Self-entrustment: how trainees’ self-regulated learning supports participation in the workplace

Clinical workplaces offer postgraduate trainees a wealth of opportunities to learn from experience. To promote deliberate and meaningful learning self-regulated learning skills are foundational. We explored trainees' learning activities related to patient encounters to better understand what aspects of self-regulated learning contribute to trainees' development, and to explore supervisor's role herein. We conducted a qualitative non-participant observational study in seven general practices. During two days we observed trainee's patient encounters, daily debriefing sessions and educational meetings between trainee and supervisor and interviewed them separately afterwards. Data collection and analysis were iterative and inspired by a phenomenological approach. To organise data we used networks, time-ordered matrices and codebooks. Self-regulated learning supported trainees to increasingly perform independently. They engaged in self-regulated learning before, during and after encounters. Trainees' activities depended on the type of medical problem presented and on patient, trainee and supervisor characteristics. Trainees used their sense of confidence to decide if they could manage the encounter alone or if they should consult their supervisor. They deliberately used feedback on their performance and engaged in reflection. Supervisors appeared vital in trainees' learning by reassuring trainees, discussing experience, knowledge and professional issues, identifying possible unawareness of incompetence, assessing performance and securing patient safety. Self-confidence, reflection and feedback, and support from the supervisor are important aspects of self-regulated learning in practice. The results reflect how self-regulated learning and self-entrustment promote trainees' increased participation in the workplace. Securing organized moments of interaction with supervisors is beneficial to trainees' self-regulated learning

Improving Feedback Research in Naturalistic Settings

This chapter discusses researching feedback inputs and processes to examine effects. Specifically, we promote a research agenda that contributes an understanding of how feedback works, for particular learners, in particular circumstances through research designs that take account of theory, occur in naturalistic settings and focus on students’ sense-making and actions. We draw attention to categories of research on effects of feedback: a) task-related performance/work; b) meta-learning processes such as self-regulation; and c) identity effects such as orienting students to the professionals they wish to become. We also discuss the difficulties in eliciting effects, attributing effects to particular feedback practices and the importance of exploring how effects are achieved and at what points in time, rather than simply looking for outcome