Examining Residents' Strategic Mindfulness During Self-Regulated Learning of a Simulated Procedural Skill

Ryan Brydges; Rose Hatala; Maria Mylopoulos

摘要

Background?Simulation-based training is currently embedded in most health professions education curricula. Without evidence for how trainees think about their simulation-based learning, some training techniques may not support trainees' learning strategies.;Objective?This study explored how residents think about and self-regulate learning during a lumbar puncture (LP) training session using a simulator.;Methods?In 2010, 20 of 45 postgraduate year 1 internal medicine residents attended a mandatory procedural skills training boot camp. Independently, residents practiced the entire LP skill on a part-task trainer using a clinical LP tray and proper sterile technique. We interviewed participants regarding how they thought about and monitored their learning processes, and then we conducted a thematic analysis of the interview data.;Results?The analysis suggested that participants considered what they could and could not learn from the simulator; they developed their self-confidence by familiarizing themselves with the LP equipment and repeating the LP algorithmic steps. Participants articulated an idiosyncratic model of learning they used to interpret the challenges and successes they experienced. Participants reported focusing on obtaining cerebrospinal fluid and memorizing the “routine” version of the LP procedure. They did not report much thinking about their learning strategies (eg, self-questioning).;Conclusions?During simulation-based training, residents described assigning greater weight to achieving procedural outcomes and tended to think that the simulated task provided them with routine, generalizable skills. Over this typical 1-hour session, trainees did not appear to consider their strategic mindfulness (ie, awareness and use of learning strategies).;What was known and gap Simulation-based training is common, but there is an incomplete understanding about how trainees regulate their learning using this educational technology.;What is new This study explored residents' awareness and use of learning strategies as they self-regulated their learning using a lumbar puncture simulator.;Limitations Small sample and single institution study may limit generalizability.;Bottom line Residents mostly used procedural outcomes to define success and tended not to describe the strategies they used while learning.;Introduction Simulation-based training has become a standard component of the curriculum at many medical schools and residency training programs in North America.1 Despite this widespread use, health professions education researchers have not developed a full understanding of trainees' conceptions of learning (ie, their system of knowledge and beliefs about learning) in the simulation environment. Without an understanding of trainees' strategies and beliefs about learning, educators run the risk of designing training experiences that unintentionally hinder rather than promote skill acquisition.2 There is a need for systematic studies of how cycles of learning unfold in authentic training contexts, like the simulation environment.3–5 Previously, researchers interviewed trainees about their perceptions and experiences during simulation-based training, with a primary focus on how the simulated experience reflected participants' clinical practice.6,7 Researchers in nursing interviewed students and found that they situated their learning by identifying the benefits and limitations of simulation-based training when practicing “fundamental nursing”8 and urethral catheterization skills.9 Researchers in medicine used a technique called self-regulated learning (SRL) microanalysis to ask students brief open-ended questions before, during, and after performing simulated venipuncture4 and a paper-based diagnostic reasoning task.7 In those studies, medical students reported using strategies to accomplish the task, like identifying contextual factors when making a diagnosis, yet most did not report thinking strategically about learning, like

机译：背景技术基于模拟的培训目前已嵌入大多数卫生专业的教育课程中。没有证据表明受训者如何考虑其基于模拟的学习，某些培训技术可能不支持受训者的学习策略。目的：本研究探讨了住院医师在腰椎穿刺（LP）培训期间如何思考和自我调节学习的方法。方法：2010年，在45名研究生的1年级内科住院医师中，有20名参加了必修的程序技能训练新手训练营。居民独立地使用临床LP托盘和适当的无菌技术在部分任务训练员上练习了全部LP技能。我们就参与者对他们的学习过程的看法和监控方式进行了访谈，然后对访谈数据进行了主题分析。结果：分析表明，参与者考虑了他们可以或不能从模拟器中学到的知识;他们通过熟悉LP设备并重复LP算法步骤来建立自信。参与者阐明了他们用来解释所经历的挑战和成功的独特学习模型。参与者报告着重于获得脑脊液并记住LP程序的“常规”版本。他们没有对自己的学习策略（例如，自我提问）进行过多思考。结论：在基于模拟的培训中，居民描述了为实现程序结果分配更大的权重，并倾向于认为模拟的任务为他们提供了常规的，可概括的技能。在这个典型的1小时课程中，受训者似乎没有考虑他们的战略正念（即意识和对学习策略的使用）。;已知的知识和基于间隙模拟的培训很普遍，但是对受训者的方式尚不完全了解使用本教育技术来调节他们的学习。;新功能本研究探讨了居民使用腰椎穿刺模拟器自我调节学习的意识和学习策略的使用。局限性小样本和单一机构研究可能会限制推广性。居民大多使用程序结果来定义成功，而往往不描述他们在学习时使用的策略。简介基于模拟的培训已成为北美许多医学院校和住院医师培训计划课程的标准组成部分。1卫生专业教育研究人员的广泛使用尚未完全了解学员的概念在模拟环境中的学习（即他们的学习知识和信念系统）。在不了解学员的学习策略和信念的情况下，教育者冒着设计无意阻碍而不是促进技能学习的培训经验的风险。2需要系统地研究学习周期如何在真实的培训环境中展开，例如仿真环境。3–5以前，研究人员采访了受训者，以了解他们在基于仿真的培训中的感受和体验，主要关注仿真体验如何反映参与者的临床实践。6,7护理研究人员采访了学生，发现他们位于通过在练习“基础护理” 8和尿道导管插入技能时确定基于模拟的培训的好处和局限性来进行学习。9医学研究人员使用一种称为“自我调节学习”（SRL）微观分析的技术，向学生提出简短的开放性问题进行模拟静脉穿刺的过程中，过程中和之后在纸质的诊断推理任务中。7在这些研究中，医学生报告使用策略来完成任务，例如在做出诊断时确定背景因素，但大多数人并未报告对学习的策略性思考，例如

Examining Residents' Strategic Mindfulness During Self-Regulated Learning of a Simulated Procedural Skill

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