2012; 34: 751–753

SHORT COMMUNICATION

Helping students to improve their academicperformance: A pilot study of a workbook withself-monitoring exercises

HEATHER LEGGETT1, JOHN SANDARS1 & PHILIP BURNS2

1The University of Leeds, UK, 2St James’s University Hospital, UK

Abstract

Background: There is increasing interest in developing student self-regulated learning skills, especially self-monitoring, to

improve academic performance.

Aims: A pilot study to investigate the impact of self-monitoring exercises on calibration accuracy and academic performance

in undergraduate medical students on a Biomedical Science (BMS) module.

Method: A randomised trial of 51 second-year students comparing a structured workbook with and without self-monitoring

exercises.

Results: Participants significantly improved calibration accuracy after completing the intervention, as well as increased self-

efficacy and greater satisfaction with performance. The intervention group significantly improved their BMS exam score compared

with the control group.

Conclusion: A relatively simple intervention seems to have the potential to improve self-monitoring skills and academic

performance. Further research is recommended to identify if the development of self-monitoring skills by a similar intervention

leads to long-term improvement in academic performance, if low-performing students can significantly benefit from a similar

intervention and if there is transfer of improved self-monitoring skills from one context to another.

Background

There is increasing interest in developing the self-regulated

learning (SRL) skills of undergraduate medical students,

especially those who are struggling with academic perfor-

mance (Winston et al. 2010; Sandars & Cleary 2011). An

essential SRL skill for effective learning is that of self-

monitoring, in which the learner is aware of a discrepancy

between their academic performance and their approach to

learning. Research has demonstrated that high academically

performing students have greater self-monitoring compared

with low performing students (DiBenedetto & Zimmerman

2010). An important aspect of self-monitoring is the accurate

prediction of the level of performance, called calibration

accuracy, since an awareness of lowered performance can

motivate the learner to alter their approach to learning, such

as by increasing their study time or by narrowing their focus

to specific problematic areas (Kitsantas 2002).

There have been few studies that have attempted to

improve calibration accuracy and test performance outside

laboratory conditions (Nietfeld et al. 2006). On an undergrad-

uate psychology course, Nietfeld et al. (2006) found that a

workbook that consisted of weekly self-monitoring exercises

and feedback on calibration accuracy improved both calibra-

tion accuracy and performance in an end of intervention test

and a later project that required integration of information.

Self-efficacy beliefs and self-satisfaction also increased and this

is important as these factors influence motivation to persist

with learning tasks, especially when they are perceived to be

difficult by the learner (Zimmerman & Martinez-Pons 1992).

The aim of this pilot study was to investigate the impact

of a workbook of self-monitoring exercises on calibration

accuracy and academic performance in undergraduate med-

ical students on a Biomedical Science (BMS) module. We

found no previous similar research in medical education.

Our research was informed by SRL theory and metacognition,

which considers students to be actively involved in the process

of their learning and have increased self-awareness in how

to control this process (Zimmerman 1990).

Method

The participants were 51 (15 male: 36 female; mean age

20 years) second-year medical students studying on a 9-week

BMS module. Participants were randomised to a control

(n¼ 26) or intervention group (n¼ 25).

The control group received a paper-based workbook,

which presented four self-test multiple choice questions

(MCQ) based on the topic of each week of the module.

The intervention group received an identical workbook to

the control group but there was an additional activity for each

week of the module. After answering each of the four MCQ’s,

participants were asked to rate their perceived confidence

Correspondence: J. Sandars, Medical Education Unit, Leeds Institute of Medical Education (LIME), The University of Leeds, Leeds LS2 9JT, UK.

Tel: 0113 343 4193; fax: 0113 343 4910; email: j.e.sandars@leeds.ac.uk

ISSN 0142–159X print/ISSN 1466–187X online/12/090751–3 � 2012 Informa UK Ltd. 751DOI: 10.3109/0142159X.2012.691188

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(on a 0–100 scale) and satisfaction that they had provided

the correct answer (on a 5-point Likert scale). In addition,

they were asked to justify their response (using a free-form

response format) before being given the correct answer. Using

a free-form response format, participants were then asked,

if their answer was incorrect, to reflect on why they thought

it was incorrect and also how they could alter their perceived

confidence of obtaining the correct answer when attempting

other questions.

The following data was collected:

(1) Intervention group

(2) Calibration accuracy: The calibration accuracy for each

MCQ was calculated using the method described by

Nietfeld et al. (2006). Calibration accuracy was calcu-

lated using participants’ confidence scores and whether

they achieved the correct answer on the MCQ. Each

confidence score (represented from 0–100) was trans-

formed to a scale of 0.00–1.00. A correct answer on the

MCQ’s was represented as a score of 1 and an incorrect

answer as 0. For each weekly MCQ, the calibration

score was calculated by subtracting the answer score

from the confidence score. The mean calibration

accuracy for week 1 and week 9 was calculated by

summing the calibration score for each MCQ and

dividing by the number of questions (of which there

were four).

(3) Self-efficacy: Self-efficacy for the BMS module was

measured at week 1 and week 9 using a questionnaire

containing seven questions, which were rated on a

5-point Likert scale, and the mean was calculated.

(4) Satisfaction: For each MCQ, a self-satisfaction score was

obtained using a single question answered on a 5-point

Likert scale. The self-satisfaction score relating to each

MCQ for that week were totalled to provide a total

self-satisfaction score for week 1 and week 9.

(5) Performance: The score for the BMS examination that

each student had taken in their first year and their score

for the BMS examination in year 2 (that was taken

3 months after the module had ended) were compared.

(6) Evaluation of usefulness: A semi-structured question-

naire with a 5-point Likert scale (1¼ strongly disagree

and 5¼ strongly agree) was completed after the

participant had completed the workbook.

(7) Control group

(a) Performance: The scores on the same first year

BMS examination and the end of module BMS

examination in year 2 as taken by the intervention

group.

(b) Evaluation of usefulness: The score using the

same method as for the intervention workbook.

(c) We compared the difference between the week 1

and week 9 calibration accuracy, self-efficacy

and satisfaction scores of the intervention group.

We also compared the intervention and control

group participants’ scores from the end of module

BMS examination scores from year 1 and year 2,

as well as the change in scores between year 1

and year 2.

Results

Participants had significantly improved calibration accuracy

after completing the intervention (mean score week 1¼ 0.30,

mean score week 9¼ 0.13: t¼ 5.651, df¼ 24, p¼ 0.001).

Participants also had increased self-efficacy (mean score

week 1¼ 25.38, mean score week 9¼ 27.67: t¼�3.45,

df¼ 23, p¼ 0.002) after completing the intervention.

Similarly, participants reported a greater satisfaction with

their answers to the multiple-choice questions in the last

week of the workbook compared with the first week they

completed the workbook (mean satisfaction week 1¼ 28.89,

mean satisfaction week 9¼ 34.08: t¼�2.62, df¼ 25,

p¼ 0.015).

The intervention group had a significantly higher score on

the BMS exam in year 1 (covering a different curriculum and

content for BMS) compared with the control group (interven-

tion mean BMS year 1¼ 70.99, control mean BMS year

1¼ 65.29, t¼ 2.023, df¼ 48, p¼ 0.049). This was controlled

for when comparing the participants in the control group and

the intervention groups scores on the BMS exam in year 2.

A univariate analysis of variance showed that the intervention

significantly improved the BMS year 2 exam scores in the

intervention group, even when their higher score on the BMS

year 1 score was controlled for (f(1,49),¼ 4.446, p¼ 0.040).

There was no significant difference in the perceived

usefulness of the workbook between the intervention

(mean¼ 3.0) and control (mean¼ 3.1) groups. Participants in

the intervention group reported finding the weekly MCQs the

most useful aspect of the intervention workbook: ‘The MCQs

at the end of each week were a good way of testing how much

I had learnt that week’ (Student 6). The participants complet-

ing the intervention workbook disliked being asked to predict

the accuracy of their answer to the MCQs and being asked

why they thought their answer might be wrong.

Discussion

The workbook, which encouraged participants to complete

self-monitoring exercises, appears to be effective in improving

their calibration accuracy and also to increase their self-

efficacy beliefs and satisfaction with performance. Participants

who completed the self-monitoring exercises had a signifi-

cantly greater improvement in their BMS year 2 exam com-

pared with those who did not complete the self-monitoring

exercises. It is interesting that some of these students disliked

completing the self-monitoring exercises despite significantly

improving their performance by using the exercises. It is

possible that they viewed the exercises as repetitive and time

consuming and did not enjoy having to continuously justify

their answers after each question.

A limitation of this pilot study is the relatively small sample

size and it was not possible to determine which students

benefited the most from the self-monitoring exercises, espe-

cially students who have a low performance prior to the

intervention. Assessment of long-term impact on academic

performance was not possible since later integrative examina-

tions did not cover the same BMS topics.

H. Leggett et al.

752

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Our findings have important implications for undergraduate

medical education. It supports research in another context

that suggests that SRL processes, including self-monitoring,

can be developed by appropriate interventions and also that

academic performance can be improved (Nietfeld et al. 2006).

Our relatively simple intervention did this through repeated

self-monitoring exercises, immediate feedback on perfor-

mance and self-reflection on approach to learning over the

course of 9 weeks. Further research is recommended to

identify if the development of self-monitoring skills by a similar

intervention leads to long-term improvement in academic

performance, if low performing students can significantly

benefit by a similar intervention and if there is a transfer of

improved self-monitoring skills from one context to another.

Conclusion

A relatively simple intervention seems to have the potential to

improve the self-monitoring skills and academic performance

of undergraduate medical students. Further research is recom-

mended to investigate and evaluate this new approach for

undergraduate medical education, especially for academically

struggling students.

Workbook: Copies of the workbook are available on

request from the corresponding author.

Acknowledgment

We would like to thank Dr. Matt Homer for expert statistical

advice.

Declaration of interest: The authors report no conflicts

of interest. The authors alone are responsible for the content

and writing of the article.

Notes on contributors

HEATHER LEGGETT, BSc (Hons), MSc, is Research Assistant and JOHN

SANDARS, MB, ChB (Hons), MD, MSc, FRCGP, MRCP, is Senior Lecturer

and Associate Director for Student Support in the Medical Education Unit,

Leeds Institute of Medical Education, The University of Leeds, UK.

PHILIP BURNS, BSc (Hons), PhD, is Senior Lecturer in Gynaecological

Cancer in the Leeds Institute of Molecular Medicine, St James’s University

Hospital, Leeds, UK.

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Improving self-monitoring

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