In health science education curricula, undergraduate students must regulate their learning not only within classrooms but also in real-world workplace contexts, particularly during their clinical practical semester or year [1]. This phase represents most students' first extended exposure to professional environments and is often perceived as particularly stressful and challenging [2,3]. The present study sought to investigate the bidirectional relationships between aspects of undergraduate students’ self-regulated learning (SRL) and stress in workplace environments.
SRL in the Workplace
SRL is a dynamic process through which individuals take an active role in their own learning by setting goals, monitoring their progress, and adapting their strategies to achieve those goals [4–6]. It encompasses a range of SRL strategies, including cognitive, metacognitive, and motivational strategies, that learners employ to effectively acquire and retain knowledge. SRL not only fosters greater academic achievement in students [7,8] but also cultivates lifelong skills for independent, self-directed learning [9].
Although most SRL literature addresses learning in classroom settings, SRL also plays a major role during learning at the workplace, when acquiring practical skills [10,11,12]. In this demanding environment, students face the challenge of balancing new responsibilities such as patient interaction and treatment while achieving their learning objectives [3]. In this context, SRL can help students attain more meaningful and sustainable learning outcomes. For example, previous studies have shown that SRL is positively associated with academic achievement and clinical skills in the workplace ([13–16]; see [17] for a scoping review on the topic).
Steinberg and colleagues [11] considered an educational psychology perspective on SRL in the workplace. According to their theory, workplace learning operates on two distinct levels: the learning process level and the metalevel. While the learning process level refers to the learning process itself, the metalevel refers to the students’ regulation of the learning process to reach the desired learning outcome. Steinberg et al. proposed four areas of SRL in the workplace: cognitive learning strategies, motivation, emotion and context (i.e., perception of the learning environment [11,18–20]). At the learning process level, the optimal learner uses cognitive or proximal metacognitive learning strategies (proximal means regulating the professional medical activity, not the learning process itself), is motivated, feels positive emotions during learning and perceives his or her learning environment as supportive and engaging. On the metalevel, the optimal learner continuously monitors every aspect of the learning process to achieve their learning goals (i.e., monitoring) and makes adjustments to the learning process as needed (i.e., control) [11].
Academic Stress in Higher Education
Stress is characterized by an individual's physiological and psychological reactions to a stressor. It manifests as a response to perceived demands or threats, disrupting the person's internal equilibrium. This response can be observed through various physiological, behavioral, emotional, and cognitive responses or reactions in the individual [21]. Academic stress in higher education is a critical issue that affects a significant portion of the student population [22]. It is characterized by stress responses that students experience due to the high demands and expectations prevalent in tertiary education settings. These demands often include challenging coursework, rigorous academic standards, and looming deadlines, which can lead to heightened levels of stress [23]. This form of stress is associated not only with poor mental and physical health [22,24,25] and low academic performance [26–28] but also with overall poorer quality of life and well-being [22,29]. The pressures associated with higher education can also have a detrimental effect on students’ motivation and engagement, potentially leading to burnout, a state characterized by emotional exhaustion, cynicism, and feelings of reduced accomplishment [30,31]. Furthermore, stress can impair cognitive functions such as concentration and memory [32,33], which could be especially crucial in higher education settings, which constantly demand the use of higher cognition from students, further hindering academic achievement [27].
Undergraduate health science students face additional stressors when transitioning to clinical or workplace settings, including the practical application of knowledge and development of practical clinical skills [3,34], the navigation of healthcare information systems [35], the management of emotional demands [36–38], and interaction with patients, while also working to develop professional autonomy [34]. Exposure to patient suffering and ethical dilemmas can lead to emotional exhaustion and increased stress, which affects well-being as well as learning outcomes [39]. Furthermore, balancing academic and workplace demands may result in stress related to time management and burnout [30,31]. Overall, the transition to clinical learning presents significant challenges for health science undergraduates [40].
Interplay of SRL and Stress in Higher Education and Workplace Environments
Previous research, mainly cross-sectional, has correlated various aspects of SRL and perceived stress (e.g., [41–44]) or explored unidirectional effects (e.g., [45]). However, there is a noticeable gap in the literature regarding the integration and exploration of the bidirectional relationships of the multifaceted areas of SRL with stress in higher education and workplace environments in one comprehensive study. Although SRL and stress seem to be linked to academic achievement [17,27], it is not entirely clear whether and how they influence each other reciprocally. In the following section, we will discuss the relevant literature for each SRL area.
Cognitive Learning Strategies
Stress is known to adversely affect cognitive processes through its neurological impact on the brain [32,33]. This effect could be particularly crucial in educational environments, such as higher education and workplace settings, where higher cognition is constantly demanded from students. The frequent use of strategies involving self-regulation in undergraduates is associated with lower levels of academic stress [46]. Additionally, Lakkonen and Nevgi [47] observed that third-year students who experience higher levels of academic stress tend to engage more in reflective learning. Interestingly, this correlation was not observed among first-year students, suggesting that the relationship between academic stress and reflective learning may develop or become more apparent later in the academic journey. Li et al. [48] reported that stress significantly and directly impacts both task and contextual performance. Additionally, their research highlights a notable indirect effect of stress on these types of performance through the mechanism of cognitive SRL strategies. Broks et al. [49] used latent profile analysis to examine links between test anxiety, SRL, and stress. Their results showed that students with low test anxiety and high SRL abilities experienced lower stress levels than did those with high test anxiety and high SRL abilities and those with moderate test anxiety and low SRL abilities. Regarding the directional effect of cognitive SRL strategies on academic stress, Häfner, Stock, and Oberst [50] highlight the benefits of time management strategies in reducing perceived stress.
Motivation
Previous research conducted in higher education and workplace settings has shown that stress negatively impacts undergraduates' motivation and engagement [41–45,51]. This reduction in motivation and engagement complicates students’ learning experiences, potentially resulting in less effective learning and subsequently hindered academic success [31,45]. Conversely, past research has suggested that students who demonstrate high levels of self-efficacy, a core element of students’ motivation, experience lower levels of perceived stress [52], indicating a potential bidirectional relationship.
Emotion
In terms of emotions, negative emotions such as anxiety and anger are closely intertwined with stress at the neurological level. In this way, they could influence students' stress levels and academic performance by activating key brain regions, notably the amygdala and the prefrontal cortex [53]. Studies investigating the well-being of undergraduate medical students often investigate anxiety and stress in conjunction, both of which are consistently listed as factors that appear to be heightened in such populations [24,54] and seem to increase during education [54–57], especially at the end of the preclinical phase [54]. The current medical education literature suggests a bidirectional relationship between stress and anxiety. Studies indicate that undergraduates with higher anxiety levels tend to experience increased stress [54]; conversely, those with elevated stress levels often report greater anxiety [52,54]. Positive emotions also play an important role in regulating the stress response, specifically by restoring resources and enhancing coping mechanisms [58]. In that context, higher levels of situational stress in undergraduates have been previously linked to increased negative emotion and reduced positive emotion [ [46,59], while suppressing the expression of positive emotion in nurses was previously found to be associated with greater subjective stress [60].
Students’ Perception of the Learning Environment
The major role of the context in which undergraduates work and learn has been increasingly recognized in the field [11,18–20]. Past studies have indicated that undergraduates’ perceptions of a supportive and well-structured learning environment not only lead to more favorable academic achievement [61] but also play a critical role in mediating stress and burnout. For instance, Sum et al. [62] reported that such positive perceptions of the learning environment seem to mediate the relationship between perceived stress and burnout. Conversely, Meriläinen and Kuittinen [63] observed that negative perceptions of the learning environment correlate with increased levels of burnout, underscoring the importance of a positive educational setting. Despite these findings, there remains a noticeable research gap regarding directional effects between undergraduates’ perceptions of the learning environment and stress.
Metalevel
The regulation of the aforementioned SRL-areas [11,64] can significantly impact students' stress levels and overall academic experience. Efficient cognitive strategy management can decrease cognitive overload and reduce stress [65], and the use of metacognitive SRL strategies has been previously shown to negatively affect academic stress [66]. Conversely, maladaptive metacognition has been shown to positively correlate with perceived stress [67].
Furthermore, improved regulation of motivation not only enhances academic performance [68] but could also lead to lower stress levels in students. Grunschel et al. [69] reported that motivational regulation can decrease academic procrastination, a significant source of academic stress, potentially contributing to stress reduction [70]. However, certain specific maladaptive avoidant motivational regulation strategies might have the opposite effect by increasing stress and negatively impacting academic performance [69].
In the emotion regulation realm, cognitive reappraisal to increase positive emotion was previously found to be negatively associated with stress [60]. Moreover, emotional coping, akin to emotional regulation in the SRL domain, plays a crucial role in managing stress and involves strategies to handle emotional responses. This concept is a key element of Lazarus and Folkman's transactional stress model and emphasizes how individuals actively manage and respond to stressful situations [71,72]. The significant effects of emotional coping on stress have been documented in numerous studies (meta-analyses: [73,74]).
Regarding the regulation of the perception of the learning environment, actively engaging with and positively influencing the learning environment could create a more supportive context, potentially further mitigating stress. However, empirical studies investigating this topic have not been reported in the literature.
Goals
Previous comprehensive studies investigating the bidirectional relationships between aspects of undergraduates’ workplace SRL and stress are limited. Building on this gap, the present study is designed to examine the nature and directionality of the longitudinal relationship between stress and various aspects of SRL in undergraduate students in a workplace environment over a 15-week period, with a particular focus on pairwise measurement points (i.e., week-to-week variations).
We present the following hypotheses for each SRL aspect:
- Stress in the previous week will impact the SRL-aspect in the current week, taking the SRL-aspect measurement in the prior week into account.
- The SRL-aspect in the previous week will impact stress in the current week, taking the stress measurement in the prior week into account.
We refrain from specifying directional hypotheses due to the limited differentiation in the literature compared to our comprehensive SRL assessment. However, accounting for the general trend in previous studies, which predominantly indicated negative associations between stress and various aspects of SRL, we expected negative associations between stress and most SRL-aspects.