title: How can medical students learn in a self-directed way in the clinical environment? Design-based research.
abstract: OBJECTIVE
  This study aimed to establish whether and under what conditions medical students can learn in a self-directed manner in the clinical environment.
  
  
  METHODS
  A web-based learning management system brought 66 placement students, in a problem-based learning (PBL) medical curriculum, into closer touch with their clinical learning objectives and ways of achieving them. Free response comments from 16 of them during the 7 weeks they used it, transcripts of group discussions before and after the period of use, and responses from all 66 students to a questionnaire were analysed qualitatively.
  
  
  RESULTS
  Students were rarely fully autonomous or subservient. They valued affective and pedagogic support, and relied on teachers to manage their learning environment. With support, they were motivated and able to choose how and when to meet their learning needs. The new system was a useful adjunct.
  
  
  CONCLUSIONS
  Self-direction, interpreted literally, was a method of learning that students defaulted to when support and guidance were lacking. They found "supported participation" more valuable. Learning in the clinical environment was a social process with as many differences from, as similarities to, PBL.
authors.affiliation: Hope Hospital, University of Manchester School of Medicine, Stott Lane, Salford, Manchester M6 8HD, UK. Tim.Dornan@Manchester.ac.uk
authors.forename: Tim
authors.initials: T
authors.lastname: Dornan
authors.forename: Judy
authors.initials: J
authors.lastname: Hadfield
authors.forename: Martin
authors.initials: M
authors.lastname: Brown
authors.forename: Henny
authors.initials: H
authors.lastname: Boshuizen
authors.forename: Albert
authors.initials: A
authors.lastname: Scherpbier
mesh_terms: D003194:Computer-Assisted Instruction; D004504:Education, Medical, Undergraduate / Q000379:methods*; D004739:England; D006801:Humans; D007858:Learning; D026684:Personal Autonomy; D018794:Problem-Based Learning / Q000379:methods*; D013337:Students, Medical / Q000523:psychology*