Learner agency in undergraduate dental education- a scoping review through self-regulated and self-directed learning

doi:10.21203/rs.3.rs-4947130/v1

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Research Article

Learner agency in undergraduate dental education- a scoping review through self-regulated and self-directed learning

https://doi.org/10.21203/rs.3.rs-4947130/v1

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Background

Learner agency (LA) involves students actively engaging in their learning process and shaping their educational experiences through autonomy, self-regulation, and decision-making. In professional education, particularly within health professions, LA is critical for fostering adaptability and lifelong learning. This scoping review explores how LA, alongside concepts such as self-regulated learning (SRL) and self-directed learning (SDL), is addressed in undergraduate dental education, aiming to understand its implications and strategies for enhancing student agency in this context.

Methods

The scoping review followed Arksey and O’Malley’s five-stage framework and examined literature on SRL, SDL, and LA in undergraduate dental education from 1994–April 2024 across five databases: PubMed, Scopus, Embase, ProQuest Central, and Web of Science. A manual search of the cited references was also conducted. Relevant studies were screened, and the findings were summarized to offer a comprehensive overview and identify research gaps.

Results

In total, 33 studies were included in the review. The results revealed a strong interconnection between intrapersonal, behavioral, and contextual dimensions in shaping learner agency (LA) through self-regulated learning (SRL) and self-directed learning (SDL) among undergraduate dental students. The studies analyzed, predominantly quantitative, highlighted the multifaceted relationships among SRL, SDL, and LA, emphasizing its significance for educational practice and policy.

Conclusions

Self-regulated learning (SRL) and self-directed learning (SDL) are crucial for developing learner agency (LA), aiding undergraduate students' transition into independent professionals and fostering lifelong learning behaviors. Educational strategies should prioritize empowering students to become independent learners, reducing their reliance on faculty. Further research is needed to identify effective methods for promoting LA development among dental students.

Learner agency

Self-directed learning

Self-regulated learning

Undergraduate dental education

Learner agency, a concept rooted in individuals' active engagement in their learning process, refers to students' will and capacity to act. It emerges from the dynamic interactions between students' independent engagement in learning within specific sociocultural settings and the contextual elements that either facilitate or hinder their ability to act (1). As professional programs in higher education increasingly prioritize decision-making, problem-solving, creativity, collaboration and navigating uncertainty, learner agency is gaining recognition (2, 3). This heightened attention stems from its relevance to student-centered approaches, academic performance (2) and collaborative learning (4, 5). In health professions, learner agency (LA) is crucial, enabling individuals to control their learning process and adapt to the changing global health landscape. However, enhancing learner agency necessitates close attention to learner support mechanisms.(6)

LA is grounded in sociocultural theories of learning, emphasizing individuals' autonomy, self-regulation, and capacity to shape their learning experiences(1, 7). It draws from constructivist perspectives, highlighting learners as active constructors of knowledge within their social and cultural contexts (8). Within this framework, learners are seen as agents who actively engage in their learning journey, make choices, set goals, and monitor their progress. The current literature on LA suggests an integrated three-dimensional framework to conceptualize it (4, 7, 9, 10). This framework, as described in Fig. 1, delineates LA across three interconnected dimensions: 1) intrapersonal, 2) action (behavioral), and 3) contextual (environmental).

Figure 1: A framework for describing the dimensions of learner agency (derived from Bandura, 2006, 2008(2, 11); Du et al., 2022(4); Jääskelä et al.(3), 2017; Mercer, 2011, 2012(1, 8); Jiang et al., 2022; 2023(12, 13)

Several concepts closely related to learner agency include self-direction, decision-making, problem-solving, creativity, collaboration, self-regulation, and the ability to handle uncertainty. Owing to its focus on these areas, learner agency is gaining increasing attention in professional programs within higher education (2, 3, 5). Self-regulated learning (SRL) is closely aligned with the concept of agency. Defined as the process where one is ‘metacognitively, motivationally, and behaviorally proactive in the learning process’(14), SRL has garnered increasing recognition as an important attribute in contemporary healthcare profession education (HPE)(15, 16). In educational contexts, self-regulation entails conscious awareness and the deliberate selection and application of suitable strategies to achieve learning objectives, whether explicit or implicit (15, 16). As learners navigate their educational journey, agency evolves through ongoing reflection and evaluation of task progression (17). When students perceive themselves as agents in their own learning process, they are more likely to utilize self-regulatory strategies effectively (18). This symbiotic relationship between agency and self-regulated learning underscores the importance of empowering learners to take ownership of their learning experience.

Self-directed learning (SDL) is another concept that is also addressed in the HPE and dental education literature (19–21). Knowles (1975) defined SDL as a process whereby individuals take the initiative, with or without the help of others, to diagnose their learning needs, establish learning objectives, identify the necessary human and material resources for learning, select and implement suitable learning strategies, and assess the outcomes of their learning efforts (22). SDL is used in medical education, and medical students an increasingly significant role in shaping their education and determining the measures needed to ensure that the growth of SDL aligns with the educational goals of the medical field (23). For medical students to become self-directed learners, the competencies they need to acquire include the ability to identify their own learning gaps in skills and set goals for learning. Additionally, they must develop self-awareness, evaluate human and material resources for learning, engage in critical thinking and reflection, perform critical appraisals, and manage information effectively. Teamwork, self-evaluation, and peer evaluation are also essential skills that contribute to their growth as self-directed learners (24, 25).

Self-directed learning (SDL) and self-regulated learning (SRL) share several fundamental similarities that underscore their efficacy in educational contexts. Both approaches can be viewed through dual dimensions: external processes or events and internal factors such as personality traits and aptitudes. In practical terms, they encompass four key phases: defining tasks, setting goals and planning, enacting strategies, and monitoring progress while reflecting on outcomes.(22, 26–28). Importantly, intrinsic motivation serves as a driving force in both approaches, emphasizing the internal desire and enthusiasm that learners cultivate to pursue their educational goals autonomously. These shared characteristics highlight how SDL and SRL empower learners to take charge of their learning, promoting deeper understanding and long-term retention of knowledge.(26)

The active engagement of the learner, along with making choices and decisions regarding learning strategies and reliance on metacognitive and cognitive operations such as self-efficacy and self-awareness, are key aspects of both SRL and SDL (29). Nevertheless, it is important to recognize that SRL commonly occurs within classroom settings, is rooted in cognitive psychology, and emphasizes the learning processes associated with a task. In SRL, tasks are usually set by teachers, who focus on the internal cognitive and metacognitive processes that students use to manage their learning. This makes SRL a narrower, microlevel construct that is closely tied to formal educational settings.(30). On the other hand, SDL involves learners designing their own learning environments and planning their learning trajectories, making it a broader, macrolevel construct that emphasizes autonomy and lifelong learning.(30). Moreover, it takes place in diverse environments and often involves self-regulated learning (29).

Recent studies give more weight to a complexity lens to conceptualize agency (4). The complexity theory of change and development is frequently utilized in educational contexts to emphasize the need for self-organizing, dynamic education systems that can effectively respond to evolving societal shifts (31) (Morrison, 2008). Complexity theory enables us to connect the elements of education to the three dimensions of learner agency identified by Bandura (2008)(11). Morrison (31) (2008) posits that this approach recognizes learning as a nonlinear and intricate process rather than a straightforward sequence and underscores the inseparable integration of the numerous factors influencing learning. Such a conceptual shift supports the arguments for the literature to move from SRL and SDL to LA.(4)

To comprehensively address the complexity of LA within undergraduate dental education, this paper provides a scoping review of how LA has been conceptualized and applied. The review undertakes a focused examination of associated concepts such as SRL, SDL and LA. Its primary objective is to gain a comprehensive understanding of LA and its ramifications in dental education. Guided by the research question "How is the learner agency of dental students addressed in contemporary undergraduate dental education programs? This review seeks to elucidate the strategies and approaches employed in addressing learner agency within current undergraduate dental education programs.

A scoping review was opted for instead of a systematic review, as the aim of this study was to identify knowledge gaps, map out a body of literature, clarify concepts, or explore research methodologies.(32, 33) Unlike systematic reviews, which typically synthesize existing evidence on relationships between exposure and outcome variables, scoping reviews are designed to map the breadth and depth of research activity on complex topics and identify gaps in the relevant literature.(34) In this scoping review, we employed the five-stage framework proposed by Arksey and O’Malley (34), which includes (1) identifying the research questions, (2) identifying relevant studies, (3) selecting the relevant studies, (4) charting the data, and (5) collating, summarizing, and reporting the results. This approach enabled our study to make significant contributions by providing a comprehensive and explicit summary of the available evidence on LA, SRL and SDL among undergraduate dental students.

2.1. Step 1: Research question and protocol registration

The purpose of our review was to investigate how LA is addressed through SRL and SDL in undergraduate dental education guided by the following research question:

What are the ways in which the learner agency of dental students is addressed through SRL and SDL in current undergraduate dental education programs? (intrapersonal, behavioral, environmental)

The protocol was registered on the open science framework platform.(35)

2.2. Step 2: Identifying relevant studies

2.2.1 Eligibility criteria

The preset inclusion and exclusion criteria were well defined, ensuring that the literature search targeted studies specifically related to LA, SRL and SDL within the undergraduate dental curriculum.

Inclusion criteria

Primary research studies on SRL and SDL published in the last 30 years, i.e., January 1994 to April 2024
Full-text studies published in English
Population: Undergraduate dental education
Types of manuscripts: peer-reviewed journal articles and conference papers

Exclusion criteria

Date: Prior to Jan. 1994 and after April 2004
Language: Not written in English
Postgraduate dental education and other disciplines within medical education, K-12 education, and vocational education
Types of manuscripts: Conference abstracts, seminars, opinion papers such as editorials, commentaries, reviews of literature, book chapters or articles not meeting the inclusion criteria

2.2.2 Information Sources and Search Strategy

A comprehensive search of electronic databases was conducted up to the last 30 years (January 1994–April 2024). The literature from five relevant databases, namely, PubMed, Scopus, Embase, ProQuest Central and Web of Science, was included in the review. Additionally, as suggested by Booth et al., 2016,(36) a manual search of the references cited by the included studies and their respective references was performed.

The search strategy was developed by combining Medical Subject Headings (MeSH) and keywords specific to PubMed, along with index terms relevant to other databases (Table 1). Boolean operators, truncation, and phrase searching were integrated into the search strings to ensure the creation of meaningful and comprehensive search queries. This process involved consultation with an experienced librarian to optimize the search strategy.

Table 1

Search strategy used to explore electronic databases
Block 1	self-regulat* OR self-organiz* OR self-directOR self-orient OR self-led OR self-regulated learning OR "self-directed learning"
Block 2	undergrad* OR undergraduate dental education
Block 3	dental students OR dentist

2.3. Step 3: Selecting the relevant studies

All identified articles were imported into reference management software (specifically, the desktop version of EndNote® X9 by Clarivate Analytics, London, UK). After removing duplicate articles, two authors in this study (NG and DJ) independently screened the remaining articles on the basis of their titles and abstracts via Rayyan Systematic Review Screening Software.(37) Disagreements were resolved through discussions between the two authors (NG and DJ), and the third author helped to moderate any residual differences through collaborative discussions aimed at reaching consensus. Articles meeting the eligibility criteria after full-text review were included in the scoping review.

2.3.1 Study Selection

The results of the literature search and study selection are depicted in the flowchart (Fig. 2). The selection process followed the methods of identification, screening, eligibility, and inclusion as described by Liberati et al.(38) Initially, the review focused on titles and keywords or topics retrieved from the five databases to keep the results manageable. The initial search yielded 1,064 articles. After 259 duplicates were eliminated, 805 articles were further screened. The following criteria were used for the review and selection of studies: availability in English and focus on SRL, SDL, and LA in undergraduate dental education. Articles that reported undergraduate dental student data when students from other programs (e.g., medical students, nursing, pharmacy, postgraduate students) were also involved in the study were included (39–45). Other scoping and systematic review papers on SRL and SDL in medical education were not further analyzed because of their limited information on dental education. Therefore, these literature review papers served solely as tools for reference list checking. The first author (NG) screened the titles and abstracts for relevance to the research questions, leading to the exclusion of 690 articles that did not meet the inclusion criteria. This included studies with irrelevant titles, keywords, and abstracts from other health professional fields not related to dental education, as well as systematic reviews and conceptual papers. The selection process was conducted twice to ensure that no relevant publications were mistakenly excluded. A full-text screening was subsequently conducted for 115 articles, and a total of 45 studies were selected for further open-coding analysis. This was followed by a full-text analysis in which another 21 articles were removed specifically for not identifying the components of LA. Given that electronic searches may miss significant published studies due to indexing limitations, errors, inaccuracies, or concepts lacking appropriate subject headings, we supplemented our search by manually (36)examining the reference lists of the remaining 24 studies and relevant systematic/scoping reviews, and an additional 9 relevant journal articles were added. Finally, 33 articles were included in the qualitative analysis. Consensus was maintained throughout the article selection process, ensuring consistency in the identification of LA themes. A codebook encompassing LA themes and references was established, and participant information was extracted by the first author.

2.4. Step 4: Data Charting and Coding Process

Data charting was carried out via Microsoft Excel, and a codebook was developed to ensure consistency in data extraction. This enabled the capture of essential data items, as outlined in Table 2. The data items extracted during charting included the author’s name, year of publication, source, type, country, research method, theories and analytical framework, participants, context, and LA themes. The extraction was performed by the first author, NG.

The auditing process involved a second reviewer (DJ), applying a thematic approach combined with open coding and referring to the provided codebook for extraction. This step was undertaken to ensure validity. Interrater reliability (IRR) was also assessed on a subset of 10% of the studies in this phase, with the IRR results showing an acceptance rate of over 0.85 for each theme. Each coder independently extracted data to a codebook using the same criteria. The second coder was blinded to the data provided by the first author. The results were based on LA themes extracted from the data. The characteristics of the included studies are as follows:

2.4.1. Sources of publication

The review encompassed various journals, with the European Journal of Dental Education being the most frequently cited, contributing eight articles. The Journal of Dental Education followed with five articles, whereas BMC Medical Education provided three. Other journals included the Journal of Clinical and Experimental Dentistry, the Journal of Education and Health Promotion, and Acta Odontológica Latinoamericana, each with two articles. Several journals were represented by a single article each: Medical Education, Pakistan Orthodontic Journal, Canadian Medical Education Journal, African Journal of Health Professions Education, Professional Medical Journal, Journal of Medical Education and Curricular Development, Academic Bulletin of Mental Health, Journal of Medical internet Research, Tidsskriftet Læring og Medier and Frontiers in Psychology. This wide range of sources reflects the interdisciplinary interest and comprehensive examination of the topic across different fields and regions.

2.4.2. Country

Given the diverse educational contexts across various countries, contextual factors, such as the study setting, were considered crucial aspects in reporting the findings (46). All the studies provided information on their respective study settings, which were distributed as follows: 9.3% in the U.S. and Korea; 12.5% in Pakistan; and 6.25% each in Australia, Syria, Chile, Qatar, and Saudi Arabia. The remaining studies were conducted in India, Belgium, Brazil, the UK, the Philippines, Denmark, Canada, Malaysia, Argentina, Turkey and Finland.

2.4.3. Year of publication

Although the search for articles spanned from 1994–2024 (Fig. 3), the first paper related to SRL/SDL/LA in undergraduate dental education appeared in 2003, indicating that these topics have gained popularity only in the last two decades. Interest in the subject grew significantly after 2016, reaching its peak in 2022.

2.4.4. Theories and analytical framework

The theories and analytical framework were specified in 26 out of 33 articles. Several studies have used multiple theories or models in their study design and analyses and can be categorized as follows: (1) active learning theories (e.g., problem-based learning (PBL), experiential learning) (n = 6); (2) theories related to SRL (n = 10); (3) self-directed learning (SDL) (n = 4); (4) theoretical models (e.g., theories on transitional psychology or organizational socialization theory, self-determination theory, assimilation theory of meaningful learning, sense of coherence) (n = 4); and (6) other theories (e.g., facets of reflective thinking, transaction distance theory) (n = 2). SRL was the most frequently employed, indicating that in discussions about learner agency, the behavioral dimensions in dental education are the most explored.

2.4.5. Research methods

Across the 33 studies investigating LA, SRL, and SDL, a wide array of research methodologies is apparent, showcasing diverse approaches to comprehending these concepts. Quantitative methods predominated, with 20 studies employing numerical data and statistical analysis to explore these educational phenomena. These studies used various approaches, including self-reported and self-evaluated questionnaires(42, 47–50), pre- and post-course questionnaires (20), and cross-sectional surveys/studies(44, 51–53). Some studies have employed descriptive statistics (40, 54–57). For example, Loka SR et al. (49) used a reflection questionnaire to assess habitual action, understanding, reflection, and critical reflection on a 5-point Likert scale. Orsini C et al. (58) conducted a longitudinal study collecting data on demographics and students’ motivation for attending university, measured through the 28-item Academic Motivation Scale (AMS). Lan M et al. (43) utilized a massive open online course (MOOC) and quantitatively analyzed data via k-means clustering to identify five SRL behavioral indicators of student activity. Notably, Alfakhry G et al. conducted quantitative studies via a quasi-experimental study design.(59, 60)

In contrast, six qualitative studies focused on in-depth exploration of SRL via focus group discussions and semi structured interviews. These include studies by Ali K et al.(61), Bowman (62), Orsini C et al. (63), Postma TC. (64), Farrukh et al. (45), and Varthis S et al. (65). For example, in the qualitative study by Varthis et al.,(65) students responded to an online questionnaire followed by a group discussion aimed at problem solving before and after the blended learning experience.

Furthermore, mixed-methods studies, numbering six, combined qualitative approaches such as interviews and focus group discussions with quantitative approaches such as surveys, questionnaires, and pre- and posttests. These studies include those of Malau-Aduli BS et al. (66), Mehboob et al. (41), Premkumar K et al. (67), Rung et al. (68), Alvarez S et al. (69), and Lee M et al. (70). For example, Lee M et al. (70) utilized qualitative analysis alongside a cross-sectional web-based survey, whereas Malau-Aduli (66) employed quantitative analysis of survey data via descriptive statistics and thematic analysis guided by the conceptual framework of organizational socialization theory (OST).

2.5. Step 5: Collating, summarizing, and reporting the results

The mapping results and information were gathered, summarized, and reported. Key themes were identified and consolidated to integrate and synthesize the literature, facilitating a clear and concise interpretation of the findings.

3.1 Ways in which LA is addressed

This section presents the findings of the integrated data analysis. Building upon the conceptual framework outlined in the introduction, which delineates three themes from the literature, this analysis examines the characteristics of SRL and SDL in relation to the development of LA across these dimensions. Table 2 provides an overview of the three dimensions, namely, Intrapersonal, Behavioral, and Contextual, which are further elaborated upon in the subsequent discussion.

Table 2

– Themes of learner agency in self-regulated learning and self-directed earning
Themes	Subthemes	Frequency	Content
Intrapersonal	Self-efficacy	7	-Efficacy on internet and online learning, comparatively higher in females (47,57) -Developing self-efficacy (5,45,52,55,70) -Varying self-efficacy levels across study years (47,49)
	Motivation	10	-Students motivation for learning (41,44,48,58,61,62,65,66) -Impact of clinical contact on motivation (58,59,64,66)
	Knowledge acquisition	13	-Recognizing learning opportunities (40,48,49,65–67) -Adopting different learning styles (42,43,48,50,51,56,57,61,62)
	Skill development	4	-Transversal skills (20,66) -Clinical reasoning skills (64) - Clinical application of skills (57,60)
Behavioral	Learning Strategies	3	Goal setting (41,45,59)
		3	Planning (41,45,54,66)
		3	Monitoring (40,41,54,59)
		11	Self-reflection (45,54,59,62,64,69) Self-perception of academic performance (40,44,45,49,50,52,53,55,65)
		6	Self-evaluation/Self-assessment (41,48,53,59,60,69)
Contextual	With peers	5	-Peer support from students in other years (62,70) - Active discussion and interactions with peers within the class (20,45,62,66,70)
	With supervisors	9	-Support from the supervisor(20,42,44,45,48,51,62,66,70)
	With institutions	17	-PBL as an effective strategy to support student autonomy (5,50,61) - Support for various learning formats (flipped classroom, blended learning and so on) (20,56,65) - Institutional support on early and gradual clinical contact experiences (50,57,63,64) -Experiential courses emphasizing patient‒physician/dentist communication (64,69) -Cognizant learning and teaching environment(42,55) -Access to resources and courseware provided by institutions (20,48,51,53,56,57,68,70)

3.1.1 Intrapersonal

Self-efficacy, motivation, knowledge acquisition, and skill development are among the key subthemes associated with the intrapersonal dimension of LA, and they are significantly related to SRL and SDL. Studies have highlighted the critical role of self-efficacy in student success (20, 45, 47, 52, 57, 61, 64). In online learning environments, self-efficacy is notably greater among female undergraduates and fourth-year students (47, 57). However, Postma (64) noted that some students may have lacked the self-efficacy beliefs necessary to meaningfully participate in case study exercises, indicating that self-efficacy is not uniformly distributed and can impact engagement and performance. Motivation was a key theme across several studies (41, 48, 58, 61, 62, 65, 66), with clinical experiences having a particularly significant impact (58, 59, 64, 66). Bowman (62) noted that participants felt positive and inspired by their first-year dental surgery course, finding enjoyment in early clinical experiences and engaging in course content despite the challenges. The theme of knowledge acquisition was prominent, with undergraduate dental students demonstrating effectiveness in acquiring subject matter knowledge and showing increased enthusiasm for learning and embracing innovative educational approaches (5, 42, 43, 48–51, 56, 57, 62, 65–67).

3.1.2 Behavioral

In the realm of the behavioral dimension within learner agency (LA), thematic analysis has identified several factors closely associated with both self-regulated learning (SRL) and self-directed learning (SDL). Key learning strategies include goal setting, identified in three studies(41, 45, 59), planning (41, 45), monitoring, noted in four studies (40, 41, 54, 59), and self-reflection, highlighted in six studies (45, 54, 59, 60, 62, 64).

These studies also delve into additional competencies crucial for professional development, including students' perceptions of academic performance and their ability to self-evaluate (44, 45, 49, 50, 52, 53, 55, 65). For example, Mehboob et al.(41) reported that students actively establish their learning goals and are adept at selecting appropriate strategies to achieve them, scoring 3.81 on average for setting goals and 3.72 for planning and implementation. High achievers tended to set process- and outcome-based goals rather than focusing solely on outcomes. They chose goals of medium difficulty that were achievable within a predetermined time frame. By continuously self-evaluating and adjusting their learning behavior, high achievers monitor their progress and align their actions with their goals. They also possessed a reflective attitude, regularly reflecting on every step of their examination process (45). In the study conducted by Malau-Aduli et al.,(66) the students acknowledged the importance of proactive planning for the day and their readiness to seek clarification on challenging topics. They also realized the necessity of putting in more effort into developing problem-solving and self-directed learning strategies.

Among the four aspects of the behavioral dimension, one-third of the studies have demonstrated a strong association between self-reflection and self-evaluation and improved self-regulated learning outcomes. Specifically, dental students who regularly engage in self-reflection and self-evaluation tend to achieve better academic performance, develop critical thinking and problem-solving skills, and enhance their overall learning processes. These practices enable learners to become more effective, autonomous, and motivated, leading to better learning outcomes and greater academic success.

This comprehensive exploration underscores how learner agency encompasses not only fundamental learning strategies but also metacognitive skills that enhance students' ability to navigate their educational journeys effectively and prepare for their future careers. These findings highlight the multifaceted nature of learner agency, demonstrating its pivotal role in fostering adaptive and proactive learning behaviors among students.

3.1.3 Contextual (Environmental)

The contextual dimension highlights the impact of external factors on an individual's agency in learning. In this dimension of learner agency (LA), thematic analysis identified critical areas that enhance self-regulated learning (SRL) and self-directed learning (SDL) through interactions with peers, supervisors, and educational settings. Peer support plays a significant role, with studies emphasizing the benefits of active discussions and interactions among classmates, as well as support from students in other years(20, 45, 62, 66, 70). Supervisory support is also crucial, with nine studies indicating that guidance and feedback from supervisors enhance student learning (20, 42, 44, 45, 48, 51, 62, 66, 70).

Institutional support is paramount and includes several effective strategies. A problem-based learning (PBL) environment promotes student autonomy (50, 61), whereas various learning formats, such as flipped classrooms and blended learning provided by institutions, cater to diverse preferences (20, 56, 65). Early and gradual clinical contact experiences help students integrate theoretical knowledge with practical skills (50, 57, 58, 64), and experiential courses that emphasize patient‒physician‒dentist communication prepare students for real-world interactions (64, 69). A conducive learning environment provided by institutions is crucial for student success (42, 55), and access to resources and courseware further supports students in their academic journeys (20, 48, 51, 53, 56, 57, 68, 70).

3.2 Synthesis of results

The results indicate a strong interconnection between intrapersonal, behavioral, and contextual dimensions in the relationships among SRL, SDL and LA. These dimensions collectively contribute to the development of LA among undergraduate dental students within the context of SRL and SDL in a professional environment. Among the studies analyzed, eight utilized qualitative methods (25%), whereas the majority employed quantitative methods (31.25%). These studies offer diverse perspectives on how SRL and SDL are interlinked with LA, highlighting the multifaceted nature of this relationship and its implications for educational practice and policy.

To the best of the authors’ knowledge, this scoping review is the first to explore the interplay between SRL, SDL and LA in undergraduate dental education. By synthesizing the literature, this review maps the current landscape of SRL and SDL implementation strategies, interventions, and assessment methods employed in undergraduate dental curricula, linking them to LA. The insights into the collective agency of these learners appear to be in line with Bandura’s claim that, by combining their shared knowledge, skills, and resources, individuals can collectively use their agency to shape their own environment (2). To connect these concepts, this study proposed a framework for conceptualizing LA in relation to SRL and SDL, aiming to understand LA development in undergraduate dental education. The study results suggest that these three dimensions of LA (intrapersonal, behavioral, and environmental) are interactive and interrelated in the SRL and SDL literature, highlighting the importance of integrating these concepts to enhance the educational experiences and outcomes of dental students.

Research indicates that an internal locus of control, self-efficacy, and SDL are significantly linked to academic success. (52). Students who believe that they have control over their learning outcomes (internal locus of control) and possess confidence in their abilities (self-efficacy) are more likely to engage in SDL, leading to better academic performance. Another study revealed that self-directed learning readiness (SDLR) was positively correlated with academic performance.(67) These elements collectively enhance the intrapersonal and behavioral dimensions of LA, empowering students to take initiative and take responsibility for their learning journeys.

Hernandez et al.(54) reported that students exhibit good self-regulation and excellent reflection but show only competence in planning, monitoring, and control. This has been explained by the presence of the Kruger–Dunning effect, where students overestimate their abilities, underscoring the importance of accurate self-assessment. (71) Studies have also revealed that self-assessment training improves SRL abilities such as goal setting, attention focusing, and self-reflection. Positive attitudes toward self-DOPS (direct observation of procedural skills) and improvements in clinical performance highlight the role of self-assessment in fostering SRL and learner agency, as students become more adept at monitoring and directing their learning. (59, 60). Additionally, a transition from a deep learning approach to a surface learning approach was noted in a study as students moved to clinical training (50). These insights collectively underscore the pivotal role of behavioral strategies in enhancing students' cognitive engagement and fostering adaptive learning practices within academic contexts.

Clinical reasoning skills are critical for developing students' ability to analyze and synthesize information in clinical contexts, thereby fostering deeper engagement and motivation. (64). Similarly, the clinical application of skills reinforces motivation by showcasing the direct impact of learning on patient care and outcomes, thereby enhancing students' sense of professional efficacy and fulfillment in their studies. (57, 59). The transition from preclinical to clinical courses has shown a shift from controlled to autonomous motivation (58). These processes align with LA principles by enabling students to take ownership of their professional growth through hands-on experience and critical thinking.

Among all the articles included in this review, only one addressed learner agency in undergraduate dental education, and it explored diverse student perspectives encompassing career readiness, the efficacy of PBL, reliance on faculty support, and the cultivation of professional identity. PBL is instrumental in fostering learner agency by promoting autonomy, problem-solving skills, and interpersonal competencies among students. (5). While PBL enhances these crucial skills, it may also present challenges such as increased workload.(61). The quantitative findings also underscore the detrimental effects of increased workload on students during their clinical transition. Initially, this heightened workload is associated with negative impacts; however, over time, students tend to cultivate resilience, heightened motivation, and a more profound sense of professional identity. (66).

The current study has several limitations that need to be acknowledged. First, the search strategy included only key databases, which means that some relevant articles might have been overlooked. This limitation could result in an incomplete representation of the literature. Second, the review was restricted to articles published in the English language and focused specifically on undergraduate dental education. This language- and field-specific focus may have excluded valuable insights from non-English publications and other educational disciplines. Furthermore, none of the reviewed articles explicitly conceptualized learner agency (LA); instead, they used the terms associated with LA as common concepts without a clear framework. This lack of explicit conceptualization highlights a gap in the literature that future research should address. Importantly, this article is a scoping review, not a systematic review. As such, we did not critically appraise the selected studies, which is a common practice in systematic reviews, to assess the quality and reliability of the evidence. However, despite this limitation, we successfully located findings that addressed our aim of examining the nature and extent of the literature on LA, SRL, and SDL and identifying potential future research directions. These findings provide a foundational understanding but also underscore the need for more rigorous and comprehensive studies to advance the field further. Additionally, robust assessment tools should be developed, and collaboration among dental educators should be promoted to share best practices while including emerging technologies such as artificial intelligence(72). To build on these findings, future steps should include empirical validation of the proposed framework linking LA, SRL, and SDL in dental education.

SRL and SDL can facilitate LA development and facilitate the professional development of undergraduate students into independent learners beyond the temporal confines of the university environment, help their transition into clinical practice and facilitate the acquisition of lifelong learning behaviors. Educational strategies should emphasize the transformation of students into independent learners with less reliance on faculty for their academic progress. Information transfer from teachers to students should take the back seat, and learning activities should support students in becoming independent learners. Dental educators should focus more closely on educational strategies that facilitate LA development so that the transition of students into clinical practice can be achieved more easily. Further research is needed to identify effective strategies to promote LA development among dental students.

learner agency

SRL

self-regulated learning

SDL

self-directed learning

IRR

interrater reliability

PBL

problem-based learning

AMS

Academic Motivation Scale

MOOC

massive open online course

OST

organizational socialization theory

SDLR

self-directed learning readiness

DOPS

direct observation of procedural skills.

Acknowledgments - The authors would like to express their gratitude to Mr. Abdalhakim Y. M. Bshawi, a senior research and instruction librarian at Qatar University, for his valuable assistance in developing the search terms and strategies for this study. Open access funding was provided by the Qatar National Library.

Ethics approval and consent to participate - Not applicable, as it is a scoping review, and no new data were generated in the study.

Consent for publication - Not applicable

Funding - The authors confirm that this scoping review received no external funding.

Availability of data and materials - The underlying data are available to the corresponding author upon request.

Competing interests - The authors declare that they have no competing interests.

Authors’ contributions - NG, KA and XD conceptualized the study. DJ contributed as an independent coder. All the authors developed the data extraction form. NG conducted the database search, screened the resulting articles and was primarily responsible for writing the manuscript. All the authors reviewed, edited and approved the final manuscript.

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No competing interests reported.

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You are reading this latest preprint version

Learner agency in undergraduate dental education- a scoping review through self-regulated and self-directed learning

Status:

Version 1

Abstract

Background

Methods

Results

Conclusions

Figures

1 Introduction

2 Methods

2.1. Step 1: Research question and protocol registration

2.2. Step 2: Identifying relevant studies

2.2.1 Eligibility criteria

2.2.2 Information Sources and Search Strategy

2.3. Step 3: Selecting the relevant studies

2.3.1 Study Selection

2.4. Step 4: Data Charting and Coding Process

3 Results

3.1 Ways in which LA is addressed

3.1.1 Intrapersonal

3.1.2 Behavioral

3.1.3 Contextual (Environmental)

3.2 Synthesis of results

4 Discussion

5 Conclusion

Abbreviations

Declarations

References

Additional Declarations

Status:

Version 1