Trajectories of self‐regulated learning patterns across medical students' transition to clerkships: A longitudinal Q‐method study

INTRODUCTION: Medical education transitions are dynamic developmental processes in which learners shift between different roles and environments. The transition to clinical clerkship is a period of heightened vulnerability. While self-regulated learning (SRL) supports learning in such complex contexts, it remains unclear how students mobilise its different processes during this transition and how individual patterns emerge and change in its early phase. This study aims to capture the heterogeneity and temporal dynamics of SRL patterns by exploring how individual agency interacts with the clinical environment. METHODS: This study employed a longitudinal Q-methodology approach. The Q-set was developed based on interviews with senior medical students and expert consensus. Then, Q-sorting was conducted with 23 medical students at two time points: 1 week (T1) and 1 month (T2) after starting their clerkships. The Q-sorting data were analysed separately at each time point using factor analysis. Factor arrays and post-sorting interviews at both time points were integrated to identify SRL patterns. Participants' transitions between patterns across the two time points were tracked to map SRL trajectories. RESULTS: The Q-set comprised 44 statements. A total of 45 Q-sortings were collected (23 at T1 and 22 at T2), leading to the identification of four SRL patterns at T1 (Goal Orientation, Environmental Sensitivity, Feedback Dependence, Structural Misalignment) and four at T2 (Role-model Orientation, Structural Conflict, Proactive Challenge-Seeking, Relational Sensitivity), respectively. By tracking participants' longitudinal transitions between patterns, a Sankey diagram was used to visualise the cohort-level flows, revealing six distinct trajectories of SRL development during the clerkship transition. CONCLUSION: This study highlights the heterogeneity and temporal dynamics of SRL during the transition to clerkship, which are shaped by the continuous interaction among learners' demands, multiple stakeholders and clinical environment. Educators should prioritise students' differentiated needs and support clinical transitions through fostering a socially shared regulation of learning.