The What and How of Self-Regulated Learning in Surgical Residents: A Qualitative Study.

OBJECTIVE: Self-regulated learning (SRL) enables learners to take ownership of their development. While prior studies have described SRL in surgical training through theoretical frameworks, how senior residents enact SRL in everyday clinical practice remains underexplored. This qualitative study examines how surgical residents operationalize SRL within the perioperative clinical environment. DESIGN: We conducted a qualitative study using semistructured interviews and a supplementary survey assessing the frequency of SRL strategy use. Directed content analysis was applied to transcripts to map strategies across the 3 phases defined by Zimmerman's framework of SRL: forethought, performance, and self-reflection. SETTING: The study was performed at a single academic quaternary medical center. PARTICIPANTS: Fourteen senior surgical residents representing 6 specialties participated. They included residents within 1 to 2 years of graduation and those in dedicated research time, all of whom have completed at least 3 years of clinical training. RESULTS: Residents described employing a range of SRL strategies across the forethought, performance, and self-reflection phases. Forethought strategies included case preparation, mental rehearsal, and goal setting. During the performance phase, residents engaged in active inquiry, observational learning, and real-time self-monitoring in the operating room. In the self-reflection phase, residents utilized written, verbal, and mental reflection, attributed causes to errors and complications, and adapted their future practice accordingly. Time constraints shaped how residents engaged in SRL, often favoring efficient, opportunistic strategies embedded within clinical workflow. CONCLUSIONS: Surgical residents engage in SRL across the perioperative period, though these processes are often variably recognized as SRL. Establishing a shared understanding of SRL and addressing structural barriers, such as time constraints, may support more deliberate and consistent learning in surgical training.