Divergence in student and educator conceptual structures during auscultation training

Area of Science:

• Medical Education
• Simulation-Based Learning
• Self-Regulated Learning (SRL)

Background:

• Simulation-based medical education facilitates self-regulated learning (SRL).
• Limited research exists on SRL mechanisms in simulation-based medical education.
• This study compares unguided SRL with directed SRL (DSRL) using an expert-designed booklet.

Purpose of the Study:

• To compare the effectiveness of unguided self-regulated learning (SRL) versus directed self-regulated learning (DSRL) in medical students learning cardiac auscultation.
• To investigate the impact of instructional design on learning strategies and diagnostic accuracy.
• To explore potential discrepancies between student and educator conceptual frameworks in medical training.

Main Methods:

• Year 1 medical students (n=37) were randomized into SRL (simulator and video) or DSRL (simulator, video, and booklet) groups.
• Diagnostic accuracy was assessed via a 22-item test 3 weeks later.
• Learner sequencing of practice and educator teaching approaches were documented and analyzed.

Main Results:

• The DSRL group spent 50% more training time than the SRL group (p < 0.001).
• No significant differences in diagnostic accuracy were observed between groups on post-test, retention, or transfer tests (p > 0.12).
• A majority of students (84% in DSRL, most in SRL) adopted a location-based approach, diverging from the expert-designed timing-based approach, and differing from educator conceptions.

Conclusions:

• Directing students' self-regulated learning (SRL) provided no additional benefit and increased practice time.
• A significant divergence exists between student and educator conceptual frameworks for structuring cardiac auscultation practice.
• This conceptual mismatch may have implications for technology-mediated medical education.