Building a Framework for Self-Regulated Learning in Surgical Education: A Delphi Consensus Among Experts in Surgical Education.

OBJECTIVE: Practice-Based Learning and Improvement is a Core Competency for surgical residents. Self-regulated learning (SRL) skills are an important component of this competency, yet are rarely taught in surgical training. Before we can teach SRL skills to residents we must understand the attributes that are essential. The purpose of this study was to develop a framework for SRL for surgical trainees. DESIGN: This mixed-methods study design utilized a two-round modified-Delphi approach to develop consensus among experts in surgical education regarding SRL in surgical training. Round One included SRL constructs derived from educational, professional, and medical literature. Based upon quantitative data and thematic coding of comments, these constructs were adapted for applicability in the context of surgical residency and reorganized using a constant comparative approach. Revised constructs and groupings were presented to the expert panel in Round Two. Further survey rounds were not needed as all items in Round Two reached the predetermined consensus level of 70%. SETTING: The Delphi panel was a purposeful sample of nationally recognized experts in surgical education, including members of the Association for Surgical Education and the Association for Program Directors in Surgery. PARTICIPANTS: Thirty-eight of 42 experts (90.5%) responded to Round One, representing 29 academic and community medical systems nationally. The response rate for Round Two was 92%, 35 of the 38 Round One participants. RESULTS: In Round One, the SRL constructs were all viewed as important with median scores ranging from 50 to 99.5, on a 100-point scale. Two hundred and ninety-one comments were coded and used to refine SRL definitions into 7 domains for Round Two, which included self-awareness, task analysis, situation awareness, strategic planning, progress evaluation, learning and performance management, and goal attainment and refinement. All Round Two items reached greater than 70% agreement, and received 51 free response comments. Several key themes emerged: clinical prioritization over learning, learner's limited control, value and reliance on external resources, low use of metacognition, and complex goal orientation. Incorporation of common themes generated a novel multi-stage framework of SRL in surgical education. CONCLUSIONS: Surgical residency represents a unique learning context, in which the ideal learner is one who understands their learning environment and utilizes available resources to optimize their own learning. Experts in surgical education believe SRL skills are important in training, and a novel framework of SRL is necessary to support a learner-centered model within the demanding environment of surgical training.