title: Exploring the factors influencing clinical students' self-regulated learning.
abstract: OBJECTIVE
  The importance of self-regulated learning (SRL) has been broadly recognised by medical education institutions and regulatory bodies. Supporting the development of SRL skills has proven difficult because self-regulation is a complex interactive process and we know relatively little about the factors influencing this process in real practice settings. The aim of our study was therefore to identify factors that support or hamper medical students' SRL in a clinical context.
  
  
  METHODS
  We conducted a constructivist grounded theory study using semi-structured interviews with 17 medical students from two universities enrolled in clerkships. Participants were purposively sampled to ensure variety in age, gender, experience and current clerkship. The Day Reconstruction Method was used to help participants remember their activities of the previous day. The interviews were transcribed verbatim and analysed iteratively using constant comparison and open, axial and interpretive coding.
  
  
  RESULTS
  Self-regulated learning by students in the clinical environment was influenced by the specific goals perceived by students, the autonomy they experienced, the learning opportunities they were given or created themselves, and the anticipated outcomes of an activity. All of these factors were affected by personal, contextual and social attributes.
  
  
  CONCLUSIONS
  Self-regulated learning of medical students in the clinical environment is different for every individual. The factors influencing this process are affected by personal, social and contextual attributes. Some of these are similar to those known from previous research in classroom settings, but others are unique to the clinical environment and include the facilities available, the role of patients, and social relationships pertaining to peers and other hospital staff. To better support students' SRL, we believe it is important to increase students' metacognitive awareness and to offer students more tailored learning opportunities.
authors.affiliation: Centre for Evidence-Based Education, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Joris J
authors.initials: JJ
authors.lastname: Berkhout
authors.affiliation: Centre for Evidence-Based Education, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Esther
authors.initials: E
authors.lastname: Helmich
authors.affiliation: Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.|Department of Obstetrics and Gynaecology, VU University Medical Centre, VU University Amsterdam, Amsterdam, the Netherlands.
authors.forename: Pim W
authors.initials: PW
authors.lastname: Teunissen
authors.affiliation: Centre for Evidence-Based Education, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Joost W
authors.initials: JW
authors.lastname: van den Berg
authors.affiliation: Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
authors.forename: Cees P M
authors.initials: CP
authors.lastname: van der Vleuten
authors.affiliation: Centre for Evidence-Based Education, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.|Centre for Research and Innovation in Medical Education, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands.
authors.forename: A Debbie C
authors.initials: AD
authors.lastname: Jaarsma
mesh_terms: D000328:Adult; D002982:Clinical Clerkship / Q000379:methods*; D002983:Clinical Competence; D005260:Female; D066296:Grounded Theory; D006801:Humans; D007858:Learning; D008297:Male; D009426:Netherlands; D010379:Peer Group; D000068356:Self-Control / Q000523:psychology*; D012951:Socialization; D013337:Students, Medical / Q000523:psychology*; D055815:Young Adult