Self-directed learning readiness in preclinical medical education: Patterns, variation, and academic outcomes from a mixed longitudinal and cross-sectional study

The transition from undergraduate education to medical school demands increasing learner autonomy and self-regulation. Guided by Zimmerman’s Self-Regulated Learning (SRL) theory and Grow’s Staged Self-Directed Learning Model, this study examined how self-directed learning readiness (SDL-R), encompassing learning motivation, planning and implementation, self-monitoring, and interpersonal communication varies across the preclinical curriculum and how these domains relate to academic performance. A mixed longitudinal and repeated cross-sectional study (2022–2024) was conducted among preclinical medical students ( N = 807 responses; 434 unique students from three cohorts, Classes of 2025–2027) at an LCME-accredited US medical school. All enrolled first- and second-year students were eligible; recruitment was voluntary via web-based REDCap surveys administered once per semester. Linear mixed-effects models evaluated within-student change in total SDL-R and its four domains across semesters. Ordinary least-squares regression with cluster-robust standard errors assessed the contribution of standardized subscale scores to cumulative grade point averages. Bonferroni correction was applied within each family of comparisons, with effect sizes and 95% confidence intervals reported. SDL-R scores varied across preclinical semesters in a pattern consistent with developmental progression, with a modest decline in first-year Spring followed by recovery through year two. Planning and implementation was the strongest positive predictor of GPA in Year 1 (β = 0.142, p = .004) and in the combined model (β = 0.154, p < .001). The SDL-R domains collectively explained 22.2% of GPA variance in Year 1 (R² = 0.222) and 9.0% in Year 2 (R² = 0.090); the combined model explained 15.0% (R² = 0.150). Interpersonal communication showed a significant negative partial association with GPA, consistent with a statistical suppressor effect. Second-year students, older learners, males, and higher-achieving students showed higher SDL-R levels. SDL-R is a dynamic, context-sensitive competency during preclinical training, with planning and implementation as its strongest academic predictor. Targeted curricular interventions that scaffold metacognitive planning, self-monitoring, and adaptive strategy use may enhance both academic performance and lifelong learning capacity.