Translating Intentions Into Actions: A Missing Piece of the Puzzle in Improving Residents' Self-Regulated Learning.

M any consider well-developed self-regulated learning skills a critical outcome in medical education. The Accreditation Council for Graduate Medical Education core competency of practice-based learning and improvement and its associated milestones codify graduate medical education’s commitment to this principle. Residents must demonstrate their ability to create and act on learning and improvement goals. Often this occurs through individualized learning plans. However, these efforts do not always achieve their intended outcomes. For instance, in a national survey of pediatrics and medicine-pediatrics residents, only 39% felt that setting goals through individualized learning plans was worth the time and effort, and only 26% of those residents tracked their progress with their learning goals. In another study, 35% of residents reported that individualized learning plans provided a useful framework for learning, and 30% felt that their goals and plans improved their awareness of the learning process. Other studies have shown that residents value opportunities to direct their own learning, that they struggle to manage their learning, and that they desire guidance on directing their learning. Clearly, with self-regulated learning, we need to understand how to support and educate our trainees more effectively. In this issue of the Journal of Graduate Medical Education, Saddawi-Konefka and colleagues provide medical educators with an important piece of that puzzle. In this study, investigators use the WOOP (Wish, Outcome, Obstacle, Plan) training technique to increase residents’ accomplishment of their personal study goals. As the authors note, WOOP is a memorable acronym used to communicate the principles of mental contrasting with implementation intentions (MCII) from the psychology literature. The authors demonstrated that by training residents to identify potential obstacles in achieving their study goals, and creating a plan to overcome those obstacles, they almost tripled the amount of goal-directed study time compared with controls. Significantly, the investigators used a robust control group in which residents were instructed on the characteristics of good goals, as would typically happen in most training programs. In contrast to many educational studies, the authors demonstrate a change in behavior, not simply increased acceptance of an intervention or greater confidence in ability. An important aspect of this study is that WOOP (as a self-regulated learning technique) is not time or resource intensive, and it can easily be implemented into residency training programs. In a commonly used cyclical model of self-regulated learning, individuals (1) make goals and plans; (2) monitor their actions to ensure that they are achieving their goals; and (3) reflect on the outcomes of their actions to determine which new goals they will create. Use of MCII (or WOOP) helps to influence the transition from goal setting to self-monitored action and improves the efficacy of that self-monitoring. Mental contrasting consists of identifying a desired future state, reflecting on the greatest benefits of obtaining the goal, and contrasting that to barriers in the current reality that may prevent that state from being obtained. When a person feels that achieving the goal is highly likely, this contrasting exercise has been found to energize the person and greatly increase her or his commitment to the goal. This process establishes a strong link in the mind of learners between the obstacles to achieving their goals and the behaviors necessary to overcome the obstacles. Contemplating the desired future state without contrasting it to the challenges of reality actually decreases a person’s energy (ie, the level of activation or invigoration leading to goal commitment). Implementation intentions involve creating specific ‘‘if-then’’ plans to overcome anticipated obstacles. In this way, the person monitors his or her activity and takes corrective action once he or she encounters given situations. Mental contrasting combined with DOI: http://dx.doi. org/10.4300/JGME-D-17-00357.1