Evaluating the Instructional Strategies Influencing Self-Regulated Learning in Clinical Clerkship Years: A Mixed Studies Review

Self-regulated learning (SRL) can significantly improve academic achievement and clinical performance. The clinical clerkship is a crucial setting for reinforcing and extending SRL skills and behaviors into clinical practice. However, learning in clinical settings is often opportunistic and contextual, requiring diverse instructional strategies and tailored learning opportunities. Studies from the past two decades have indicated challenges in implementing SRL strategies particularly in Asian countries. While many of the pedagogical approaches used in medical education include aspects of SRL theory, a comprehensive overview of effective SRL instructional strategies in clinical clerkships is lacking. We reviewed all studies (published between January 2012 and May 2024, identified via systematic search of EBSCOhost, PubMed, ScienceDirect, Scopus, and Web of Science) that discuss instructional strategies influencing SRL among clinical clerkship students, in general, and with special reference to the Asian context. Twenty seven articles were included in the final analysis. We conducted convergent integrated synthesis on the data extracted from all included studies to generate categories and themes. SRL instructional strategies reported included implementing learning plans and goal setting, operationalizing formal mentoring and feedback processes, utilizing technology-enhanced learning, facilitating collaborative group learning, providing simulation-based learning experiences, and applying experiential learning strategies. When implemented effectively, such strategies were shown to promote self-regulated learning, motivational beliefs, self-monitoring, and self-reflection. Faculty support, mentoring and timely feedback were crucial in successfully implementing SRL strategies. Incorporating SRL into existing curricula was ideal for ensuring feasibility and long-term sustainability. Limited research from the Asian region indicates that SRL has not been used to its full potential in Asian medical education. Asian medical students' SRL potential could be maximized with shared roles of students and teachers in a student-driven approach. Medical educators should take responsibility for providing opportunities and a conducive environment to foster SRL among clinical clerkship students. Future research should prioritize longitudinal, experimental studies with comparison groups and objective SRL outcome measures to rigorously evaluate the impact of instructional strategies in the clinical clerkship context.