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document
Divergence in student and educator conceptual structures during auscultation training . CONTEXT Simulation-based medical education allows trainees to engage in self-regulated learning ( SRL ) , yet research aimed at elucidating the mechanisms of SRL in this context is relatively absent . We compared 'unguided ' SRL with 'directed ' SRL ( DSRL ) , wherein learners followed an expert-designed booklet . METHODS Year 1 medical students ( n = 37 ) were randomly assigned to practise identifying seven cardiac murmurs using a simulator and video only ( SRL group ) or a simulator and video plus the booklet ( DSRL group ) . All participants completed a 22-item test 3 weeks later . To compare interventions , we analysed students ' diagnostic accuracy . As a novel source of evidence , we documented how participants autonomously sequenced the seven murmurs during initial and delayed practice sessions . In addition , we surveyed clinical educators ( n = 17 ) to find out how they would sequence their teaching of these murmurs . RESULTS The DSRL group used 50 % more training time than the SRL group ( p < 0.001 ) . The groups ' diagnostic accuracy , however , did not differ significantly on the post-test , retention test or transfer test items ( p > 0.12 ) . Despite practising with the expert-defined 'timing-based ' approach to murmur diagnosis ( i.e . systolic versus diastolic ) , 84 % of DSRL participants implemented a location-based approach ( i.e . practising aortic murmurs separately from mitral murmurs ) during a second , unguided practice session . Notably , most SRL participants used that same approach spontaneously . By contrast , clinical educators were split in their use of the timing-based ( n = 10 ) and the location-based ( n = 6 ) approaches . Chi-squared analyses suggested educators ' conceptions for organising murmurs differed significantly from students ' conceptions . CONCLUSIONS Contrary to our predictions , directing students ' SRL produced no additional benefit and increased their practice time . Our findings suggest one potential source of these results was a divergence between student and educator conceptions for structuring the practice of cardiac auscultation skills . This phenomenon has not been well articulated in the medical education literature , and may have important implications in many ( especially technology-mediated ) educational contexts .
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Intervention_Educational
'unguided ' SRL
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Intervention_Educational
'directed ' SRL
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Intervention_Educational
simulator and video only ( SRL group )
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Intervention_Educational
simulator and video plus the booklet
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Outcome_Physical
additional benefit
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Outcome_Physical
practice time .
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Participant_Condition
student and educator conceptual structures
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Participant_Condition
auscultation training
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Participant_Sample-size
n = 37