Walking a tightrope: A thematic analysis of residents' co-regulated learning in the clinical workplace

Understanding how residents co-regulate their learning in clinical settings is essential because modern healthcare hinges on teamwork. As residents learn within teams, identifying their co-regulators is important. This study explores pediatric residents' views on co-regulated learning (Co-RL), detailing whom they consider to be co-regulators and how these co-regulators shape residents' regulation of learning.

We explored Co-RL in the clinical workplace using reflexive thematic analysis, enabling theory-informed interpretation of pediatric residents' perceptions while accommodating context and variation. Seventeen in-person semi-structured interviews were conducted with pediatric residents at Kandang Kerbau Women's and Children's Hospital, Singapore, from September 2023 to January 2024. Interviews were audio-recorded and transcribed. Data were coded and organized in ATLAS.ti, with themes developed through iterative analysis and reflexivity.

Four themes were generated: (1) hierarchical coaching shaping clinical reasoning, (2) fear of appearing incompetent, (3) productive struggle with peers, and (4) Co-RL with health professionals (HPs) when expertise aligned with learning goals. Across these themes and all relationships, two appraisals recurred and gated co-regulation, opening or restricting access to it: residents' fear of appearing incompetent and their judgements of a co-regulator's credibility. The control that followed shifted by relationship: the amount of guidance with seniors, the timing of exchanges under fear, jointly held control with peers, and co-regulation with HPs when their expertise aligned with the residents' learning goals.

Co-RL during residency is a delicate balancing act, akin to walking a tightrope: residents build competence while managing fears of appearing incompetent. Across themes, fear and credibility judgements acted as shared gates that opened or restricted co-regulation and shaped how control was distributed. Self-regulated learning (SRL) was embedded within Co-RL, with residents addressing gaps and informing future encounters. This reframes residency training: residents regulate their learning through co-regulators, reflective practice, and adaptive goal setting.