title: Self-regulated learning in simulation-based training: a systematic review and meta-analysis.
abstract: BACKGROUND
  Self-regulated learning (SRL) requires an active learner who has developed a set of processes for managing the achievement of learning goals. Simulation-based training is one context in which trainees can safely practise learning how to learn.
  
  
  OBJECTIVE
  The purpose of the present study was to evaluate, in the simulation-based training context, the effectiveness of interventions designed to support trainees in SRL activities. We used the social-cognitive model of SRL to guide a systematic review and meta-analysis exploring the links between instructor supervision, supports or scaffolds for SRL, and educational outcomes.
  
  
  METHODS
  We searched databases including MEDLINE and Scopus, and previous reviews, for material published until December 2011. Studies comparing simulation-based SRL interventions with another intervention for teaching health professionals were included. Reviewers worked independently and in duplicate to extract information on learners, study quality and educational outcomes. We used random-effects meta-analysis to compare the effects of supervision (instructor present or absent) and SRL educational supports (e.g. goal-setting study guides present or absent).
  
  
  RESULTS
  From 11,064 articles, we included 32 studies enrolling 2482 trainees. Only eight of the 32 studies included educational supports for SRL. Compared with instructor-supervised interventions, unsupervised interventions were associated with poorer immediate post-test outcomes (pooled effect size: -0.34, p = 0.09; n = 19 studies) and negligible effects on delayed (i.e. > 1 week) retention tests (pooled effect size: 0.11, p = 0.63; n = 8 studies). Interventions including SRL supports were associated with small benefits compared with interventions without supports on both immediate post-tests (pooled effect size: 0.23, p = 0.22; n = 5 studies) and delayed retention tests (pooled effect size: 0.44, p = 0.067; n = 3 studies).
  
  
  CONCLUSIONS
  Few studies in the simulation literature have designed SRL training to explicitly support trainees' capacity to self-regulate their learning. We recommend that educators and researchers shift from thinking about SRL as learning alone to thinking of SRL as comprising a shared responsibility between the trainee and the instructional designer (i.e. learning using designed supports that help prepare individuals for future learning).
authors: Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors: Ryan
authors: R
authors: Brydges
authors: Julian
authors: J
authors: Manzone
authors: David
authors: D
authors: Shanks
authors: Rose
authors: R
authors: Hatala
authors: Stanley J
authors: SJ
authors: Hamstra
authors: Benjamin
authors: B
authors: Zendejas
authors: David A
authors: DA
authors: Cook
mesh_terms: D003198:Computer Simulation; D004501:Education, Medical / Q000379:methods*; D018961:Educational Technology; D006801:Humans; D007858:Learning; D017145:Models, Educational; D016544:Patient Simulation