2009; 31: e477–e483

WEB PAPER

Metacognitive awareness and self-regulated

learning skills of medical students in different
medical curricula
SEVGI TURAN1, ÖZCAN DEMIREL2 & _ISKENDER SAYEK1
1
Hacettepe University Faculty of Medicine, Turkey, 2Hacettepe University Faculty of Education, Turkey

Abstract
Aim: The aim of this study was to investigate the acquisition of metacognitive awareness and self-regulated learning skills in
medical schools using different curricular models.
Methods: The study was carried out in four medical schools implementing different curricular models. Eight hundred and sixty
two medical students took part in the study and two scales (self-regulated learning perception scale – SRLPS and metacognitive
awareness inventory – MAI) were used. Cronbach’s alpha was 0.93 for the MAI, and 0.88, 0.91, 0.83, and 0.76 for the four
dimensions of the SRLPS.
Results: There were no statistically significant differences in MAI scores according to gender, curricular language, or previous
exposure or not to a learner-centered method during secondary school, but the differences in scores according to the phase and
curricular model were found to be significant. With regard to SRLPS total scores, no difference was found according to gender, but
significant differences were found according to phase, curricular language, and curricular model. MAI and SRLPS scores of students
from the medical school using a learner-centered curriculum were higher than the other schools’ students.
Conclusion: This study suggests that students who experience a learner-centered curriculum, such as PBL during their medical
education demonstrate improved metacognitive awareness and self-regulated learning skills.

Introduction Practice points

The knowledge explosion results in information obsolescence
. Problem based learning fosters both metacognitive and
before it is even acquired. This rapid change in knowledge self-directed learning skills.
requires that students develop their lifelong learning . The learner-centered approach which begins at an early
skills if the educators intend to prepare students for stage of education motivates to students to learn.
the future. The ability to engage in lifelong learning is based . Monitoring of students learning skills during the mod-
on the development, and subsequent successful application, of ification process of curriculum is needed for supporting
two skill areas: metacognition and self-directedness (Dunlap students.
2005).
Metacognitive strategies as defined by Flavel are under-
standing and regulating one’s own cognitive processes in
order to monitor, direct, and control them (Kincannon et al. Self-regulation is defined as self-regulated thoughts, feel-
1999). Metacognition could be simply defined as thinking ings, and actions for attaining academic goals (Zimmerman
about thinking or as a ‘‘person’s cognition about cognition’’ 1998). Self-regulated learners are proactive in their efforts to
(Gama 2004). Metacognitive skills include taking conscious learn, monitor their behavior in terms of their goals, and self-
control of learning, planning, and selecting strategies, mon- reflect on their increasing effectiveness, which enhances their
itoring the progress of learning, correcting errors, analyzing the self-satisfaction and motivation to continue to improve their
effectiveness of learning strategies, and changing learning methods of learning (Zimmerman 2002). Self-regulated stu-
behaviors and strategies when necessary (Dunlap 2005). dents are metacognitively, motivationally and behaviorally
Metacognitively aware learners are more effective learners, active participants in their own learning (Zimmerman 1990).
show higher performance levels, use more strategies, and According to Zimmerman & Martinez-Pons (1990), successful
better regulate their own learning (Hammann & Stevens 1998). students surpass other students because they possess more
As a result of the findings of studies showing that metacog- information about their own cognition and they actively
nitive strategies can be learned (Kincannon et al. 1999), the engage in more techniques to help foster learning.
interest of educators and curriculum developers has focused Successful students play a more active role in learning, process
on this issue. new information more effectively, relate new information to

Correspondence: Sevgi Turan, Department of Medical Education and Informatics, Hacettepe University Faculty of Medicine, Sihhiye 06100 Ankara
– Turkey. Tel: 90 312 305 26 17; fax: þ90 312 310 05 80; email: [email protected]
ISSN 0142–159X print/ISSN 1466–187X online/09/100477–7 ß 2009 Informa Healthcare Ltd. e477
DOI: 10.3109/01421590903193521
S. Turan et al.

previous information, organize and transform presented as being the development of effective self-directedness. PBL
material, set goals for themselves, plan their strategies, and appeals to curriculum developers because it is based on
seek assistance when needed (Bland 2005). interdisciplinary learning, results in multiple outcomes, is
The proposed model and theory indicate that there is a integrated and competency-based, and emphasizes metacog-
relationship between metacognition and self-regulation. Even nitive or high-order skills and real-life perspectives (Putnam
some theorists assert that these concepts are alike. On the 2001).
other hand, others define that self-regulation is more compre- Consequently, investigating metacognitive awareness and
hensive than metacognition. According to Winne, metacogni- self-regulated learning skills of medical students is very
tive knowledge and monitoring are components of self- important in order to evaluate the curriculum and to modify
regulated learning when measured as an aptitude, and they it as necessary. Therefore, the aim of the study was to
state that ‘self-regulated’ is associated with forms of learning investigate the metacognitive awareness and self-regulated
that are metacognitively guided, at least partly intrinsically learning skills of medical students in different medical
motivated, and strategic (Winne & Perry 2005). The other curricular models. In the study design, answers to the
perspective of self-regulated learning is based on the social following questions were sought:
cognitive theory. Considering these theorists, self-regulated
(1) Is there a significant difference in perception of self-
learning is more than metacognitive knowledge and skills.
regulated learning skills and metacognitive awareness
Self-regulated learning involves an underlying sense of self-
of medical students based on the curricular model?
efficacy and personal agency and the motivational and
(2) Is there a significant difference in perception of self-
behavioral processes to put these self beliefs into effect. regulated learning skills and metacognitive awareness
Views of self-regulated learning that do not include this core of medical students based on their medical education
self-referential system have difficulty in explaining human phase, curricular language, gender, and whether or not
failures to self-regulate. The social cognitive theorists indicate they were previously exposed to the learner-centered
that educational psychologists need to expand their views of method in secondary school?
self-regulation beyond metacognitive trait, ability, or stage
formulations, and begin treating it as a complex interactive
process involving social, motivational, and behavioral compo- Methods
nents (Zimmerman 1995). There is, however, general agree-
ment that the relationships between metacognition and self- Subjects
regulated behavior are not yet well-understood (Winne 1996;
The study was carried out in four different medical schools in
Hammann & Stevens 1998; Sperling et al. 2004). Turkey that use different curricular models; 862 medical
Metacognitive awareness and self-regulated learning skills students took part in the study. The medical education is
are important in medicine because of the rapid change in composed of 6 years – the first 3 years are considered the
knowledge. The World Federation for Medical Education preclinical phase and the last 3 years as the clinical phase
describes lifelong and self-directed learning as professional (Bahar-Ozvaris¸ et al. 2004).
characteristics that should be evaluated in the training of The medical schools taking part in this study were coded.
physicians (Hoban et al. 2005). Description of their curricular models (Sayek et al. 2006) is
The range of curricular models that medical schools may shown in Table 1. Two schools (A and B) apply an integrated
employ is wide, including discipline-based, system-based, and model with PBL. Since medical school A integrated PBL into
problem-based learning (PBL). In the discipline-based curri- the curriculum one year prior to the start of the study (2005–
culum, often called conventional or traditional curriculum, 2006), its curriculum was considered to be in a process of
well-defined, distinct subjects form the basis of the curriculum. transition. Medical school C applies PBL and medical school D
The school program is strictly determined by the subjects a conventional curriculum. Entrance requirements for all
studied and is often inflexible. The second model, a system- schools are the same because of the centralized university
based curriculum, is an integrated curriculum. It is based on entrance exam in Turkey.
body and organ systems. In this model, basic science is taught
as it relates directly to clinical medicine. The third model is the
PBL curriculum. PBL is identified by tutorials in which students Research design and implementation
are presented with a specific practical, real problem, or set of Two scales were developed and used in the present study.
problems to solve (Wood 2003). In medicine, PBL is centered Scales included a brief cover letter informing students about
around the discussion and learning that emanates from a the purpose of the study and demographic data was also
clinically based problem. obtained. Students signed an informed consent before they
PBL is accepted as helping students develop metacognitive completed the scales. The participation rate of medical schools
awareness and depends on self-regulated learning skills (Paris varied between 47% and 60%.
& Paris 2001; Dunlap 2005). One of the objectives of these
types of educational methodologies is that students will
Instruments
become active participants in their own learning, constructing
knowledge rather than just being passive recipients (Levett- Self-regulated learning perception scale (SRLPS) and metacog-
Jones 2005). Barrows and Tamblyn (1980) identified one of the nitive awareness inventory (MAI) were used. These scales are
primary educational objectives that can be addressed by PBL described below.
e478
 Learning skills of medical students

Table 1. Curricular models of participating medical schools.

Medical school Curricular model The percent of PBL time Participants Participation rate (%)
a
A Integrated (transition process) 10 Preclinical phase 57
B Integrated 10 Preclinical phase 47
C PBL All Preclinical and clinical phase 56
D Conventional None Preclinical and clinical phase 60

a
Since medical school A integrated PBL into the curriculum one year prior to the start of the study (2005–2006), its curriculum was considered to be in a process of
transition.

Self-regulated learning perception scale. The scale is com- psychometric properties). As a result, the scale was applied
posed of four dimensions and 41 items (see the appendix, the with 28 items, with a Cronbach’s alpha value of 0.93.
presented questions are mixed in the study). Items were
included by taking into account the literature, expert opinion, Questionnaire. A questionnaire was used with the aim of
and students’ narratives about their learning strategies. The determining the students’ gender, curricular language (Turkish
items were answered on a five-point scale ranking from one to or English), phase, and previous exposure or not to a learner-
five, and item scores were summed to obtain sub-dimensions centered method during secondary school.
and total score. For total score, the minimum possible score is
41 and the maximum possible score is 205. Dimensions of the
scale were as follows: Statistical analysis

. Motivation and action to learning: Seven items, the Student-t test was used to compare scores according to gender,
minimum possible score is seven and the maximum curricular language, medical school phase, and previous
possible score is 35. exposure or not to a learner-centered method during second-
. Planning and goal setting: Eight items, the minimum ary school. To compare scores between different medical
possible score is eight and the maximum possible score is curricular models, Kruskal Wallis analysis of variance was used
40. as variances were not equal. After these analyses, the Mann–
. Strategies for learning and assessment: Nineteen items, the Whitney U test was used for determining different groups.
minimum possible score is 19 and the maximum possible
score is 95.
. Lack of self-directedness: Seven items, the minimum possi-
Results
ble score is seven and the maximum possible score is 35. About 50.5% of the students who participated in study were
male, and for 74.1% of the students the curricular language
Cronbach’s alpha coefficients for reliability were 0.88, 0.91,
was Turkish. 58.9% of students declared that they were not
0.83, and 0.76, respectively, for the four dimensions.
exposed to learner-centered education while in secondary
The scale’s items were prepared by taking into account the
school.
literature, expert comments, and students’ narratives on their
Seven hundred and ninety-one students completed the
learning strategies. To provide content validity, seven experts
MAI. The mean score of the scale was 99.55. There were no
were asked to evaluate the items. Sixty-six items, of which 12
statistically significant differences according to gender, curri-
were negative, were written at first. And to determine evidence
cular language, or exposure or not to a learner-centered
for construct validity, an exploratory factor analysis was
method during secondary school. However, a statistically
conducted. Items with loadings below 0.45 or where the
significant difference was found according to medical school
difference between two factors was greater than 0.1 were
phase and curricular model. The scores of students in the
dropped. The last factor analysis, which included 41 items,
preclinical phase were lower than those of students in the
produced four factors with an eigenvalue greater than 1.5, and
clinical phase ( p ¼ 0.002). The MAI scores of students from
recovered 47.10% of variance. The factors explained 18.36%,
school C were found to be higher than those from schools A
16.94%, 11.95%, and 7.87% of the variance, respectively.
( p ¼ 0.000), B ( p ¼ 0.009), and D ( p ¼ 0.03); and students’
scores from school B were also greater than those from school
Metacognitive awareness inventory. The MAI, devised by
A ( p ¼ 0.005) (Table 2).
Schraw and Dennison (1994), was adopted for medical
Eight hundred and fifty-two students completed the SRLPS.
students. After the scale was translated into Turkish, two
The mean score of the scale was 143.39. The mean scores of
experts assessed the linguistic concurrence. Items were rated
the dimensions were 25.98 for motivation and action to
on a five-point Likert scale and item scores were summed to
learning, 29.48 for planning and goal setting, 68.57 for
obtain total score. The minimum possible score is 28 and the
strategies for learning and assessment, and 19.36 for lack of
maximum possible score is 140.
self-directedness. The SRLPS scores were analyzed separately
Factor analysis using varimax rotation was employed to
for total and dimension scores. Results were as follows
determine the components of MAI of the Turkish version.
(Table 3):
However, the results of the factor analysis were not included in
the theoretical definition of dimensions (see Schraw and . There was no difference according to gender in total and
Dennison (1994), for full data on scale development and dimension scores.
e479
S. Turan et al.

Table 2. Students mean scores of metacognitive awareness.

na Mean SD 2/t b
p
Gender
Female 361 98.52 16.76 t ¼ 1.84 0.066
Male 375 100.70 15.39
Phase
Preclinical 646 98.79 16.34 t ¼ 3.09 0.002
Clinicalc 145 103.62 14.32
Curricular language
Turkish 532 99.18 17.01 t ¼ 1.36 0.174
English 204 100.80 13.43
Prior exposure or not to a learner-centered method during secondary school
Yes 298 100.59 18.02 t ¼ 1.24 0.217
No 433 99.03 14.67
Curricular model
A 320 96.37 18.30 2 ¼ 25.64 0.000
B 209 100.72 13.35
C 145 104.35 14.54
D 117 100.21 14.98

a
Groups n is lower than students who answered the scale because some questions in the questionnaire were not answered. b2 ¼ Kruskal Wallis, t ¼ student-t test.
c
Out of 145 clinical students, 83 attend medical school C, and the others medical school D.

Table 3. Students mean scores of self-regulated learning perception.

Motivation and action Planning and goal Strategies for learning

to learning setting and assessment Lack of self-directedness Total

Mean SD Mean SD Mean SD Mean SD Mean SD

Gendera
Women (n ¼ 389) 26.03 4.51 29.92 5.50 68.52 11.04 19.03 5.24 143.49 18.10
Men (n ¼ 404) 25.87 5.04 29.16 6.07 68.64 11.49 19.56 5.23 143.24 20.07
t 0.45 1.84  0.16  1.44 0.19
p 0.650 0.126 0.874 0.150 0.854
Phasea
Preclinical (703) 25.87 4.82 29.21 5.87 68.24 11.45 19.43 5.15 142.74 19.53
Clinical (146) 26.39 4.62 31.13 5.18 70.44 10.12 18.62 5.63 146.59 16.52
t 1.16 3.46 2.03 1.61 2.09
p 0.249 0.001 0.043 0.109 0.037
Curricular languagea
Turkish (n ¼ 639) 25.64 5.03 29.28 6.02 67.86 11.83 19.43 5.27 142.22 20.32
English (n ¼ 210) 26.82 3.93 30.23 5.09 70.61 9.24 18.93 5.15 146.58 14.82
t 3.44 2.18 3.41 1.19 3.29
p 0.001 0.03 0.001 0.234 0.001
Prior exposure or not to a learner-centered method during secondary schoola
Yes (n ¼ 348) 26.43 4.96 29.65 6.28 69.02 12.24 19.23 5.39 144.32 20.97
No (n ¼ 494) 25.60 4.66 29.45 5.44 68.27 10.56 19.37 5.14 142.69 17.77
t 2.39 0.47 0.91  0.36 1.18
p 0.017 0.640 0.362 0.720 0.239
Curricular Modela
A (n ¼ 378) 25.23 5.25 28.45 6.30 66.47 12.08 20.11 5.08 140.26 21.84
B (n ¼ 211) 26.87 3.86 30.08 5.16 70.39 9.39 18.95 5.11 146.29 15.24
C (n ¼ 146) 26.39 4.82 31.13 5.05 71.27 10.29 18.56 5.52 147.35 15.59
D (n ¼ 117) 26.27 4.03 29.64 5.44 68.73 10.96 18.70 5.03 143.39 18.97
2 16.82 24.53 23.16 16.18 20.85
p 0.001 0.000 0.000 0.001 0.000

. With respect to medical school phase, clinical phase . With respect to curricular language, there was no difference
students had higher scores than the others in planning in lack of self-directedness, but a significant difference was
and goal setting ( p ¼ 0.001), in strategies for learning and found in the scores of motivation and action to learning
assessment ( p ¼ 0.043) and in their total score ( p ¼ 0.037). ( p ¼ 0.001), in planning and goal setting ( p ¼ 0.03), in
There was no difference in the other scores. strategies for learning and assessment ( p ¼ 0.001), and in
e480
 Learning skills of medical students

Table 4. . The differing groups of students self-regulated learning retention and evaluate their own progress automatically
perception scores according to curricular models.
(Hacker 1998; Sperling et al. 2002; Gama 2004). Although
clinical-phase students are more experienced in learning, it
Differing groups of seems that they are conscious of their strategies but that the
Dimensions medical schools
metacognitive processing aspect has not yet become
Motivation & action to learning A–B ( p ¼ 0.000) automatic.
A–C ( p ¼ 0.015)
In this study, there was no statistical difference in MAI
Planning & goal setting A–B ( p ¼ 0.003)
A–C ( p ¼ 0.000) scores according to gender, curricular language, and prior
B–C ( p ¼ 0.036) exposure or not to a learner-centered method in secondary
C–D ( p ¼ 0.010)
Strategies for learning & assessment A–B ( p ¼ 0.000)
school (Table 2). In contrast to our study, some studies have
A–C ( p ¼ 0.000) implied significant differences in the use of cognitive and
C–D ( p ¼ 0.044) metacognitive strategies in favor of girls among young learners
Lack of self-directedness A–B ( p ¼ 0.000)
A–C ( p ¼ 0.001)
(Zimmerman & Martinez-Pons 1990; Niemivirta 1997) and
Total A–B ( p ¼ 0.000) among adult learners (Bidjerano 2005). This difference has
A–C ( p ¼ 0.000) been explained as male and female students demonstrating
C–D ( p ¼ 0.024)
differential propensity in using these strategies for learning, or
as female students perhaps being more reflective upon their
learning experiences (Bidjerano 2005).
total score ( p ¼ 0.001), with students from the English The mean score of the SRLPS in this study was found as
stream curriculum having higher scores than the others. 143.39. All dimensions and total scores were greater than the
. The students who reported having previous exposure to possible mean score ((41 þ 205)/2 ¼ 123). Shokar et al. (2002)
learner-centered methods during secondary school had reported that the self-directed learning readiness scores of
higher scores than the others in the dimension of motivation third-year medical students who participated in a PBL curric-
and action to learning ( p ¼ 0.017). No difference was found ulum were significantly higher than the mean reported for
in the other dimension scores or in the total score for this general adult learners.
variable. In our study, differences in SRLPS scores between genders
. There were significant differences in the total and all were not found to be significant. In contrast to our study, some
dimension scores according to medical curricular model. studies have implied significant differences in the use of self-
The differing groups are shown in Table 4. regulated learning strategies in favor of girls (Zimmerman &
Martinez-Pons 1990; Niemivirta 1997; Patrick et al. 1999; Ray
et al. 2003; Bidjerano 2005).
There were significant differences in motivation and action
Discussion to learning, strategies for learning and assessment, and total
Metacognition becomes increasingly important in situations of score, with higher scores noted in the English stream
heightened learner self-direction, where learners are asked to curriculum. The higher scores of these students might have
decide what, how and when to explore (Kincannon et al. been affected by their general performance level because their
1999). Similarly, developing metacognitive strategies is impor- school entrance scores were also higher.
tant for reaching the goals of PBL (Hmelo-Silver 2004). In this A significant difference in scores in the dimension of
study, the scores of the students attending the medical school motivation and action to learning was determined between
that used a PBL curriculum (C) were higher than those of the those students exposed or not to a learner-centered method
other schools’ students, with a significant difference (Table 2). during secondary school, with students having previous
Furthermore, inclusion of PBL into the curriculum, at a rate of exposure scoring higher. The response in the question about
even as little as 10%, led to an increase in the metacognitive whether a learner-centered method was used at the secondary
awareness score. school was limited by the students’ judgment. In any case, this
The lower scores of students from school A might reflect result indicates that students become motivated to learn if the
difficulties in the transition process. However, it is clear that learner-centered approach begins at an early stage of
the curricular model is related to obtaining metacognitive education.
awareness. Other studies have also revealed that a self- Planning and goal setting and total scores according to
directed learning environment (Kincannon et al. 1999) and medical school phase were also significantly different, with
PBL (Sungur & Tekkaya 2006) have enhanced metacognitive clinical-phase students having higher scores. This might be a
skills. As shown by Cartier et al. (2001), half of the strategies result of both creating more independent learning opportu-
used by medical students in a PBL program were of a nities in the clinical environment and being exposed to PBL.
metacognitive nature. One of the important findings of this study is that there was
In the current study, the medical education phase had a a significant difference in students’ SRLSP scores according to
significant effect on the MAI score (Table 2). The MAI scores of the medical curricular model. The total scores of the students
preclinical-phase students were lower than those of the in the medical school that used a PBL curriculum (C) were
clinical-phase students. The relationship between metacogni- higher than those of the students in the school using a
tion and experience is known. However, it is indicated that traditional curriculum. Similar to that observed with the
expert learners may monitor their comprehension and metacognitive awareness score, the findings from the SRLSP
e481
S. Turan et al.

scores of the school in the transition process (A) were Cartier S, Plante A, Tardif J. 2001. Learning by reading: Description of
learning strategies of students involved in a problem-based learning
interesting. The SRLSP scores of students from that school
(Research Report-143). (ERIC Document Reproduction Service No. ED
were not significantly different from those of the school using
452 511).
the traditional curriculum. Also in accordance with results in Dunlap JC. 2005. Problem-based learning and self-efficacy: How a capstone
metacognitive awareness, there was evidence that inclusion of course prepares students for a profession. ETR&D 53(1):65–85.
even as little as 10% of PBL into the curriculum contributes to Gama CA. 2004. Integrating metacognition instruction in interactive
an increase in self-regulated learning skills, since students in learning environments. Unpublished Doctoral Dissertation, University
of Sussex, UK.
the medical school that used a PBL curriculum and those in the
Hacker DJ. 1998. Metacognition: Definitions and Empirical Foundations.
school that used PBL in only 10% of the curriculum differed in Memphis: The University of Memphis, The University of Memphis,
only the planning and goal setting dimension. Studies have 11.11.2005: Available from: http://www.psyc.memphis.edu/trg/
also confirmed that PBL improved self-directed learning skills meta.htm.
(Hmelo et al. 1994; Litzinger et al. 2001; Yeung et al. 2003). In Hammann LA, Stevens RJ. 1998, April. Metacognitive awareness assessment
in self regulated learning and performance measures in an introductory
light of these findings, it could be said that PBL achieves the
educational psychology course. Paper Presented at the Annual Meeting
goal of improving the self-directedness of medical students. of the American Educational Research Association, San Diego, CA.
Hmelo C, Gotterer GS, Bransford JD. 1994, April. The cognitive effects of
problem-based learning: A preliminary study. Paper Presented at the
Conclusions Annual Meeting of the American Educational Research Association,
New Orleans, LA.
The findings of this study show that the students in PBL Hmelo-Silver CE. 2004. Problem-based learning: What and how do students
curriculum have higher MAI and SRLSP scores. A learner- learn? Educ Psychol Rev 16(3):235–266.
centered approach is essential to learn those skills that are Hoban JD, Lawson SR, Mazmanian PE, Best AM, Seibel HR. 2005. The self
important for attaining lifelong learning. The quantitative directed learning readiness scale: A factor analysis study. Med Educ
39:370–379.
evaluation of the score has shown that curriculum develop-
Kincannon J, Gleber C, Kim J. 1999. February. The effects of metacognitive
ment studies are needed to improve the levels of metacogni- training on performance and use metacognitive skills in self-directed
tive and self-regulated learning skills. learning situation. Paper Presented at the National Convention of the
The most important limitation of the current study is that it Association for Educational Communication and Technology, Houston,
was descriptive in nature and did not attempt to explain a TX.
Levett-Jones TL. 2005. Self-directed learning: Implications and limitations
cause and effect relationship. Nevertheless, this study provides
for undergraduate nursing education. Nurs Educ Today 25:363–368.
a hint as to where to start investigating and indicates those Litzinger T, Wise J, Lee S, Simpson T, Joshi S. 2001. Assessing readiness for
methods that appear more promising for achieving improved lifelong learning. American Society for Engineering Education Annual
metacognitive awareness and self-regulated learning skills. Conference & Exposition, Albuquerque, NM.
Niemivirta M. 1997. March. Gender differences in motivational-cognitive
patterns of self-regulated learning. Paper Presented at the Annual
Meeting of the American Educational Research Association, Chicago, IL.
Declaration of interest: The authors report no conflicts of Paris SG, Paris AH. 2001. Classroom applications of research on self-
interest. The authors alone are responsible for the content and regulated learning. Educ Psychol 36(2):89–101.
Patrick H, Ryan AM, Pintrich PR. 1999. The differential impact of extrinsic
writing of the article.
and mastery goal orientations on males’ and females’ self-regulated
learning. Learn Individ Differ 11(2):153–171.
Putnam AR. 2001. Problem-based teaching and learning in technology
Notes on contributors education. Paper Presented at the Annual Conference of the
Association for Career and Technical Education, New Orleans, LA.
S. TURAN, PhD, is a research assistant in the Department of Medical
Ray MW, Garavalia L, Gredler ME. 2003. April. Gender differences in self-
Education, Hacettepe University Faculty of Medicine.
regulated learning, task value, and achievement in developmental
O. DEM_IREL, PhD, is Professor of Curriculum Development and Instruction college students. Paper Presented at the Annual Meeting of the
and the Head of the Department in the Department of Curriculum American Educational Research Association, Chicago, IL.
Development and Instruction, Hacettepe University Faculty of Education Sayek _I, Kiper N, Odabas¸{ O. 2006. Mezuniyet öncesi t{p eğitimi raporu.
_I. SAYEK, MD, is Professor of Surgery, Department of Surgery, Faculty of Ankara: Türk Tabipleri Birliği.
Medicine, in the Hacettepe University. Schraw G, Dennison RS. 1994. Assessing metacognitive awareness.
Contemp Educ Psychol 19:460–475.
Shokar GS, Shokar NK, Romero CM, Bulik RJ. 2002. Self-directed learning:
Looking at outcomes with medical student. Fam Med 34(3):197–200.
References Sperling RA, Howard BC, Miller LA, Murphy C. 2002. Measures of children’s
Bahar-Ozvaris S, Aslan D, Sahin-Hodoglugil N, Sayek I. 2004. A faculty knowledge and regulation of cognition. Contemp Educ Psychol
development program evaluation: From needs assessment to long-term 27:51–79.
effects, of the teaching skills improvement program. Teach Learn Med Sperling RA, Howard BC, Staley R, DuBois N. 2004. Metacognition and self-
16(4):368–375. regulated learning cunstructs. Educ Res Eval 10(2):117–139.
Barrows HS, Tamblyn RM. 1980. Problem-based learning: An approach to Sungur S, Tekkaya C. 2006. Effects of problem-based learning and
medical education. New York: Springer Publishing Company. traditional instruction on self-regulated learning. J Educ Res
Bidjerano T. 2005. Gender differences in self-regulated learning. The 36th 99(5):307–317.
Annual Meeting of the Northeastern Educational Research Association. Winne PH, Perry NE. 2005. Measuring self regulated learning.
Kerhonkson, NY. In: Boekarters M, Pintrich PR, ve Zeidner M, editors. Handbook of
Bland LS. 2005. The effects of a self-reflective learning process on student self regulation. San Diego: Academic Press. pp 532–566.
art performance. Unpublished Doctoral Dissertation, The Florida State Winne PH. 1996. A metacognitive view of individual differences in self-
University School of Visual Arts and Dance. regulated learning. Learn Individ Differ 8(4):327–353.

e482
 Learning skills of medical students

Wood DF. 2003. ABC of learning and teaching in medicine problem based Zimmerman BJ. 1998. Academic studying and the development of personal
learning. BMJ 326:328–330. skill: A self-regulatory perspective. Educ Psychol 5(2/3):73–86.
Yeung E, Au-Yeung S, Chiu T, Mok N, Lai P. 2003. Problem design in Zimmerman BJ. 2002. Becoming a self-regulated learner: An overview.
problem-based learning: Evaluating students’ learning and self-directed Theor Pract 41(2):64–72.
learning practice. Innov Educ Teach Int 40(3):237–244. Zimmerman BJ. 1990. Self-regulated learning and academic achievement:
Zimmerman BJ, Martinez-Pons M. 1990. Student differences in self- An overview. Educ Psychol 25(1):3–17.
regulated learning: Relating grade, sex, and giftedness to self-efficacy Zimmerman BJ. 1995. Self-regulation involves more then metacognition: A
and strategy use. J Educ Psychol 82(1):51–59. social cognitive perspective. Educ Psychol 30(4):217–221.

Appendix: Dimensions and items of . I assess whether or not my goals are accomplished.
the SRLPS . I strive to eliminate any difficulties I face during the learning
process.
Motivation and action to learning . I continuously improve my problem–solving methods.
. I take action to learn according to my interests. . I strive to improve my weaknesses in learning.
. I search for possibilities to learn new things. . I choose the most appropriate learning approach to reach
. When faced with a problem, I take action to solve it. my goal.
. I take every opportunity to learn new things. . I evaluate my mistakes during the learning process and
. I am curious about the causes of things I see, hear or read. learn from them.
. I attentively observe/examine things around me. . After accomplishing my objective(s), I identify new goals to
. I derive new learning assignments for myself from the achieve.
things I observe around me. . I evaluate my learning approaches to see if they really help
me learn.
Planning and goal setting . I use my own strategies of learning.
. I make a plan to utilize resources and strategies in order to . I apply my newly acquired knowledge into new problem
reach my goal. states.
. I make a plan as to how I will carry out the learning process. . I experiment with new learning strategies until I learn the
. I prioritize my goals. material completely.
. I manage my time in order to learn as efficiently as possible. . I objectively judge my work during the learning process.
. I make a plan to utilize learning resources efficiently. . I explore other peoples’ methods of problem solving.
. I identify the resources needed during the learning . I compare other peoples’ problem solving strategies with
process. my own.
. I clearly identify the objectives to be achieved at the end of Lack of self-directedness
the learning process.
. I identify the learning materials that will help me to learn. . I wait for other people to tell me what to do in order to
learn.
Strategies for learning and assessment . I have difficulties in determining how I should study a
. I search for ways to facilitate learning in new situations. particular subject.
. After any learning assignment, I assess whether I learned . I wait for other people to provide me with the important
the material completely. knowledge that I have to learn.
. I use different learning strategies for the acquired knowl- . When faced with difficulties in solving a problem, I prefer
edge to be sustainable. other people to solve it.
. I search for new strategies if those used in implementing my . The instructor is primarily responsible for my learning.
plan are inadequate. . I prefer to wait for someone to instruct me as to how to
. I use different learning strategies for the knowledge I study.
acquire to be meaningful. . I face problems in identifying how I should start to study.

e483