title: How clinical medical students perceive others to influence their self-regulated learning.
abstract: OBJECTIVE
  Undergraduate medical students are prone to struggle with learning in clinical environments. One of the reasons may be that they are expected to self-regulate their learning, which often turns out to be difficult. Students' self-regulated learning is an interactive process between person and context, making a supportive context imperative. From a socio-cultural perspective, learning takes place in social practice, and therefore teachers and other hospital staff present are vital for students' self-regulated learning in a given context. Therefore, in this study we were interested in how others in a clinical environment influence clinical students' self-regulated learning.
  
  
  METHODS
  We conducted a qualitative study borrowing methods from grounded theory methodology, using semi-structured interviews facilitated by the visual Pictor technique. Fourteen medical students were purposively sampled based on age, gender, experience and current clerkship to ensure maximum variety in the data. The interviews were transcribed verbatim and were, together with the Pictor charts, analysed iteratively, using constant comparison and open, axial and interpretive coding.
  
  
  RESULTS
  Others could influence students' self-regulated learning through role clarification, goal setting, learning opportunities, self-reflection and coping with emotions. We found large differences in students' self-regulated learning and their perceptions of the roles of peers, supervisors and other hospital staff. Novice students require others, mainly residents and peers, to actively help them to navigate and understand their new learning environment. Experienced students who feel settled in a clinical environment are less susceptible to the influence of others and are better able to use others to their advantage.
  
  
  CONCLUSIONS
  Undergraduate medical students' self-regulated learning requires context-specific support. This is especially important for more novice students learning in a clinical environment. Their learning is influenced most heavily by peers and residents. Supporting novice students' self-regulated learning may be improved by better equipping residents and peers for this role.
authors.affiliation: Center for Evidence-Based Education, Academic Medical Center (AMC-UvA), University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Joris J
authors.initials: JJ
authors.lastname: Berkhout
authors.affiliation: Center for Evidence-Based Education, Academic Medical Center (AMC-UvA), 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 Gynecology, VU University Medical Center, VU University Amsterdam, Amsterdam, The Netherlands.
authors.forename: Pim W
authors.initials: PW
authors.lastname: Teunissen
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: Center for Research and Innovation in Medical Education, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: A Debbie C
authors.initials: AD
authors.lastname: Jaarsma
mesh_terms: D000223:Adaptation, Psychological; D001291:Attitude of Health Personnel; D002982:Clinical Clerkship / Q000379:methods*; D004504:Education, Medical, Undergraduate; D066296:Grounded Theory; D006801:Humans; D007858:Learning; D010379:Peer Group; D036301:Qualitative Research; D000068356:Self-Control / Q000523:psychology*; D013337:Students, Medical / Q000523:psychology*