
==== Front
J Educ Health Promot
J Educ Health Promot
JEHP
J Edu Health Promot
Journal of Education and Health Promotion
2277-9531
2319-6440
Wolters Kluwer - Medknow India

JEHP-13-243
10.4103/jehp.jehp_1849_23
Original Article
Readiness for self-directed learning among basic sciences medical students
Dehghani Gholamali
Ghaffarifar Saeideh
Medical Education Research Centre, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
Address for correspondence: Dr. Gholamali Dehghani, Department of Medical Education, Education Development Centre, Tabriz University of Medical Sciences, Tabriz, Iran. E-mail: dehghani_gholamali@yahoo.com
2024
11 7 2024
13 24311 11 2023
22 1 2024
Copyright: © 2024 Journal of Education and Health Promotion
2024
https://creativecommons.org/licenses/by-nc-sa/4.0/ This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
BACKGROUND:

Self-directed learning is a required skill for medical students for remaining lifelong learners. This study focuses on measuring the readiness for self-directed learning of basic sciences medical students.

MATERIALS AND METHOD:

In the second half of 2022, a descriptive cross-sectional study was conducted on 288 basic sciences medical students at Tabriz University of Medical Sciences in Iran. The students were selected using convenience sampling. The instrument used was Fisher’s self-directed learning readiness (SDLR) scale consisting of “self-management”, “desire for learning”, and “self-control” domains. The data were analyzed by SPSS-25 and also by using descriptive statistics [mean, standard deviation (SD), median, frequency, and percentage] and inferential statistics techniques (Chi-square test and t-test, ANOVA, and MANOVA). Statistical significance was set at P < 0.05.

RESULT:

The results revealed that the scores of 63.9% students were more than 150. Also, the mean total score of self-directed learning readiness was 152.98 (SD = 16.76), suggesting that the self-directed learning readiness of the students was high level. The highest score was for “self-control” (59.99 ± 6.95), followed by “desire for learning” (46.99 ± 5.64) and “self-management” (46.01 ± 7.07). The total SDLR score and its three sub-scales did not show any notable interdependence with student contextual factors (age, gender, marital and residential status). However, a higher cumulative grade point average (>17) showed a significant higher mean in the “self-management” domain of SDLR among medical students (F = 3.730; P = 0.025).

CONCLUSION:

To become life-long learners, self-directed learning is crucial for medical students. The basic sciences medical students participating in this study showed a high level of SDL readiness. Even though the students obtained the highest score for the self-control sub-scale, the desire for learning and self-management skills needs further improvement, which can be achieved through multi-disciplinary approaches.

Curriculum
lifelong learner
medical education
SDLRS score
self-directed learning
==== Body
pmcIntroduction

Medicine is considered to be one of the fastest evolving fields of knowledge.[1] In various learning domains, the traditional teacher-centered curriculum is predominantly focused on knowledge acquisition rather than skills.[2] Thus, the traditional education procedure is insufficient to meet the demands of dynamically changing medical science and the fast-growing medical field.[3] Medical professionals should master the latest medical technologies and methods to maintain professional competence and to serve patients better. It is highly demanded of medical education to prepare students to be lifelong learners.[4]

Self-directed learning (SDL) is a well-structured educational method frequently used as a crucial skill in the current century.[5] SDL, as proposed by Knowles, is one of the critical components of adult learning. Knowles provided one of the earliest and most widely used definitions. In his view, SDL consists of a five-step process: Individuals come forward, with or without the help of others, in (1) diagnosing their learning needs, (2) creating learning goals, (3) identifying the human and material resources for learning, (4) choosing and applying appropriate learning strategies, and (5) evaluating learning outcomes.[6] Learners’ willingness to drive their own learning was added later to the definition of SDL.[7] SDL gives learners the freedom and sovereignty to choose the what, why, how, and where of their learning.[8] As a result, the students learn on their own initiative and have primary responsibility for planning, conducting, and evaluating the effort and outcome. The responsibility of the learning process remains with students.[9] Some of the learners in a formal classroom setting will be ready to participate in SDL strategies; others will not. Consequently, teachers play an important role in helping learners develop and apply SDL skills.[10] SDL requires a coach to accommodate and guide students. Effective coaching is the result of learning from interactions with students, cooperation, exchanging learning materials, and giving encouragement to the learners.[11]

SDL is seen as an important element of lifelong learning and is thus emphasized in medical school curricula.[12] As scientific knowledge constantly develops, medical professionals should be able to learn and upgrade their competency from time to time in today’s society.[13] SDL is a process that can motivate students to continue learning, making them independent learners and ensuring lifelong learning.[1415] SDL is a necessary teaching–learning method for transforming medical students into lifelong learners, which enables them to identify their learning needs, adapt resources, formulate learning objectives, and evaluate the learning process throughout their medical career. In SDL, medical students should take the initiative in their own learning to deal with an educational challenge and as a propitious methodology for lifelong learning in medicine.[16]

Medical education aims to develop and promote SDL among students. The goal is for students to attain a level of individual competence where they can identify and meet their educational needs without being in a specific educational system. Additionally, they should be able to evaluate their learning. Incoming medical students tend to rely more on their families and teachers, have less experience with SDL during their school years, and are more accustomed to rote learning. Classroom dynamics would differ significantly from traditional instruction in this educational paradigm shift. Therefore, students’ readiness presents a challenge.[5] Considering the significance of SDL in medicine, it may be necessary to increase learning activities that promote SDL in the current curriculum. Additionally, it is crucial to consider strategies that can modify the learning environment to facilitate SDL. This study aimed to measure the readiness for SDL among basic sciences medical students at Tabriz University of Medical Sciences.

Material and Methods

Study design and setting

In the present study, the descriptive cross-sectional method was applied. Several researchers have developed scales to evaluate SDL readiness, such as the Self-directed Learning Readiness Scale (SDLRS),[171819] the Self-rating Scale of SDL (SRSSDL),[20] and the Self-directed Learning Instrument (SDLI).[21] In this study, the SDLR scale developed by Fisher, King, and Tague was used.[18] This scale was translated and standardized into Persian for the first time by Nadi and Sadjadian[22] in Iran, and the internal reliability of the Persian version of the scale was confirmed by calculating the Cronbach’s alpha coefficient for the scale (α =0.82) and the self-management (α = 0.78), desire for learning (α = 0.71), and self-control (α = 0.60) sub-scales. Moreover, according to the results of the validating factor analysis, the construct validity of the scale was favorable. In addition, the validity and reliability of the Persian version of this scale have been confirmed in various studies.[23242526] The internal consistency reliability for the SDLR in this study had an overall Cronbach’s α coefficient of 0.92, and as for the three domains, it was 0.86 (SM), 0.80 (DL), and 0.863 (SC).

Study participants and sampling

This study was conducted in the second half of 2022 at the Faculty of Medicine, Tabriz University of Medical Sciences in Iran. The study population was all year-one and year-two medical students (N = 1200). The research sample consisted of 288 students that were selected by the convenience sampling method. The study’s inclusion criteria required each eligible student to (1) be currently registered in faculty of medicine, (2) be a basic sciences medical student, and (3) have consented to participate in the study.

Data collection tool and technique

Data were collected using a two-part online questionnaire (avalform.com). The first part of the questionnaire asked for contextual factors such as gender, marital status, residential status, age, and cumulative grade point average (CGPA). The second part of the questionnaire was the SDLR scale.[18] This tool includes a 40-item questionnaire using a 5-point Likert scale (1–5) of strongly disagree, disagree, undecided, agree, and strongly agree. Overall scores range from 40 to 200; higher scores reflect stronger SDLRS. Mean scores ≥150 represent a high level of SDLR scale, while mean scores <150 indicate a low level of SDLR scale. Also, the SDLR scale identified three sub-scales with their corresponding Cronbach’s alpha score: self-management (SM, α = 0.92), desire for learning (DL, α = 0.85), and self-control (SC, α = 0.83). The self-management sub-scale is delineated by 13 items and reflects about the characteristics of being able to manage one’s own learning. The maximum score of this sub-scale is 65. The desire for learning sub-scale is defined by 12 items, and the maximum score of this sub-scale is 60. The self-control sub-scale is defined by 15 items related to the self-control features and being in control of one’s own learning process. The maximum score obtainable from this sub-scale is 75. Mean scores were computed for the three sub-scales with higher mean scores indicating higher levels of SM, DL, and SC.[18] Also, the validity of this scale has been reported by the construct validity method and by using the confirmatory factor analysis method.[19]

The collected data were analyzed using SPSS version 25, and for statistical analysis, descriptive statistics [mean, standard deviation (SD), frequency, and percentage] and inferential statistics techniques (t-test, ANOVA and MANOVA) were used. Statistical significance was set at P < 0.05.

Ethical consideration

Before starting the study, written approval was obtained from the Research Ethics Committee of University (IR.TBZMED.REC.1401.479). The students in the target population were informed about the purpose of the study, and it was emphasized to them that they could withdraw from the study at any time they wished without any consequences. Written consent was obtained from all the students prior to their participation in the study. In addition, the fact that personal information would not be disclosed to third parties and compliance with the principle of “Privacy and Protection of Privacy” ensured.

Results

A total of 288 medical students participated in the survey. The participants’ ages ranged from 17 to 38 years, with a mean age of 20.15 (SD = 1.92). 151 male students (52.4%) and 137 female ones (47.6%) took part in the study, and most of the participants were single (98.6%). About half of the participants (47.9%) lived with their families, and 42.0% lived in university dormitories. About 40% (39.9%) reported a CGPA >17, and the mean CGPA of the participants was 16.68 (SD = 1.53) score. The details are shown in Table 1.

Table 1 Contextual factors of basic sciences medical students (n=288)

Variables	Category	Frequency	Percent	
Age	<19	100	34.7%	
20-21	155	53.8%	
>22	33	11.5%	
Gender	Male	151	52.4%	
Female	137	47.6%	
Marital status	Single	284	98.6%	
Married	4	1.4%	
Residential status	University’s dormitory	121	42.0%	
Private dormitory	7	2.4%	
Family housing	138	47.9%	
Individual housing	22	7.6%	
*CGPA	<14.99	22	7.6%	
15-16.99	98	34.0%	
>17	115	39.9%	
Missing	53	18.4%	
Notes: *cumulative grade point average

Table 2 indicates that the SDLR score ranged from a low of 44 to a high of 199. Out of 288 students, 184 (63.9%) scored >150. The mean score obtained from the “self-control” sub-scale (59.99 ± 6.95) is the highest, and the score obtained from the “desire for learning” sub-scale (46.99 ± 5.64) is higher than the score obtained from the “self-management” sub-scale (46.01 ± 7.07). The mean total score of SDL readiness was 152.98 (SD = 16.76), indicating that the SDLR of the students was high level.

Table 2 Self-directed learning readiness and sub-dimensions in basic sciences medical students (n=288)

Variables	Items	Min	Max	Median	Mean	SD	
Self-Management	13	17	65	47	46.01	7.07	
Desire for learning	12	12	60	47	46.99	5.64	
Self- Control	15	15	75	60	59.99	6.95	
SDLR Total Scores	40	44	199	154	152.98	16.76	
Notes: 184 (63.9%) participants achieved score ≤150 indicates positive attitude

The mean score of SDLR is shown in Table 3, and out of 40 items of measuring SDLR, 14 items scored 4 and above (SM: 1 item, DL: 5 items and SC: 8 items). The highest mean item scores under SC and DL were registered for “I am responsible for my own decisions/actions” (4.35 ± 0.68) and “I want to learn new information” (4.31 ± 0.69), respectively. The lowest mean score under SM was registered for “I set strict time frames” (2.63 ± 0.98). The details are shown in Table 3.

Table 3 Mean score of individual items of the self-directed learning readiness scale

Item/Domain	Mean	SD	
I manage my time well	3.06	0.99	
I am self-disciplined	3.44	0.90	
I am organized	3.31	0.95	
I set strict time frames	2.63	0.98	
I have good management skills	3.55	0.92	
I am methodical	4.05	0.73	
I am systematic in my learning	3.90	0.81	
I set specific times for my study	3.36	0.96	
I solve problems using a plan	3.48	0.87	
I prioritize my work	3.80	0.86	
I can be trusted to pursue my own learning	3.76	0.80	
I prefer to plan my own learning	3.92	0.83	
I am confident in my ability to search out information	3.75	0.83	
“Self-Management” Domain	3.53	0.54	
I want to learn new information	4.31	0.69	
I enjoy learning new information	4.26	0.77	
I have a need to learn	4.17	0.75	
I enjoy a challenge	3.91	0.94	
I enjoy studying	3.77	0.93	
I critically evaluate new ideas	3.23	1.00	
I like to gather facts before I make a decision	4.04	0.75	
I like to evaluate what I do	3.89	0.78	
I am open to new ideas	3.70	0.88	
I learn from my mistakes	3.90	0.80	
I need to know why	4.09	0.82	
When presented with a problem I cannot resolve, I will ask for assistance	3.71	0.87	
“Desire for learning” Domain	3.91	0.47	
I prefer to set my own goals	4.05	0.68	
I like to make decisions for myself	4.22	0.75	
I am responsible for my own decisions/actions	4.35	0.68	
I am in control of my life	3.85	0.80	
I have high personal standards	3.81	0.80	
I prefer to set my own learning goals	4.10	0.74	
I evaluate my own performance	3.78	0.80	
I am logical	4.04	0.80	
I am responsible	4.09	0.74	
I have high personal expectations	4.23	0.82	
I am able to focus on a problem	4.21	0.85	
I am aware of my limitations	3.83	0.82	
I can find out information for myself	3.82	0.76	
I have high beliefs in my abilities	3.88	0.93	
I prefer to set my own criteria on which to evaluate my performance	3.73	0.79	
“Self-Control” Domain	3.99	0.46	
Self-directed Learning Readiness Scale	3.82	0.41	
Notes: Adapted from Nurse Education Today. 2001; 21(7):516-525.[18]

The relation between contextual factors and SDLR (total and subscale of SDL scores) is shown in Table 4. Regarding the association of SDLR with the selected characteristics of students, a higher CGPA (>17) shows a significant higher mean in the self-management domain of SDLR among medical students (F = 0.720, P = 0.025). In other two domains, that is, desire for learning and self-control, higher mean scores were observed in higher CGPA, even though the difference was not notable. Nevertheless, no significant relationship was revealed between students’ SDLR and their age, gender, and marital and residential status [Table 4].

Table 4 Relationship between contextual factors and SDLR scale

Variables	Category	SM	DL	SC	SDL	
Age	<19	46.63±7.28	47.15±5.98	59.78±8.03	153.56±18.42	
20-21	45.51±7.11	46.63±5.62	60.01±6.64	152.14±16.56	
>22	46.45±6.18	48.18±4.65	60.55±4.59	155.18±11.83	
Statistical test	F=0.836	F=1.099	F=0.150	F=0.537	
P	0.435	0.335	0.860	0.585	
Gender	Male	46.51±7.70	46.96±5.86	60.11±7.28	153.58±18.04	
Female	45.45±6.28	47.01±5.41	59.85±6.59	152.32±15.26	
Statistical test	t=1.268	t=-0.081	t=0.315	t=0.637	
P	0.206	0.935	0.753	0.524	
Marital status	Single	46.01±7.10	46.97±5.65	60.02±6.99	153.00±16.83	
Married	45.75±5.18	48.00±5.47	58.00±2.44	151.57±11.17	
Statistical test	t=0.073	t=-0.361	t=0.575	t=0.148	
P	0.942	0.718	0.565	0.883	
Residential status	University’s dormitory	45.59±6.78	46.73±5.12	59.83±6.60	152.14±14.91	
Private dormitory	45.29±5.99	45.71±5.70	57.00±5.97	148.00±14.54	
Family housing	46.61±6.75	47.41±4.92	60.38±6.44	154.40±15.44	
Individual housing	44.77±10.37	46.18±10.75	59.36±11.23	150.32±30.30	
Statistical test	F=0.720	F=0.604	F=0.658	F=0820	
P	0.504	0.613	0.578	0.484	
CGPA	<14.99	43.45±8.04	45.64±4.84	58.59±6.24	147.68±15.89	
15-16.99	45.09±6.74	46.61±5.24	60.03±7.24	151.73±15.84	
>17	47.15±7.17	47.39±6.52	60.08±7.35	154.62±18.70	
Missing	43.45±8.04	45.64±4.84	58.59±6.24	147.68±15.89	
Statistical test	F=3.730	F=1.028	F=0.413	F=1.780	
P	0.025*	0.359	0.662	0.171	
Notes: *The significance level is <0.05

Discussion

This study investigated the readiness for SDL among the first-semester medical students by using SDLRS which was developed by Fisher et al.[18] The results show that more than 63.9% of the students scored above 150. Compared to previous studies, the results of the present study were generally higher[2728293031] but lower than the scores reported in three studies.[323334]

Results indicated that basic sciences medical students had a high readiness for self-directed learning. The mean scale score of the SDLR was 152.98 ± 16.76, which was higher than the cutoff score of ≥150. According to Fisher et al.,[18] the developers of the scale, total scores higher than 150 indicate positive attitude toward readiness for SDL and high SDLR. Many studies can be found with similar results to the present study. In studies that have been previously conducted on medical sciences students in Australia,[1835] Turkey,[36] China,[28] India,[2734] Saudi Arabia,[3337] Taiwan,[38] Nepal,[32] Philippines, Thailand,[37] and Iran,[24252639] students’ SDLR levels have been reported to be high. According to Owen,[40] individuals with higher levels of self-direction readiness can select their learning targets, the activities they will perform, and the sources they will reach in a more effective way. SDL’s main focus is on the learning process and its outcomes.[41] The students who are ready for SDL can manage their own learning throughout their career.[42] However, these findings contradict with the results of several studies that indicate medical sciences students reported a low level of SDLR.[29303143] The low SDLR in these studies could be the result of many factors, such as students’ attributes, their cultural and educational background, and unfamiliarity with the process.[4445] To have good SDLR and be capable and independent learners, the students need to be supervised for SDL at a very young age and they have to be encouraged to participate in learning activities that improve their intellectual growth and cognitive functions to help control their behavior, emotions, motivation, and self-regulation. The necessary techniques for improving self-direction skills in higher education are the individualized teaching–learning process and contract learning.[46]

According to the study findings, the highest mean sub-scale score was obtained for SC, followed by DL, while the lowest score was obtained for SM, similar to the findings of other studies.[1824272935] This result is congruent with many studies that the mean sub-scale score obtained for SC was the highest, followed by SM and DL.[252630333439] Then again, this result contradicts with the findings of several studies that the mean sub-scale score for DL was the highest, followed by SC and SM.[374347] Moreover, Örs[36] has reported that the highest score was for DL, followed by SM and SC.

These findings were also consistent with AlRadini et al.,[29] who stated that the undergraduate students in the first to fifth years in Saudi Arabia scored the highest for the SC sub-scale and the least for SM. On the other hand, Abraham et al.[27] reported that the first-year undergraduate medical students in India scored the highest for the SC domain and the least for SM. Also, Soltani Arabshahi and Naeimi[24] found that the highest score obtained by the medical students (Basic sciences, Pre-clinical period, Clerkship) in Tehran University of Medical Sciences was for SC and the least score was for SM. However, this result contradicts Kumar et al.,[43] who mentioned that the first-year undergraduate medical students in India scored the highest for the DL sub-scale and the least for SM. Moreover, Soliman and Al-Shaikh[47] found that the highest score obtained by first-year Saudi medical students was for the Dl domain, while the least score was for the SM domain.

The current study threw a light on the fact that despite having a high desire for learning and having self-control ability, students need support in self-management skills, especially in domains of planning and time management for learning. Based on the results of the current study, it would be reasonable to plan specific strategies concerning the improvement of self-management skills of students in order to improve their academic performance. As a result, it is advised that practical programs must be planned to improve self-management skills of basic sciences medical students. This goal can be achieved through extra-curricular workshops particularly designed to tackle specific items.

In this study, the highest mean item score under SDLR was recorded for “I am responsible for my own decisions/actions”. This is in agreement with Soliman and Al-Shaikh,[47] Abraham et al.,[27] and AlRadini et al.[29], while other authors registered “I manage my time well” and “I prioritize my work”,[18] “I want to learn new information”,[43] and “I enjoy learning new information”.[24] The lowest mean item score on the SDLR was recorded for “I set strict time frames,” similar to the study by Kumar et al.,[43] Abraham et al.,[27] and Soltani Arabshahi and Naeimi.[24] However, other studies have shown the lowest mean scores for “I do not manage my time well”,[29] “I am not in control of my life”,[47] and “I am systematic in my learning”.[18]

In the current study, the total SDLR score and its three sub-scales did not show any significant correlation with student contextual factors (e.g., age, gender, marital and residential status). Also, many of the available studies did not recognize any correlation between students’ demographic variables (e.g., age, gender, marital and residential status) and SDLR.[222526303439] Conversely, this result contradicts Örs,[36] who stated that there was a statistically significant difference between the genders in terms of their SDLR scale scores. Male students scored lower than female students. Moreover, Naeimi et al.[48] reported that the score obtained by the female participants from the SDLR scale and SM sub-scale was statistically and significantly lower compared to that of the male participants.

According to the study findings, a higher CGPA (>17) showed a significant higher mean in the SM domain of SDLR among medical students, while in the SDLR scale and other two domains, that is, DL and SC, a higher mean score was observed in higher CGPA, though the difference was not significant. These results were consistent with Ballad et al.[30] However, Naeimi et al.[48] and Nadi et al.[23] found that there was no significant difference between SDLR scores and CGPA scores. Many previous studies have found that students exhibiting lower academic performance (e.g. GPA) had lower levels of SDL readiness.[495051] Evidence suggests that students on academic probation have poor study habits, test preparation techniques, time management, and self-regulation skills.[52]

Limitations and recommendation

It is important to consider the limitations of this study when interpreting the results. For instance, the study only included basic science medical students at Tabriz University of Medical Sciences and did not encompass students from other universities in Iran. Additionally, the study relied on an online self-report questionnaire to explore student perceptions, which is not a direct measure of their SDL readiness. Further longitudinal studies are recommended to investigate the relationship between students’ SDLR scores and their academic performance.

Conclusion

This study shows that SDLR is crucial for medical students to develop lifelong learning skills. The basic sciences medical students in this study exhibited a high level of SDL readiness. Even though students obtained the highest score for the self-control sub-scale, the desire for learning and self-management skills needs further improvement which can be achieved through multi-disciplinary approaches. Therefore, further studies are needed to determine the reasons for SDLR deterioration among medical students during their clinical years.

Ethical approval

This study received ethical approval from the Research Ethics Committee of Tabriz University of Medical Sciences (Approval ID: IR.TBZMED.REC.1401.479).

Financial support and sponsorship

This research was supported by the Medical Education Research Centre of Tabriz University of Medical Sciences.

Conflicts of interest

There are no conflicts of interest.

Acknowledgments

This study was granted ethical approval by the Research Ethics Committee of Tabriz University of Medical Sciences (Approval ID: IR.TBZMED.REC.1401.479). The author expresses gratitude to the Medical Education Research Centre of Tabriz University of Medical Sciences for financially supporting this study (Project Number: 69952), as well as the medical students who participated in this study.
==== Refs
References

1. Williamson JW German PS Weiss R Skinner EA Bowes F 3rd Health science information management and continuing education of physicians. A survey of U.S. primary care practitioners and their opinion leaders Ann Intern Med 1989 110 151 60 2909205
2. Quintero GA Medical education and the healthcare system--why does the curriculum need to be reformed? BMC Med 2014 12 213 25387484
3. Charokar K Dulloo P Self-directed learning theory to practice: A footstep towards the path of being a life-long learne J Adv Med Educ Prof 2022 10 135 44 35910513
4. Yang C Zhu Y Jiang H Qu B Influencing factors of self-directed learning abilities of medical students of mainland China: A cross-sectional study BMJ Open 2021 11 e051590
5. Mohamed ER Alotaibi BK Alhaddad FM Aljohani RI Alhussain FM Albulaihed SA Self-directed learning readiness among Saudi undergraduate medical students in the pre-clinical versus clinical years Int J Med Dev Ctries 2023 7 665 71
6. Knowles MS Self-directed Learning: A Guide for Learners and Teachers Chicago Follett Publishing Company 1975
7. Raychaudhuri S Kahlon N Sidam D Singh M Pujani M Singh K Introducing case study-based panel discussion as an effective means of self-directed learning in phase 2 MBBS students: A cross-sectional study on MBBS phase 2 students J Clin Diagn Res 2023 17 EC05 8
8. Francis H The Role of Technology in Self-directed Learning: A Literature Review England ACS Center For Inspiring Minds 2017
9. Khiat H Academic performance and the practice of self-directed learning: The adult student perspective J Furth High Educ 2017 41 44 59
10. Brandt WC Measuring Student Success Skills: A Review of the Literature on Self-Directed Learning 21st Century Success Skills. National Center for the Improvement of Educational Assessment 2020
11. Noh GO Kim DH Effectiveness of a self-directed learning program using blended coaching among nursing students in clinical practice: A quasi-experimental research design BMC Med Educ 2019 19 225 31234843
12. Anil D Kumar DS Murthy M Self-directed learning: The impact among medical students J Med Educ Dev 2023 16 21 7
13. Kidane HH Roebertsen H van der Vleuten CPM Students’ perceptions towards self-directed learning in Ethiopian medical schools with new innovative curriculum: A mixed-method study BMC Med Educ 2020 20 7 31914977
14. Ahmadi S Sohrabi S Habibi A Arabzadeh N Assessment of self-directed learning readiness in nursing students of Shahid Beheshti University of Medical Sciences in 2020 J Nurs Educ 2022 10 44 52
15. Dulloo P Singh S Vedi N Singh P Development and implementation of a self-directed learning readiness scale for undergraduate health professional students J Educ Health Promot 2023 12 43 37113439
16. Thota S Nimmanapalli HD Bitla AR Implementation and evaluation of self-directed learning activity in biochemistry for first-year MBBS students J Med Educ 2022 21 e126957
17. Guglielmino LM Development of the Self-Directed Learning Readiness Scale University of Georgia 1977
18. Fisher M King J Tague G Development of a self-directed learning readiness scale for nursing education Nurse Educ Today 2001 21 516 25 11559005
19. Fisher MJ King J The Self-Directed Learning Readiness Scale for nursing education revisited: A confirmatory factor analysis Nurse Educ Today 2010 30 44 8 19541394
20. Williamson SN Development of a self-rating scale of self-directed learning Nurse Res 2007 14 66 83 17315780
21. Cheng SF Kuo CL Lin KC Lee-Hsieh J Development and preliminary testing of a self-rating instrument to measure self-directed learning ability of nursing students Int J Nurs Stud 2010 47 1152 8 20223455
22. Nadi MA Sadjadian I Validation of a self-directed learning readiness scale for medical and dentistry students Iran J Med Educ 2011 11 174 182
23. Nadi M Yosefy A Changiz T Medical and dentistry students’ perceptions of self directed learning and its relationship with personal traits J Strides Dev Med Educ 2012 8 173 181
24. Soltani Arabshahi SK Naeimi L Assessment of the current situation of-self-directed learning skills in medical students Razi J Med Sci 2013 20 10 9
25. Jafari Sani H Mohamadzadeh Ghasr A Garavand H Hosseini SA Learning styles and their correlation with self-directed learning readiness in nursing and midwifery students Iran J Med Educ 2013 12 842 53
26. Sadeghi M Khalili Geshnigani Z The role of self-directed learning on predicting academic buoyancy in students of Lorestan university of medical sciences Res Med Educ 2016 8 9 17
27. Abraham RR Fisher M Kamath A Izzati TA Nabila S Atikah NN Exploring first-year undergraduate medical students’ self-directed learning readiness to physiology Adv Physiol Educ 2011 35 393 5 22139776
28. Yuan HB Williams BA Fang JB Pang D Chinese baccalaureate nursing students’ readiness for self-directed learning Nurse Educ Today 2012 32 427 31 21458116
29. AlRadini F Ahmad N Ejaz Kahloon L Javaid A Al Zamil N Measuring readiness for self-directed learning in medical undergraduates Adv Med Educ Pract 2022 13 449 55 35547868
30. Ballad CAC Labrague LJ Cayaban ARR Turingan OM Al Balushi SM Self-directed learning readiness and learning styles among Omani nursing students: Implications for online learning during the COVID-19 pandemic Nurs Forum 2022 57 94 103 34676552
31. Mirzaei-Alavijeh M Karami-Matin B Hosseini N Rahimi S Jalilian F Self-directed learning readiness and the associated contextual factors among Kermanshah University of Medical Sciences Students Educ Strategy Med Sci 2017 10 431 7
32. Gyawali S Jauhari AC Shankar PR Saha A Ahmad M Readiness for self directed learning among first semester students of a medical school in Nepal J Clin Diagn Res 2011 5 20 3
33. El-Gilany AH Abusaad Fel S Self-directed learning readiness and learning styles among Saudi undergraduate nursing students Nurse Educ Today 2013 33 1040 4 22640900
34. Kaur A Lakra P Kumar R Self-directed learning readiness and learnign styles among nursing undergraduates Nurs Midwifery Res J 2020 16 40 50
35. Smedley A The self-directed learning readiness of first year bachelor of nursing students J Res Nurs 2007 12 373 85
36. Örs M The self-directed learning readiness level of the undergraduate students of midwife and nurse in terms of sustainability in nursing and midwifery education Sustainability 2018 10 3574
37. Grande RAN Berdida DJE Cruz JP Cometa-Manalo RJ Balace AB Ramirez SH Academic motivation and self-directed learning readiness of nursing students during the COVID-19 pandemic in three countries: A cross-sectional study Nurs Forum 2022 57 382 92 35094399
38. Chen Y-F Wang C-M Lin H-J Explore the relationships among demography, personality traits and self-directed learning J Hum Resour Adult Learn 2006 2 141 50
39. VeisKarami H Garavand H NaserianHjiabadi H Afsharizadeh S Montazeri R Mohammadzade Ghasr A A Comparative study of functions of thinking style and self-directed learning among nursing and midwifery students in Mashhad Res Med Educ 2012 4 53 62
40. Owen TR Self-directed learning in adulthood: A literature review Kentucky Morehead State University 2002
41. Kaufman DM ABC of learning and teaching in medicine Br Med J 2003 326 213 6 12543841
42. Greveson GC Spencer JA Self-directed learning--the importance of concepts and contexts Med Educ 2005 39 348 9 15813753
43. Kumar AP Omprakash A Mani PKC Swaminathan N Maheshkumar K Maruthy KN Validation of internal structure of self-directed learning readiness scale among indian medical students using factor analysis and the structural equation modelling approach BMC Med Educ 2021 21 614 34895214
44. Al Kindy S Al Kindy F Al Kindy A The advantages and disadvantages of self directed learning: A survey study of Saudi medical students MedEdPublish 2018 7 58
45. Madhavi KVP Madhavi BD Readiness for self-directed learning among undergraduate medical students of Andhra Medical College, Visakhapatnam Int J Community Med Public Health 2017 4 2836 40
46. Hiemstra R Self-directed learning: Why do most instructors still do it wrong Int J Self Directed Learn 2013 10 23 34
47. Soliman M Al-Shaikh G Readiness for self-directed learning among first year saudi medical students: A descriptive study Pak J Med Sci 2015 31 799 802 26430406
48. Naeimi L Bigdeli S Soltani Arabshahi K Level of self-directed learning readiness in medical students Educ Strategy Med Sci 2012 5 177 81
49. Ojekou GP Okanlawon FA Nursing students’ readiness for self-directed learning and its effect on learning outcome in south-West Nigeria Open J Nurs 2019 9 586 601
50. Alotaibi KN The learning environment as a mediating variable between self-directed learning readiness and academic performance of a sample of saudi nursing and medical emergency students Nurse Educ Today 2016 36 249 54 26586258
51. Zhoc KC Chung TS King RB Emotional intelligence (EI) and self-directed learning: Examining their relation and contribution to better student learning outcomes in higher education Br Educ Res J 2018 44 982 1004
52. Renzulli SJ Using learning strategies to improve the academic performance of university students on academic probation J Natl Acad Adv Assoc 2015 35 29 41
