22 J Gandhara Med Dent Sci

July - September 2025

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ORIGINAL ARTICLE

FACTORS INFLUENCING SELF-REGULATED LEARNING OF DENTAL STUDENTS DURING
TRANSITION FROM PRE-CLINICAL TO CLINICAL ENVIRONMENT: A MIXED-METHODS

STUDY
Summaya Wajid1, Nowshad Asim2, Brekhna Jamil3, Syeda Shamal4, Alia Jehan Zaib5, Rizwan Ullah6

How to cite this article

Wajid S, Asim N, Jamil B, Shamal S,
Zaib AJ, Ullah R. Factors Influencing
Self-Regulated Learning of Dental
Students During Transition from Pre-
Clinical to Clinical Environment: A
Mixed-Methods Study. J Gandhara
Med Dent Sci. 2025;12(3):22-27.https://


Date of Submission: 30-11-2024
Date Revised: 26-01-2025
Date Acceptance: 20-03-2025

1MHPE Scholar, Institute of Health
Professions Educations and Research,

Khyber Medical University, Peshawar
3Professor of Medical Education,
Institute of Health Professions
Educations and Research, Khyber
Medical University, Peshawar

4MHPE Scholar, Institute of Health
Professions Education and Research,
Khyber Medical University, Peshawar

5MHPE Scholar, Institute of Health
Professions Education and Research,
Khyber Medical University, Peshawar

6MHPE Scholar Institute of Health ,
Professions Education and Research,
Khyber Medical University, Peshawar

Correspondence

2Nowshad Asim, PhD Scholar,
Assistant Professor, Institute of Health
Professions Education and Research,
Khyber Medical University, Peshawar

+92-300-5898407
drnowshadasim@kmu.edu.pk

ABSTRACT
OBJECTIVES
This study aimed to identify the self-regulated learning (SRL) strategies
employed by students in the dentistry curriculum and to explore the factors
influencing the self-regulated learning of dental students during the transition
from pre-clinical to clinical environments.
METHODOLOGY
An Explanatory mixed-methods study was conducted from June to November
2024, combining quantitative survey data with qualitative responses to gain a
comprehensive understanding of the experiences of third-year BDS students
at Watim Medical and Dental College, Rawalpindi, who have transitioned
from the preclinical to the clinical learning environment. Quantitative data
were collected using validated questionnaires on self-regulated learning
(SRL), while qualitative data were gathered through in-depth interviews. The
integrated analysis identified factors influencing changes in SRL during the
transition to clinical training.
RESULTS
The findings indicated that a significant number (76%) of students
experienced increased workload, and 84% perceived a noticeable gap
between theoretical knowledge and clinical practice. In response to these
challenges, students adapted their Self-Regulated Learning (SRL) strategies
by improving time management, actively seeking support from peers and
mentors, and modifying their study habits. These adaptive strategies played a
key role in helping them navigate the transition effectively.
CONCLUSION
The study concludes that enhancing self-regulated learning (SRL) is critical
for dental students transitioning from pre-clinical to clinical training. This
transition often induces stress and anxiety due to perceived knowledge gaps
and challenges in adapting to a new clinical environment. To support SRL,
the study recommends practical strategies, including structured guidance,
thorough orientation, early patient contact, and SRL techniques like goal
setting and time management. Institutions should incorporate Self-Regulated
Learning (SRL) into their curricula, provide training in goal-setting and time
management, and offer ongoing mentorship and feedback to help students
adopt SRL strategies successfully.
KEYWORDS: Self-regulated learning, Dental Education, Pre-clinical,
Clinical transition, Time Management, Mentorship, Clinical Training,
Medical Education

INTRODUCTION

Self-regulated learning (SRL) is a crucial component of
academic success, particularly in professional education
settings such as dentistry. SRL refers to students’ ability
to set their learning goals, monitor their progress, and
adjust their strategies to achieve favourable outcomes.1
Self-regulated learners tend to exhibit higher self-
efficacy, stronger goal orientation, and more effective
learning strategies.1,2 It develops essential skills such as
critical thinking, adaptability, and self-motivation, all of
which are vital for dental students as they navigate the

complex academic and clinical demands.1 The
development of SRL enables students to transform from
being passive recipients of knowledge to active learners
who take charge of their educational journeys in the
field of dentistry.2 A particularly challenging period for
SRL is the transition from preclinical to clinical
training. This phase presents a significant shift for
dental students, transitioning from structured, theory-
based learning to hands-on, patient-centred care. The
clinical environment requires students not only to apply
their theoretical knowledge but also to manage real-
world responsibilities, including patient interaction,

doi.org/10.37762/jgmds.12-3.692

23J Gandhara Med Dent SciJuly - September 2025

decision-making, and time management. This new
setting often intensifies stress, increases workload, and
demands greater self-directed learning.3,7,8 The
transition from preclinical to clinical education in
medical and dental programs represents a challenging
shift. This period often requires students to adjust to
real-life patient interactions, procedural learning, and
time-sensitive tasks, all within the context of increased
accountability and reduced teacher supervision.12,13
Inadequate self-regulation during this period may lead
to stress, decreased motivation, and lower academic
performance.12,13 Many students struggle to adapt their
self-regulated learning (SRL) strategies to this new
reality, which can impact their overall academic
performance and confidence. According to the Pakistan
Medical and Dental Council (PM&DC), the
undergraduate curriculum aims to produce a "general-
purpose, community-oriented doctor" equipped with
lifelong learning skills.11 Self-regulated learning plays a
critical role in achieving this vision. However, in the
absence of robust local research, educators lack the data
needed to scaffold students’ development of SRL
behaviours during key transitional periods. This study
addresses this gap by employing a mixed-methods
approach to investigate the self-regulated learning
(SRL) strategies used by dental students during their
transition to clinical training. Most existing studies are
either cross-sectional or generalised findings from
medical to dental students, despite the significant
differences in their clinical exposure and curriculum
structure.14,15

METHODOLOGY

An explanatory mixed-methods study was conducted
from June to November 2024 to investigate the factors
contributing to self-regulated learning (SRL) during the
transition from preclinical to clinical training among
dental students at Watim Medical and Dental College,
Rawat. After approval from the Khyber Medical
University Advanced Studies & Research Board
(KMU-AS&RB) in its 155th meeting held on June 06,
2024, the Ethical Clearance certificate was granted by
the Institute of Health Professions Education &
Research Ethics Board vide Ref No: 1-
12/IHPER/MHPE/KMU/23-15 Dated: 13-06-2024.
Informed consent was obtained from all participants,
who were assured that their participation was voluntary

and that their data would remain confidential. The
quantitative tool was a validated survey instrument by
Prince et al., which was administered to 3rd-year BDS
students in Watim Medical and Dental College. The
survey assessed information in five transition domains:
professional socialisation, workload, patient contact,
knowledge/skill application, and learning/education.
Fifty students responded to 69 items on a 5-point Likert
Scale. Data were analysed using SPSS version 26
employing descriptive statistics and the Mann-Whitney
U test to examine the associations among the transition
domains and gender. In addition to the survey data, nine
participants completed in-depth face-to-face interviews.
The interviews provided insight into the experiences
and challenges faced by individual students during their
transition phases. The qualitative analysis was guided
by Zimmerman’s Self-Regulated Learning (SRL)
model, which comprises the forethought, performance,
and self-reflection phases, as well as Pintrich’s
Motivated Strategies for Learning Questionnaire
(MSLQ).9,16,18,1,17 Interview data were transcribed,
coded, and analysed using both theory-based and
inductive coding methods. The study subjects were
third-year BDS students during the initiation of clinical
exposure in our institution. A mixed-methods study
design helped provide a comprehensive understanding
of SRL by pairing quantitative scores with individual
thoughts and approaches. This approach was suitable
for assessing both the measurable concepts of
transitioning to clinical training and the particular
challenges.

RESULTS

The transition from preclinical to clinical training in
dental education presents various challenges that affect
students’ self-regulated learning (SRL) strategies. This
section outlines the key factors identified in this study
that influence Self-Regulated Learning (SRL),
including workload, feedback mechanisms, peer
support, personal time management, and stressors.
These factors are analysed using both quantitative and
qualitative data to provide a comprehensive
understanding of their impact. The study explored the
experiences and perceptions of medical students during
their clinical placements. A total of 50 students
participated in the survey, and nine were selected for an
interview. Key findings include:

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24 J Gandhara Med Dent Sci

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Table 1: Mean scores for the Likert-scale statements by domain
S.no Domain Key points Mean

Range
1. Transition

&
Socializati
on

- Orientation was considered
essential and helpful (Mean =
4.46).
- Many felt unprepared and
faced an abrupt transition (Mean
= 2.58).
- High levels of initial stress and
nervousness were reported.

1.96 –
4.46

2 Workload Significant increase in workload
post-transition (Mean = 4.20).
- Clinical placements were tiring
(Mean = 4.12).
- Many struggled with new
routines.

3.06 –
4.20

3. Patient
Contact

Patient interaction motivated
learning (Mean = 3.88).
- Some discomfort in examining
patients (Mean = 3.36).
- Early real patient contact was
desired

3.36 –
4.00

4 Knowledg
e & Skills

- Confident in history-taking
(Mean = 4.14).
- Less confident in physical
exams (Mean = 2.96) and
starting patient conversations
(Mean = 2.54).
- Recognised gap between
theoretical and clinical
knowledge.

2.54 –
4.26

5. Learning
&
Education

Bedside and real-patient tutorials
were valued (Means ≈ 4.0+).
- Learning became more self-
directed and assessment-driven.
Junior and senior peers were
regarded as effective teachers.

3.50 –
4.28

Transition and Professional Socialisation:
Medical students experienced a range of emotions
during the transition from pre-clinical to clinical
settings. While some found the transition smooth,
others struggled with the increased workload and the
demanding clinical environment. Peer collaboration
was a positive aspect, and a need for a comprehensive
introduction to clinical placements was highlighted.
Notably, gender differences emerged, with female
students reporting higher levels of nervousness and
stress while male students experienced more
uncertainty.
Workload
A significant challenge for students was the incre ased

workload during clinical placements. A busy schedule
often limits time for self-directed learning, which in
turn impacts their ability to integrate knowledge and
skills effectively.
Patient Contact
Students generally found interacting with patients to be
a positive and stimulating experience. However, some
expressed uneasiness in examining patients,
highlighting the need for enhanced training and support.
There was a strong preference for earlier patient contact

and preparation.
in the curriculum to facilitate better understanding

Knowledge, Knowledge Application, and Skills
Students displayed varying levels of confidence in
different clinical skills. While they expressed
confidence in taking patient histories and understanding
the theoretical aspects of medicine, they faced
challenges in initiating patient conversations and
recognising pathological symptoms. Clinical staff
feedback was crucial in improving their knowledge and
skills.
Learning and Education:
Students generally observed junior and senior medical
doctors as effective teachers. Both real and simulated
patient tutorials were considered valuable learning
experiences. However, assessments had a significant
influence on study habits, with a primary focus on test
preparation. Clinical practice provided a valuable
learning opportunity, enabling students to refine their
study methods and learn from daily patient interactions.
The qualitative analysis revealed that students engaged
in various self-regulated learning (SRL) strategies
during the transition from preclinical to clinical
training. These strategies were characterised into three
main phases based on Zimmerman‘s model of self-
regulation: forethought, performance, and self-
reflection.
Forethought Phase
During the forethought phase, students actively
engaged in goal setting, task analysis, and self-
motivation. They created weekly study plans, identified
key topics, and developed effective study strategies to
enhance their learning. A student commented, "I plan
every week ahead of time." This positive approach
demonstrates their commitment to organising their
learning.

Factors Influencing Self-Regulated Learning of Dental

25J Gandhara Med Dent Sci
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Table 2: Explanation of How Third-Year Dental Students Engage
the Forethought Phase of Srl in a Transition Phase

Performance Phase
Students adopted a range of strategies to enhance their
learning, including rehearsal, elaboration, articulation,
organisation, and self-testing. They used various
techniques such as note-taking, drawing diagrams, and

summarising material in their own words. One student
stated, "I draw diagrams. Text doesn’t make sense to
me, but a picture does," highlighting the importance of
visual learning for some students.

Table 3: Explanation of how Third-year medical students engage
the Performance Phase of SRL in the Transition phase

Tasks Behaviours Examples
Rehearsal

Repeating notes and
course materials to
support memorisation
and recall

"I give multiple passes at the
material. I first get a sense of
the basics, then revisit after
some time."

Elaborati
ng

Connecting new
knowledge to
previous learning

―When I start a new topic, I
always try to relate it to
something we studied earlier -
it helps me understand and
remember it better."

Articulati
ng main
ideas

Summarising and
paraphrasing
material in one’s
own words

I read multiple books and
rephrased them in a way that
suits the course." This
strategy is effective for learners
who prefer to synthesis
different perspectives.

Organisi
ng

Synthesising ideas
and clustering
information through
frameworks

―I use videos as a starting
point. Then I go into textbooks
for details." Some prefer
visual learning tools, such as
videos, for an initial understan-
ding of complex topics.

Self-
Testing

Using flashcards or
other learning
resources to self-
test knowledge

" After watching videos, I use
flashcards to retain the material.

" Flashcards work well for
students who prefer active recall
methods to test themselves.

Tasks Behaviours Examples Quotes
Goal
Setting

Setting study goals
for the week

"I plan every week ahead of
time." "For every week, I take
one subject and study it for
the whole week."

Organising study
sessions for clinical
rotations

"First, I plan for the clinical
quota. I study for clinical
rotations these days." "I
utilise my weekends for study."

Task
Analysis

Analysing the
syllabus to identify
key topics

"First, you should know the
syllabus?" -Which chapter is
more important?

Preparing
systematically for
upcoming tests

"I start 2-3 days before the
test. I do read first."
"I have a plan, but it’s all in
my mind due to family
commitments."

Self
Motivatio
n Beliefs

Gaining confidence
in study methods

"I feel comfortable when I
plan first." "I study through
YouTube because I can’t read
many books."

Setting realistic
outcomes for study
efforts

“I keep weekends for studying."
"I prefer reading directly from

the book as making notes is a
wastage of time to me."

Bridging theoretical
knowledge to
clinical applications

"I relate pre-clinical
knowledge to clinical
settings."

Self-Reflection Phase
Students actively engaged in self-evaluation, course
evaluation, co-reflection, self-judgment, and self-
reaction. They evaluated their learning progress,
identified areas for improvement, and adjusted their
study strategies accordingly. A student mentioned, "I
evaluate my learning at the end of each week,"
demonstrating their dedication to ongoing self-
assessment. These findings highlight the complicated
nature of SRL and the importance of these strategies in
supporting students' learning during the transition to
clinical practice. By understanding the specific
techniques employed by students, educators can
develop targeted interventions to enhance self-regulated
learning (SRL) and improve student outcomes.

Table 5: Explanation of How First-Year Medical Students
Engage the Self- Reflection Phase of Srl

Tasks Behaviours Examples
Self-
Evaluation

Utilise question
banks, flashcards, or
learning objectives to
quiz yourself and
adjust your study
habits as needed.

"I evaluate my learning at
the end of each week."
"Using charts to track what I
have learned."

Course-
Evaluation

Use grades and both
summative and
formative evaluations
at the end of each
course to reflect on
performance and
adjust your study
strategies.

"I had to change my
strategies multiple times."
"Adapting study strategies
by increasing study time."

Co-
Reflection

Use peer preparation
as a benchmark to
assess understanding
and engage in peer
learning.

" If I get stuck, I compare
with peers." "In group study,
I learn facts I missed."

Self-
Judgment

Mentally assess
knowledge and use
quizzes to check
understanding

"I assess in my mind whether
I know it or not." "I will
open its MCQs/ quiz and
see. If I feel that I am solving
it, then I will know that I can
move on to the next topic."

Self-
Reaction

Gauge satisfaction
with learning
progress and make
decisions about focus
areas

"If I remember it, then I
move on to another topic."
"If I start forgetting
something, or if I am not
able to solve it, then I need
to focus more on this topic."

DISCUSSION

The transition from preclinical to clinical training is a
critical phase in dental education and medical
education, bringing about significant changes in how
students adjust to self-regulated learning (SRL). The

Factors Influencing Self-Regulated Learning of Dental

26 J Gandhara Med Dent Sci July - September 2025

results of this study offer a substantial understanding of
the variables affecting SRL during this transition,
emphasising the complex relationship between
strategies like using feedback, peer support, and time
management and demands (like workload and stress).4
This study explored factors influencing self-regulated
learning (SRL) among dental students transitioning
from pre-clinical to clinical training at Watim Medical
and Dental College, Rawalpindi. The transition was
marked by increased stress and anxiety, particularly for
female students.
Gender Differences in Transition Stress
Female students experienced more stress, needed more
time to adapt, and felt uncertain. This aligns with
previous studies reporting higher stress levels among
female medical students.5 Cultural expectations,
differences in psychological handling, and inequalities
in access to support networks are the multiple
contributing factors. Another factor could be societal
expectations of gender roles, which may put pressure
on female students to succeed in industries that men
have traditionally dominated.6
Gaps in Foundational Knowledge and Clinical
Application
Students struggled to apply theoretical knowledge to
practical settings, highlighting the need for early
clinical experience. A thorough introduction to clinical
placements is essential, as evidenced by the high mean
score (4.38) assigned to this statement. Students noted
significant gaps in basic science concepts and
challenges in integrating theory with practical
applications. Educators should adopt teaching styles
that incorporate patient-based or problem-based clinical
learning, which aids in retention and skills acquisition.7
Workload Management and Academic Stress
Clinical placements were recognised as significantly
more demanding than pre-clinical training. Students
struggled to balance academic and clinical
responsibilities, with long hours negatively impacting
study time. Structured timetables, study hours, and
stress management workshops can help students better
manage their workload.8
Self-Regulated Learning Strategies and Adaptation
The forethought phase of SRL, encompassing goal-
setting and time management, is crucial for effective
adaptation. Students established metacognitive abilities,
monitoring and regulating their learning processes.
Encouraging active learning strategies and guiding
students to set realistic goals can facilitate work-life
balance.9
Resilience and Adaptability in Transition
Transitioning from a preclinical to a clinical
environment requires adaptability and resilience to cope
with new role expectations. Evidence suggests that
resilience training programs can reduce stress and

promote success.10 Incorporating resilience and mental
well-being training into medical education is essential.
Implications for Education
1. Integrate clinical experience earlier in the
curriculum.
2. Provide comprehensive orientations to the clinical
environment.
3. Implement structured timetables and study hours.
4. Offer stress management workshops and mentorship
programs.
5. Foster self-regulated learning strategies.

LIMITATIONS

The relatively small sample size, drawn from a single
institution, confines the generalizability of the findings,
meaning that the factors influencing SRL identified
here may not fully represent the experiences of dental
students across different institutions or regions.
Additionally, the cross-sectional design provides only a
glimpse of students’ SRL practices during their
transition to clinical training. Future longitudinal
research is recommended to understand better how SRL
strategies evolve, especially as students gain more
clinical experience and encounter varied learning
environments. A larger and more diverse sample should
be considered to gain a more detailed understanding of
SRL trends. Particularly, interventions such as
enhanced orientation programs and structured
mentorships support smoother transitions and
strengthen self-regulated learning (SRL).

CONCLUSIONS

This study sheds light on the factors influencing self-
regulated learning (SRL) among dental students during
the transition from preclinical to clinical training.
Findings emphasise that students, particularly female
students, encounter greater stress and challenges in
adjusting to clinical settings, managing workloads, and
transforming theoretical knowledge into practice. There
is potential for reducing these stressors and promoting a
smoother transition by addressing these difficulties
through individual support, such as structured
orientation, resilience training, and gender-sensitive
mentorship programs. Students’ confidence and
comprehension of the clinical relevance of their studies
may be enhanced by incorporating practical
simulations, early patient contacts, and continuity of
care experiences into the preclinical curriculum.
Additionally, structured programs for goal-setting, time
management, and mentorship, led by trained senior
students, may enhance students’ self-regulation and
learning (SRL) skills, offering practical guidance.
Introducing resilience workshops focused on coping

Factors Influencing Self-Regulated Learning of Dental

27J Gandhara Med Dent Sci

July - September 2025

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strategies and reflective practices can further support
students in managing stress and developing a proactive
approach to challenges in clinical training. By bridging
the gap between preclinical and clinical training, this
study offers valuable insights into the development of
instructional strategies that can ultimately provide a
positive learning environment. Future studies should
examine how these SRL interventions impact academic
and clinical outcomes over time, as well as how gender
influences stress, to inform the development of targeted
solutions. The generalizability of these findings will be
enhanced by extending the research across various
institutions and backgrounds, enabling educators to
support students more effectively in achieving learning
success, adaptation, and overall well-being.

CONFLICT OF INTEREST: None

FUNDING SOURCES: None

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Factors Influencing Self-Regulated Learning of Dental

Summaya Wajid - Concept & Design; Data Acquisition;Data
Analysis/Interpretation; Drafting Manuscript; Final Approval
Nowshad Asim - Concept & Design; Data Acquisition;
Drafting Manuscript; Critical Revision; Final Approval
Brekhna Jamil - Concept & Design; Data Acquisition;
Drafting Manuscript; Critical Revis i o n ; Supervision;

Syeda Shamal -
Drafting Manuscript; Final Approval
Alia Jehan Zaib - Concept & Design; Data Acquisition;
Drafting Manuscript; Critical Revision; Final Approval
Rizwan Ullah - Concept & Design; Data Acquisition; Data
Analysis/Interpretation; Drafting Manuscript;

Final Approval
Concept & Design; Data Acquisition;

Critical Revision; Final Approval

AUTHORS CONTRIBUTION

The authors accept responsibility for all aspects of the work
and will ensure that any concerns regarding the accuracy or
integrity of any part are properly investigated and resolved.