scholar 

  • Schön, D. A. (1984). The reflective practitioner. New York, NY: Basic Books.

    Google Scholar 

  • Schumacher, D. J., Englander, R., & Carraccio, C. (2013). Developing the master learner: Applying learning theory to the learner, the teacher, and the learning environment. Academic Medicine, 88(11), 1635–1645.

    Article  Google Scholar 

  • Sibbald, M., De Bruin, A. B., & Van Merrienboer, J. J. (2014). Twelve tips on engaging learners in checking health care decisions. Medical Teacher, 36(2), 111–115.

    Article  Google Scholar 

  • Steinert, Y. (2013). The “problem” learner: Whose problem is it? AMEE Guide No. 76. Medical Teacher, 35(4), e1035–e1045.

    Article  Google Scholar 

  • Sterkenburg, A., Barach, P., Kalkman, C., Gielen, M., & Ten Cate, O. (2010). When do supervising physicians decide to entrust residents with unsupervised tasks? Academic Medicine, 85(9), 1408–1417.

    Article  Google Scholar 

  • Stolper, C. F., Van de Wiel, M. W., Hendriks, R. H., Van Royen, P., Van Bokhoven, M. A., Van der Weijden, T., & Dinant, G. J. (2014). How do gut feelings feature in tutorial dialogues on diagnostic reasoning in GP traineeship?. Advances in health sciences education: theory and practice. doi:10.1007/s10459-014-9543-3.

  • Sutkin, G., Wagner, E., Harris, I., & Schiffer, R. (2008). What makes a good clinical teacher in medicine? A review of the literature. Academic Medicine, 83(5), 452–466.

    Article  Google Scholar 

  • Swanwick, T. (2005). Informal learning in postgraduate medical education: From cognitivism to ‘culturism’. Medical Education, 39(8), 859–865.

    Article  Google Scholar 

  • Tavakol, M., & Sandars, J. (2014). Quantitative and qualitative methods in medical education research: AMEE Guide No 90: Part II. Medical Teacher 1–11. doi:10.3109/0142159X.2014.915297.

  • Taylor, D. C., & Hamdy, H. (2013). Adult learning theories: Implications for learning and teaching in medical education: AMEE Guide No. 83. Medical Teacher, 35(11), e1561–e1572.

    Article  Google Scholar 

  • Ten Cate, O. (2005). Entrustability of professional activities and competency-based training. Medical Education, 39(12), 1176–1177.

    Article  Google Scholar 

  • Ten Cate, O., & Scheele, F. (2007). Competency-based postgraduate training: Can we bridge the gap between theory and clinical practice? Academic Medicine, 82(6), 542–547.

    Article  Google Scholar 

  • Ten Cate, O., Snell, L., Mann, K., & Vermunt, J. (2004). Orienting teaching toward the learning process. Academic Medicine, 79(3), 219–228.

    Article  Google Scholar 

  • Tracey, J. M., Arroll, B., Richmond, D. E., & Barham, P. M. (1997). The validity of general practitioners’ self assessment of knowledge: Cross sectional study. BMJ, 315(7120), 1426–1428.

    Article  Google Scholar 

  • Tromp, F., Vernooij-Dassen, M., Grol, R., Kramer, A., & Bottema, B. (2012). Assessment of CanMEDS roles in postgraduate training: The validation of the Compass. Patient Education and Counseling, 89(1), 199–204.

    Article  Google Scholar 

  • Van Berkestijn, L. G. M. (2002). Learning to Learn. Curricular changes in the postgraduate training for general practitioners. [Leren leren. Over de vernieuwing van de huisartsopleiding.]. Huisarts en Wetenschap, 45(5), 248–252.

    Google Scholar 

  • Van de Pol, J., Volman, M., & Beishuizen, J. (2010). Scaffolding in teacher-student interaction: A decade of research. Educational Psychology Review, 22(3), 271–296.

    Article  Google Scholar 

  • Van Leeuwen, Y. D., Dusman, H., Mol, S. S., Pollemans, M. C., Drop, M. J., Grol, R. P., et al. (1997). Factors influencing the growth in knowledge of trainees in general practice. Advances in Health Sciences Education: Theory and Practice, 2(1), 61–70.

    Article  Google Scholar 

  • Van Weel, C., Schers, H., & Timmermans, A. (2012). Health care in the Netherlands. Journal of the American Board of Family Medicine, 25(Suppl 1), S12–S17.

    Article  Google Scholar 

  • Veloski, J., Boex, J. R., Grasberger, M. J., Evans, A., & Wolfson, D. B. (2006). Systematic review of the literature on assessment, feedback and physicians’ clinical performance: BEME Guide No. 7. Medical Teacher, 28(2), 117–128.

    Article  Google Scholar 

  • Wallenburg, I. (2012). The modern doctor: Unraveling the practices of residency training reform. Amsterdam: University of Amsterdam.

    Google Scholar 

  • Wearne, S., Dornan, T., Teunissen, P. W., & Skinner, T. (2012). General practitioners as supervisors in postgraduate clinical education: An integrative review. Medical Education, 46(12), 1161–1173.

    Article  Google Scholar 

  • Wenger, E. C. (2002). Cultivating communities of practice: A guide to managing knowledge. Boston, MA: Harvard Business School Press.

    Google Scholar 

  • Withagen, R., de Poel, H. J., Araujo, D., & Pepping, G.-J. (2012). Affordances can invite behavior: Reconsidering the relationship between affordances and agency. New Ideas in Psychology, 30(2), 250–258.

    Article  Google Scholar 

  • Zimmerman, B. J. (2000). Attaining self-regulation: A social cognitive perspective. In M. Boekaerts, P. R. Pintrich, & M. Zeidner (Eds.), Handbook of self-regulation (pp. 13–39). San Diego, CA: Academic Press.

    Chapter  Google Scholar 

  • Zwart, D. L., Heddema, W. S., Vermeulen, M. I., Van Rensen, E. L., Verheij, T. J., & Kalkman, C. J. (2011). Lessons learnt from incidents reported by postgraduate trainees in Dutch general practice. A prospective cohort study. BMJ Quality and Safety, 20(10), 857–862.

    Article  Google Scholar 

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Acknowledgments

We acknowledge the supervisors who participated in this study and shared their experiences of supporting self-regulated learning. We acknowledge Nadine Elstrodt (NE) for participating in the analysis and Elke Butterbrod for transcribing.

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Correspondence to Margaretha H. Sagasser.

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Sagasser, M.H., Kramer, A.W.M., van Weel, C. et al. GP supervisors’ experience in supporting self-regulated learning: a balancing act. Adv in Health Sci Educ 20, 727–744 (2015). https://doi.org/10.1007/s10459-014-9561-1

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