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How to Close the Learning Circle? Students' Perspectives on How Programmatic Assessment Influences Self-Regulated Learning in a Global Online Programme

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Title: How to Close the Learning Circle? Students' Perspectives on How Programmatic Assessment Influences Self-Regulated Learning in a Global Online Programme
Language: English
Authors: Xian Liu (ORCID 0000-0002-4247-6088), Diana Dolmans (ORCID 0000-0002-4802-1156), Maryam Asoodar (ORCID 0000-0001-6044-6790), Zhien Li (ORCID 0009-0007-2223-8940), Daniëlle Verstegen (ORCID 0000-0001-6811-175X)
Source: Assessment & Evaluation in Higher Education. 2025 50(8):1207-1222.
Availability: Routledge. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Page Count: 16
Publication Date: 2025
Document Type: Journal Articles
Reports - Research
Tests/Questionnaires
Education Level: Higher Education
Postsecondary Education
Descriptors: Student Attitudes, Graduate Students, Student Evaluation, Learning Strategies, Independent Study, Foreign Countries, Allied Health Occupations Education, Feedback (Response), Coaching (Performance), Portfolios (Background Materials), Personal Autonomy, Pass Fail Grading
Geographic Terms: Netherlands
DOI: 10.1080/02602938.2025.2513008
ISSN: 0260-2938
1469-297X
Abstract: Programmatic assessment (PA) is widely implemented in higher education and is theorised to support self-regulated learning (SRL). However, its mechanisms remain unclear. This study explored students' perceptions of PA's impact on SRL in a part-time, predominantly online Master's programme for healthcare professionals worldwide. A pragmatic exploratory mixed-methods approach was employed, integrating quantitative data (survey, N = 46) and qualitative data (interviews, N = 14) collected concurrently with equal emphasis. Quantitative findings showed an overall positive perception of PA. Thematic analysis of interviews identified five key themes: (1) Intermediate feedback provides immediately useful directions for learning, but final feedback is more difficult to use and act upon. (2) Coaches are important in supporting students by providing guidance, reassurance and scaffolding on where to go next. (3) E-portfolios help aggregate data points to monitor competency development and uncover strengths and weaknesses. (4) Autonomy in choosing work-relevant tasks enhanced students' motivation, planning and reflection. (5) The lack of pass-fail decisions in PA creates uncertainty at first but ultimately it stimulates students to regulate their own learning process. While students reported overall satisfaction, challenges still existed, including initial uncertainty, processing narrative feedback and integrating e-portfolios. Structured faculty support may enhance PA's effectiveness in promoting SRL.
Abstractor: As Provided
Entry Date: 2026
Accession Number: EJ1491808
Database: ERIC
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  Value: <anid>AN0189651305;eva01dec.25;2025Dec01.05:40;v2.2.500</anid> <title id="AN0189651305-1">How to close the learning circle? Students' perspectives on how programmatic assessment influences self-regulated learning in a global online programme </title> <p>Programmatic assessment (PA) is widely implemented in higher education and is theorised to support self-regulated learning (SRL). However, its mechanisms remain unclear. This study explored students' perceptions of PA's impact on SRL in a part-time, predominantly online Master's programme for healthcare professionals worldwide. A pragmatic exploratory mixed-methods approach was employed, integrating quantitative data (survey, N = 46) and qualitative data (interviews, N = 14) collected concurrently with equal emphasis. Quantitative findings showed an overall positive perception of PA. Thematic analysis of interviews identified five key themes: (<reflink idref="bib1" id="ref1">1</reflink>) Intermediate feedback provides immediately useful directions for learning, but final feedback is more difficult to use and act upon. (<reflink idref="bib2" id="ref2">2</reflink>) Coaches are important in supporting students by providing guidance, reassurance and scaffolding on where to go next. (<reflink idref="bib3" id="ref3">3</reflink>) E-portfolios help aggregate data points to monitor competency development and uncover strengths and weaknesses. (<reflink idref="bib4" id="ref4">4</reflink>) Autonomy in choosing work-relevant tasks enhanced students' motivation, planning and reflection. (<reflink idref="bib5" id="ref5">5</reflink>) The lack of pass-fail decisions in PA creates uncertainty at first but ultimately it stimulates students to regulate their own learning process. While students reported overall satisfaction, challenges still existed, including initial uncertainty, processing narrative feedback and integrating e-portfolios. Structured faculty support may enhance PA's effectiveness in promoting SRL.</p> <p>Keywords: Programmatic assessment; self-regulated learning; health professions education; mixed methods</p> <hd id="AN0189651305-2">Introduction</hd> <p>Traditionally, examinations have assessed students' knowledge and skills to ensure graduate requirements by grading or pass-fail evaluations. Recent educational developments have increasingly recognised 'assessment for learning' as a valuable complement to 'assessment of learning', highlighting the need for a deeper understanding of how assessment supports learning processes (Schuwirth and Van der Vleuten [<reflink idref="bib21" id="ref6">21</reflink>]; Schellekens et al. [<reflink idref="bib18" id="ref7">18</reflink>]). Programmatic assessment (PA) is a promising approach that has been applied worldwide in higher education, professional education and health professions education (Timmerman and Dijkstra [<reflink idref="bib24" id="ref8">24</reflink>]). It has a strong focus on both 'assessment of learning' and 'assessment for learning'. Building on this foundation, van der Vleuten et al. ([<reflink idref="bib28" id="ref9">28</reflink>]) proposed a model for PA, emphasising the systematic nature of PA in aligning assessment with learning goals. In a cyclical process, individual assessments are structured to optimise learning. High-stakes decisions concerning advancement or competencies are informed by synthesising aggregated data from multiple assessments. Expert judgment is central to the program and systematic sampling and bias-reduction strategies are needed to mitigate inherent subjectivity. By transitioning from a reliance on isolated assessment tools to a holistic, empirically grounded systems approach, PA not only facilitates continuous learning but also establishes a rigorous mechanism for evaluating comprehensive competencies. PA involves a series of integrated and curriculum-aligned assessments that collectively evaluate student competencies. Heeneman et al. ([<reflink idref="bib7" id="ref10">7</reflink>]) further advanced this perspective by defining 12 principles for PA (Figure 1), offering practical guidelines for its design and implementation.</p> <p>Graph: Figure 1. Final Ottawa 2020 consensus principles of programmatic assessment (Heeneman et al. [<reflink idref="bib7" id="ref11">7</reflink>]).</p> <p>Essential elements in PA, such as constructive feedback, learning tasks, e-portfolios and coaching, can be incorporated into curriculum designs, thereby enhancing students' overall educational experience. Feedback is provided to aid students' development and continuous feedback offers a comprehensive view of student progress over time (Van der Vleuten et al., 2012). Authentic learning tasks are real-world activities that stimulate students to apply knowledge in practical settings and enhance students' sense of self, self-worth and well-being (McArthur [<reflink idref="bib13" id="ref12">13</reflink>]). Elective learning tasks allow students to customise their educational experiences to align with their personal needs and career goals, thereby fostering reflective practice (Greenfield et al. [<reflink idref="bib6" id="ref13">6</reflink>]). E-portfolios act as a comprehensive repository of student work and feedback (de Jong et al. [<reflink idref="bib5" id="ref14">5</reflink>]), enabling continuous and holistic assessments of student performance and fostering a sense of ownership and self-regulation in the learning process. Additionally, coaching by teaching faculty or mentors supports students in interpreting feedback and devising improvement strategies (van der Vleuten, Lindemann, and Schmidt [<reflink idref="bib27" id="ref15">27</reflink>]). Together, these elements of PA are designed and applied to support and enhance student learning.</p> <p>Self-regulated learning (SRL) emerges as a key concept within 'assessment of and for learning', highlighting the importance of learners' active role in exercising agency and engaging with assessment practices. SRL describes a cyclical process in which students proactively manage their cognition, motivation and behaviours to achieve their objectives within specific contexts (Panadero [<reflink idref="bib15" id="ref16">15</reflink>]). SRL conceptualises learning as a goal-directed process that involves self-evaluation and self-reflection, fostering student agency and accountability (Zimmerman [<reflink idref="bib30" id="ref17">30</reflink>]; Torre, Schuwirth, and Van der Vleuten [<reflink idref="bib25" id="ref18">25</reflink>]). This concept positions learners as active agents who engage in self-evaluation, strategic planning and adaptive reflection. It also aligns closely with the principles of formative assessment and feedback literacy (Heikkinen et al. [<reflink idref="bib8" id="ref19">8</reflink>]).</p> <p>Various SRL models have been proposed, among which Zimmerman's model is particularly suited for the context of 'assessment of learning', 'assessment for learning' and PA. Its cyclical phases align well with iterative feedback processes and emphasise learner agency in monitoring and adapting learning strategies. Zimmerman's ([<reflink idref="bib31" id="ref20">31</reflink>]) framework emphasises goal-setting and metacognitive reflection. It is composed of three interconnected phases: forethought, performance, and self-reflection. In the forethought phase, students establish learning objectives, plan strategies, and motivate themselves. In the performance phase, they engage in activities while monitoring progress and employing self-control strategies. In the self-reflection phase, students evaluate performance and assess strengths and weaknesses (Figure 2). This cyclical process of forethought, performance and self-reflection enhances metacognitive skills and a sense of ownership among students (Westbroek et al. [<reflink idref="bib29" id="ref21">29</reflink>]). Empirical research supports the role of formative assessment in promoting SRL by offering actionable feedback that enables learners to adjust their strategies and reflect on their progress (Järvenoja, Järvelä, and Malmberg [<reflink idref="bib9" id="ref22">9</reflink>]).</p> <p>Graph: Figure 2. Structure and function of self-regulatory processes (Zimmerman & Campillo, [<reflink idref="bib32" id="ref23">32</reflink>]).</p> <p>SRL is central to PA principles, as it emphasises deliberate practice, supporting student autonomy and responsibility (Torre, Schuwirth, and Van der Vleuten [<reflink idref="bib25" id="ref24">25</reflink>]). Implementing PA is intended to stimulate students to be self-regulated learners, critically reflect on assessments and make evaluative judgments (Charlton and Newsham-West [<reflink idref="bib3" id="ref25">3</reflink>]). To achieve these, students also need to understand the purposes and processes of assessment (Schellekens et al. [<reflink idref="bib18" id="ref26">18</reflink>]). The continuum of low-stakes assessments in PA facilitates ongoing learning opportunities, providing a steady stream of information that learners can use to guide and regulate their learning processes (Schuwirth and Van der Vleuten [<reflink idref="bib21" id="ref27">21</reflink>]; Schut et al. [<reflink idref="bib20" id="ref28">20</reflink>]). Empirical research has reported students' positive perceptions of PA in supporting SRL across all phases (Schellekens et al. [<reflink idref="bib19" id="ref29">19</reflink>]). While literature addresses PA supports SRL by theoretical mechanisms, its effective implementation in practice to stimulate SRL remains challenging. Schut et al. ([<reflink idref="bib20" id="ref30">20</reflink>]) and van der Gulden et al. ([<reflink idref="bib26" id="ref31">26</reflink>]) reported that feedback in e-portfolios often lacks specific details, background information, or recommendations for improvement. King, Schuwirth, and Jordaan ([<reflink idref="bib10" id="ref32">10</reflink>]) highlighted difficulties in maintaining consistent coaching quality with large student numbers. Additionally, in their examination of medical education programs, Misra et al. ([<reflink idref="bib14" id="ref33">14</reflink>]) identified that the curriculum frameworks outlining competencies for assessment often lacked clarity. While literature addresses the individual impact of these elements on student learning, there is limited research on how and under what conditions PA can stimulate students' SRL (Torre, Schuwirth, and Van der Vleuten [<reflink idref="bib25" id="ref34">25</reflink>]).</p> <p>In summary, PA has been introduced in higher education as an implementation of 'assessment for learning' and has shown its effectiveness. However, it comes with challenges and existing literature does not provide sufficient insight into how PA can stimulate students' SRL (Torre, Schuwirth, and Van der Vleuten [<reflink idref="bib25" id="ref35">25</reflink>]). Understanding the mechanisms behind PA is essential to better support students' learning. Therefore, this study aims to explore students' perceptions of how and why PA influences their self-regulated learning. The research questions are as follows:</p> <p>Q1: To what extent do students think PA supports their SRL?</p> <p>Q2: According to students, how and why does PA enhance or hinder their SRL?</p> <hd id="AN0189651305-3">Methods</hd> <p></p> <hd id="AN0189651305-4">Study design</hd> <p>This study adopts a pragmatic methodological approach, which prioritises methodological flexibility and practical utility in addressing complex real-world questions (Ramanadhan et al. [<reflink idref="bib16" id="ref36">16</reflink>]). Guided by this approach, an exploratory study design was employed to investigate students' perceptions of how and why PA enhances or hinders SRL. To capture both breadth and depth, a mixed methods strategy was used, integrating quantitative data (questionnaire survey) and qualitative data (individual interviews) collected concurrently with equal emphasis. This methodological combination supports triangulation and the development of complementary insights, deepening our understanding of the phenomenon.</p> <hd id="AN0189651305-5">Setting</hd> <p>The Maastricht Master of Health Professions Education (MHPE) is a part-time, predominantly online postgraduate program for healthcare professionals pursuing careers in health professions education. About 50 students from diverse global backgrounds enrol each year. Most combine the MHPE program with clinical work (as physicians, nurses, allied health workers, etc.) and teaching in undergraduate or graduate programs or clinical training. The two-year curriculum includes two three-week on-campus periods, with the remaining time dedicated to online learning. The rest of the time, students work on authentic learning tasks during online periods of two months. About 40% are mandatory learning tasks, which are often group tasks. The other 60% are (mostly individual) electives and a thesis project.</p> <p>Assessment is grounded in a competency framework with eight core competencies (Figure 3). Each task targets specific competencies. Students submit final products for narrative feedback and rubric-based scoring (low-stakes assessments). Some tasks include peer or staff intermediate narrative feedback during the process. Students compile their work and feedback in an electronic portfolio. Two high-stakes decision moments: entry to the second campus period and graduation. These moments require students to submit reflective self-assessments on their competency development. Each student is supported by a personal coach, meeting online 4–5 times annually.</p> <p>PHOTO (COLOR): Figure 3. The MHPE competency framework.</p> <p>The MHPE program integrates all 12 PA design principles (Heeneman et al. [<reflink idref="bib7" id="ref37">7</reflink>]) by embedding assessment within the learning process. Each task is purposefully designed as a meaningful data point that evaluates performance and supports ongoing learning through rich formative feedback. This approach ensures that learners and assessors have a continuum of assessment evidence, promoting holistic and transparent decision-making. Assessment evidence is triangulated across narrative feedback, rubrics, and reflective self-assessments, fostering an active learning environment that enhances student agency and personalises learning. High-stakes decisions are based on aggregated portfolio evidence, aligning assessment with the program's goal of developing SRL in authentic and complex contexts. Implementation of PA is reflected in five core elements: authentic tasks (principles 1, 4, 5), electives (principle 12), narrative feedback (principles 2, 8), e-portfolios (principles 3, 6, 7, 9), and coaching (principles 10, 11, 12). Together, these elements operationalise the design principles and support meaningful, learner-centred assessment.</p> <hd id="AN0189651305-6">Sampling</hd> <p>The online survey was distributed to all second-year and graduating students from the 2021 (<emph>N</emph> = 56) and 2022 (<emph>N</emph> = 51) cohorts, with 46 students participating (Table 1). First-year students were excluded due to their limited exposure to PA within the MHPE curriculum. Of the survey participants, 14 students volunteered for follow-up individual interviews (Table 1). The interviewees represented a diverse range of ages, nationalities, professions, and cultural backgrounds. Data collection continued until saturation was reached.</p> <p>Table 1. Demographic information of survey participants (<emph>N</emph> = 46) and interview participants (<emph>N</emph> = 14).</p> <p> <ephtml> <table><thead><tr><td /><td>Survey</td><td>Interviews</td></tr><tr><td>Characteristic</td><td>(<italic>N</italic> = 46)</td><td>(<italic>N</italic> = 14)</td></tr></thead><tbody valign="top"><tr><td>Age (years old)</td><td><italic>N</italic></td><td>%</td><td><italic>N</italic></td><td>%</td></tr><tr><td> 20–30</td><td char=".">6</td><td char=".">13</td><td /><td /></tr><tr><td> 31–40</td><td char=".">25</td><td char=".">54.3</td><td char=".">10</td><td char=".">71.4</td></tr><tr><td> 41–50</td><td char=".">12</td><td char=".">26.1</td><td char=".">4</td><td char=".">28.6</td></tr><tr><td> 51–60</td><td char=".">3</td><td char=".">6.5</td><td /><td /></tr><tr><td>Nationality</td><td /><td /><td /><td /></tr><tr><td> North America</td><td char=".">14</td><td char=".">30.4</td><td char=".">2</td><td char=".">14.3</td></tr><tr><td> Europe</td><td char=".">13</td><td char=".">28.3</td><td char=".">6</td><td char=".">42.9</td></tr><tr><td> Asia</td><td char=".">17</td><td char=".">37</td><td char=".">5</td><td char=".">35.7</td></tr><tr><td> Africa</td><td char=".">1</td><td char=".">2.2</td><td char=".">1</td><td char=".">7.1</td></tr><tr><td> Prefer not to say</td><td char=".">1</td><td char=".">2.2</td><td /><td /></tr><tr><td>Profession</td><td /><td /><td /><td /></tr><tr><td> Medicine</td><td char=".">26</td><td char=".">56.5</td><td char=".">3</td><td char=".">21.4</td></tr><tr><td> Health Professionals</td><td char=".">8</td><td char=".">17.4</td><td char=".">10</td><td char=".">71.4</td></tr><tr><td> Educator</td><td char=".">2</td><td char=".">4.3</td><td /><td /></tr><tr><td> Others</td><td char=".">10</td><td char=".">21.7</td><td char=".">1</td><td char=".">7.1</td></tr><tr><td>Experience as an educator</td><td /><td /><td /><td /></tr><tr><td> Less than 5 years</td><td char=".">19</td><td char=".">41.3</td><td char=".">6</td><td char=".">42.9</td></tr><tr><td> 5–10 years</td><td char=".">17</td><td char=".">37</td><td char=".">4</td><td char=".">28.6</td></tr><tr><td> 11–15 years</td><td char=".">7</td><td char=".">15.2</td><td char=".">4</td><td char=".">28.6</td></tr><tr><td> More than 15 years</td><td char=".">3</td><td char=".">6.5</td><td /><td /></tr><tr><td>Year of starting</td><td /><td /><td /><td /></tr><tr><td> 2022</td><td char=".">36</td><td char=".">78.3</td><td char=".">11</td><td char=".">79</td></tr><tr><td> 2021</td><td char=".">9</td><td char=".">19.6</td><td char=".">3</td><td char=".">21.4</td></tr><tr><td> Transitioned from the old curriculum</td><td char=".">1</td><td char=".">2.2</td><td /><td /></tr></tbody></table> </ephtml> </p> <hd id="AN0189651305-7">Data collection</hd> <p>This mixed-methods study employed concurrent data collection. An online survey (Figure 4) comprised 33 Likert-scale items (1 = Strongly Disagree, 2 = Disagree, 3 = Neutral, 4 = Agree, 5 = Strongly Agree). The items were structured to align with Zimmerman's SRL phases (2002) and five PA design elements: authentic learning tasks (items 1–6), elective learning tasks (items 7–13), feedback (items 14–20), e-portfolio (items 21–25), and coaching (items 26–33). Each subscale integrated Zimmerman's three SRL phases (forethought, performance, self-reflection) and key SRL components (e.g. goal-setting, planning, motivation, and monitoring). To establish content validity, we consulted experts in the fields of assessment and learning theories, who reviewed the questionnaire and provided feedback. Based on their suggestions, minor revisions were made, and the final version was deemed to have satisfactory content validity.</p> <p>PHOTO (COLOR): Figure 4. Descriptive results of individual items.</p> <p>Fourteen semi-structured interviews were conducted by the primary author, using a guide (Appendix 1). The guide included: (<reflink idref="bib1" id="ref38">1</reflink>) Demographic questions; (<reflink idref="bib2" id="ref39">2</reflink>) Transitional questions (exploring general PA experiences); (<reflink idref="bib3" id="ref40">3</reflink>) Core questions (structured around Zimmerman's SRL phases and participants' engagement with the five PA design elements).</p> <hd id="AN0189651305-8">Data analysis</hd> <p>Each survey was assessed following Creswell and Creswell ([<reflink idref="bib4" id="ref41">4</reflink>]) guidelines to ensure response accuracy, retaining 46 questionnaires for analysis. Quantitative data from online questionnaires underwent descriptive statistical analysis using SPSS 29.0.1. The average mean scores and standard deviations for each question and category were calculated by aggregating individual responses and computing scores. Qualitative data from interviews were transcribed, with identifiable data removed by the primary researcher before sharing with others. Thematic data analysis was guided by 12 principles for PA (Heeneman et al. [<reflink idref="bib7" id="ref42">7</reflink>]) and Zimmerman's ([<reflink idref="bib31" id="ref43">31</reflink>]) SRL framework, employing both theory-driven and data-driven approaches to align with the study's exploratory nature. Multiple rounds of discussions were conducted until themes emerged. Coders first familiarised themselves with the transcripts by reading through all transcripts. The initial four transcripts were coded by all coders, after which a codebook was developed based on these discussions. Then, this codebook was used to code the remaining interviews. To minimise bias, all transcripts were coded by at least two researchers (XL, DV, MA, and ZL). Themes were discussed among all team members (XL, DV, MA, ZL and DD). Thematic analysis was conducted using ATLAS.ti 23. Braun and Clarke's ([<reflink idref="bib2" id="ref44">2</reflink>]) framework guided the identification of patterns.</p> <hd id="AN0189651305-9">Ethical considerations</hd> <p>Ethical approval for this study was granted by the Faculty of Health, Medicine and Life Sciences Research Ethics Committee (FHML-REC/2023/048) at Maastricht University. All participants provided informed consent prior to enrolment.</p> <hd id="AN0189651305-10">Reflexivity</hd> <p>We engaged in critical reflection on how our professional identities and roles informed this research. The research team brought diverse expertise: XL focuses on assessment, SRL and teacher education; DV specialises in instructional design and innovation; MA focuses on instructional design and e-learning; ZL's work explores simulation and technology in education; and DD contributes expertise in learning theory and curriculum design. Notably, DV, MA, and DD are involved as faculty members in the MHPE program, whereas XL and ZL operate as external researchers without direct teaching responsibilities. The collaboration among researchers, curriculum designers, and educators enriched the study with multifaceted insights, ensuring a holistic and nuanced analysis of the program.</p> <hd id="AN0189651305-11">Results</hd> <p></p> <hd id="AN0189651305-12">Survey results</hd> <p>Participants' perceptions of PA in supporting their SRL within the MHPE program were generally positive. As shown in Table 2, the overall mean score was 3.97 (SD = 0.86) on a 5-point Likert scale (1 = Strongly disagree to 5 = Strongly agree). Among the five PA elements, coaching received the highest mean score (<emph>M</emph> = 4.23, SD = 0.63), followed by elective learning tasks (<emph>M</emph> = 4.17, SD = 0.47) and authentic learning tasks (<emph>M</emph> = 4.11, SD = 0.43). In contrast, feedback (<emph>M</emph> = 3.56, SD = 0.70) and e-portfolio (<emph>M</emph> = 3.71, SD = 0.66) were rated lower and showed greater variability in responses. Regarding internal consistency, Cronbach's alpha coefficients (α) ranged from acceptable to excellent. Coaching demonstrated the highest internal consistency (α = 0.910), whereas authentic learning tasks had the lowest (α = 0.683), slightly below the conventional threshold for acceptable reliability. The overall scale demonstrated excellent reliability (α = 0.935).</p> <p>Table 2. Mean, standard deviations (SD) and reliability for students' perceptions of PA on SRL (<emph>N</emph> = 46).</p> <p> <ephtml> <table><thead><tr><td /><td>Mean</td><td>SD</td><td>Cronbach's α</td></tr></thead><tbody valign="top"><tr><td>Authentic learning tasks (6 items)</td><td char=".">4.11</td><td char=".">0.43</td><td char=".">0.683</td></tr><tr><td>Electives learning tasks (7 items)</td><td char=".">4.17</td><td char=".">0.47</td><td char=".">0.810</td></tr><tr><td>Feedback (7 items)</td><td char=".">3.56</td><td char=".">0.70</td><td char=".">0.880</td></tr><tr><td>E-portfolio (5 items)</td><td char=".">3.71</td><td char=".">0.66</td><td char=".">0.836</td></tr><tr><td>Coaching (8 items)</td><td char=".">4.23</td><td char=".">0.63</td><td char=".">0.910</td></tr><tr><td>Overall (33 items)</td><td char=".">3.97</td><td char=".">0.86</td><td char=".">0.935</td></tr></tbody></table> </ephtml> </p> <p>1 <emph>Note:</emph> Mean ratings and SDs on a Likert scale (1 = Strongly disagree to 5 = Strongly agree).</p> <p>Figure 4 displays the distribution of participants' responses across individual survey items, grouped into five categories: authentic learning tasks (items 1–6), elective learning tasks (items 7–13), feedback (items 14–20), e-portfolio (items 21–25), and coaching (items 26–33). Each item was rated on a 5-point Likert scale with colour coding representing response options. The vertical line denotes the neutral midpoint. Bars extending to the right of the line represent agreement, while bars extending to the left indicate disagreement, with the length of each segment corresponding to the proportion of responses. Overall, most responses clustered to the right of the neutral line, indicating generally positive perceptions across PA elements. More diverse opinions, however, were evident for items related to feedback and the e-portfolio.</p> <hd id="AN0189651305-13">Interview results</hd> <p></p> <hd id="AN0189651305-14">Intermediate feedback provides immediately useful directions for learning, but final feedback...</hd> <p>Students reflected on the two feedback moments: intermediate feedback and final feedback. They described these narrative feedback moments as 'elaborate' and 'informative', helping them understand task performances comprehensively and in detail. Many students highlighted that intermediate feedback provided directional guidance while doing learning tasks. For example, a student described intermediate feedback 'as a tool to monitor their work and progress' (P9) in the learning task. Students stated that intermediate feedback helped to 'direct to the correct roads' (P14) when they were 'at the crossroads' (P14).</p> <p>I like that [intermediate feedback] because that helped me understand that I'm doing the task that is expected of me and not just going off somewhere in a random direction or not missing out on some important things. (P9)</p> <p>Students also appreciated the final feedback with both narrative feedback and rubric scores, but some noted that it arrived too late to be useful for planning the next period. Students expressed that the delay diminished the impact of feedback, with some stating they would not read the feedback in detail because they had lost the context (P8), but only checked the scored competency levels instead.</p> <p>So basically, sometimes the feedback comes when we've already moved on to the subsequent period, and we have probably already chosen our next elective tasks. It may sometimes be a bit hard to then apply and do active experimentation again, acting on the feedback that you have received with delay. (P10)</p> <hd id="AN0189651305-15">Coaches are important in supporting students by providing guidance, reassurance and scaffoldi...</hd> <p>Students valued the individualised support that coaches provided. Most students reported that they met their coaches at the designated times, but some students arranged coach meetings as needed, based on their ongoing tasks and schedules. During these sessions, students found that talking to their coaches' decreased uncertainty and increased their autonomy. They emphasised coaches' assistance in planning and reflecting. For example, one student explained how their coach helped to understand their progress. In this process, students indicated that the e-portfolio served as a valuable tool for self-assessment, with one student highlighting its role in aiding 'reflections in my daily practice as well' (P6). Another student emphasised the significance of self-reflection for long-term career development (P9).</p> <p>So I think my coach is someone who can see the program and progress more in a bigger picture and can help me situate myself as to, where I am and whether I am progressing as expected. It was also very useful to kind of help guide where I go next based on some of the competencies that I had worked on before. (P7)</p> <p>I talk with my coach, and we go through the e-portfolio, so that gives a natural moment to evaluate which aspects and which roles you have moved in and which you need to still focus on. (P11)</p> <p>Many students described their coaches as 'consoling', 'supportive', and 'encouraging' to help with balancing their work for the master program with other activities (P8). Some students mentioned coaches' guidance in pacing their work and life beyond the curriculum. Another student described her coach's assistance in balancing the program with her work at a local hospital:</p> <p>And then she [coach] helps me to see, 'You're actually improving and you're really on the right track and don't worry'. So emotional support, but based on the e-portfolio. (P13)</p> <p>I will probably use the word 'sounding board' to describe my coach. She was useful in terms of checking and reflecting on me to pace myself as well as to take time off. It felt like a pacer in a marathon, someone who runs by your side when you are trying to finish a very long run, for example. (P1)</p> <p>Students reported that coaches did not give 'direction' on what to do next, nor evaluated their performance (P9). Instead, coaches asked more 'why' questions to stimulate 'much deeper self-reflection' (P4), or engaged with them in 'thinking out loud together' (P11) until they 'realised what was going wrong with the planning' (P9). Additionally, students mentioned that coaches encouraged them to 'identify which path to go ahead with' based on their competency levels (P4) and also to explore beyond their interests.</p> <p>The coaching is very much a self-reflection portion. I have to understand it for myself, make sense of the feedback, and it's really up to me. I've never had a coach meeting that specifically delved into, 'What was the feedback you received for a particular task? Let's talk about it'. (P10)</p> <hd id="AN0189651305-16">E-portfolios help aggregate data points to monitor competency development and uncover strengt...</hd> <p>Students described the e-portfolio as the space to document all assessments for reflection and planning. To fill out the self-assessment form, students stated they would 'go back and reflect on evaluations and feedback' collected in their e-portfolios. Some students mentioned that they would check their progress by checking their portfolios over the whole year.</p> <p>When it came time for my self-assessment, then I went back and reread most of my feedback and see if that fit well with where I thought I was and see whether or not I had some progress. (P7)</p> <p>Some students appreciated the overview of competency levels in the dashboard, as it directly informed them of their deficiencies and areas for improvement. For competencies where students received positive assessment scores, they indicated a preference to continue employing their current learning strategies. They also identified areas needing improvement and strategised for enhancement by selecting corresponding electives.</p> <p>I think it's [rubrics and competencies] very helpful from the beginning. So you know what is expected of you. Instead of just kind of blindly throwing yourself in, you know if you're doing way over the curve or you're doing way too little. (P11)</p> <p>Students differ widely in how they use different kinds of feedback. Some students express a strong preference for narrative feedback, especially when it provides actionable advice, while others primarily rely on rubric scores and hardly read narrative feedback on their final products because of 'its sheer volume, and it's maybe harder to operationalize because there are pages and pages of it' (P6). Some students also stress the value of having both forms of feedback.</p> <p>I am quite struck by the richness of the narrative feedback that every single faculty provided, how much effort they put into it. It is very specific to the work that I have submitted and of high quality, honest and non-judgmental. And often, for example, rather than just pointing out some areas for improvement, they give some practical suggestions. (P10)</p> <p>I felt the feedback would have been more valuable if it had been timely. For example, if I had finished an elective and received the feedback within the week, that would have really helped. But at this point, it was mostly like we were getting feedback in the middle of the next period, and we barely had time to glance at it. So, most of us would be looking at the levels of performance and leaving it there. (P4)</p> <hd id="AN0189651305-17">Autonomy in choosing work-relevant tasks enhanced students' motivation, planning and reflecti...</hd> <p>Students appreciated the flexibility and the authenticity of learning tasks, and this freedom has increased their motivation. Students described the autonomy that PA provided, yet within the guidance of the competency framework and the rubrics.</p> <p>So the whole authenticity of the task plays a big role for me. It keeps me going and gives me some motivation to do that. Otherwise, if I have to extrapolate too much, then it just becomes a bit tedious to do. (P7)</p> <p>The autonomy given to us comes back as a double-edged sword. We are allowed to do what we want to do because they are telling us. But at the end of the day, there are certain objectives and rubrics that our assignments have to match and fulfil the criteria for the objectives. That was the big mismatch that I felt. (P9)</p> <p>Some students perceived being able to choose learning tasks and building the link with their work as 'the biggest motivator'. They enrolled in the course because of a perceived deficit in their skill set, thus finding motivation to 'directly apply new skills' in working contexts (P3). As expressed by one participant: 'I can relate them to my professional tasks as much as possible' (P6), and 'try to use the results from my tasks in my professional work'(P6). Many students also highlighted how autonomy helped with their planning and their tasks in the real educational and/or clinical context. As one student described: 'I can make some connections as to how I could envision something like that working in my context'.</p> <p>The programmatic assessment enhanced the planning because it gives us the freedom to choose which elective assignments. [...] And usually, I link or join this planning to our college curriculum. And I am also able to choose the framework for these educational problems and to link it to the learning and teaching in our college here. (P14)</p> <p>Students noted that receiving feedback from their professional contexts on their authentic tasks also enriched their reflection on their learning tasks.</p> <p>You could easily apply some of the things that you have tried out in the learning task, and use it to improve your program or make some interventions. So, I think it was good because we could see the relevance of what we were doing, and it was like a double agent. You learn, and you are doing something that makes sense to you at your work rather than some other. (P10)</p> <hd id="AN0189651305-18">The lack of pass-fail decisions in PA creates uncertainty at first but ultimately it stimulat...</hd> <p>Most students stated that they needed time to adapt to PA. Some students mentioned that the procedures and expectations had been explained well during the onsite period at the start of the program. However, the majority pointed out that they required more time to fully understand the concepts and gradually adapt to PA until they 'understood what the expectations were' (P4). Additionally, insufficient data points in the first months were mentioned as a challenge for reflection and decision-making in their learning.</p> <p>The program does a good job at the beginning of the campus one. It set that expectation and the outline as to how the program is going to be evaluated. So it is easy to situate yourself and figure out how it works. (P7)</p> <p>So initially I didn't understand what people said. I was just doing the assignments in a way how I used to do it. [...] But then once I started getting my feedback, I realised that they were asking me to be more critical and think outside. So slowly I adapted to that uncertainty, but initially, it was hard for me because of how I have been trained. (P9)</p> <p>Initially, many students disliked the 'uncertainty', with some even feeling 'demotivated' (P5). Meanwhile, some students felt that uncertainty brought stress and they needed time to understand that the uncertainty is part of PA.</p> <p>You don't have a pass-fail decision that you can forget after you pass, so it remains constant. [...] Things might be stressful for me, but in fact, keeping more uncertainty as part of the programmatic assessment is creating stress. (P3)</p> <p>Students explained that their identities as healthcare professionals did not allow them to make mistakes in clinical settings, leading to a dilemma in facing feedback. Over time, students began to realise that 'it's not necessarily a grade, it's more about how you improve your performance for next time'. They started to 'find it more interesting afterwards' after adapting to the process.</p> <p>The whole philosophy behind educational sciences is completely different from anything we do in medicine. [...] Feedback is to make me better and is not necessarily to judge my performance, (but) with that I want to make myself better over time in the right direction. (P5)</p> <hd id="AN0189651305-19">Conclusion and discussion</hd> <p>In this study, we explored students' perceptions of how and why PA enhances or hinders their SRL using a mixed-methods approach. Quantitative survey data assessed students' overall perceptions toward PA, while qualitative data provided insights into how and why PA either enhances or hinders their SRL. Students perceive that PA enhances their learning experience. The ability to choose their own tasks, receiving rich feedback and coaches' scaffolding contributed positively to SRL. However, challenges also emerged. Students reported feeling uncertain of using PA at the beginning, and aggregating feedback on multiple learning tasks to monitor competency development is complex. The complexities of PA underscore the need for teachers' and coaches' support in the context of PA to ensure the cyclical process of SRL.</p> <p>Feedback helps students' SRL, yet different types of feedback are used in different ways. Students found intermediate feedback helpful in monitoring performance on learning tasks, aligning with findings by Greenfield et al. ([<reflink idref="bib6" id="ref45">6</reflink>]). However, students often viewed final feedback as late and less useful since it arrived after the completion of the learning tasks and too late to use in their direct planning (i.e. the selection of learning tasks in the next period). Using narrative feedback on single learning tasks to monitor overall competency development is a complex task. Some students only checked rubric scores without engaging with the accompanying narrative feedback. The lack of pass-fail decisions also creates uncertainty, especially in the beginning. These findings align with Schut et al. ([<reflink idref="bib20" id="ref46">20</reflink>]), who demonstrated that PA could act as a catalyst for learning but also brings challenges, particularly when attempting to simultaneously foster competency development and evaluate outcomes using scores and rubrics. The idea of 'assessment for learning' is not fully attained when students prioritise competency scores over narrative feedback, as some students in this study reported. Narrative feedback may be perceived as overwhelming and less helpful due to its excessive length and delayed delivery, which can hinder students' ability to interpret the feedback effectively, monitor their competency development and plan subsequent steps. This supports the arguments of Tai et al. ([<reflink idref="bib23" id="ref47">23</reflink>]) that students often lack effective support to develop evaluative judgment in relation to their e-portfolios. Additionally, feedback that addresses both task performance and competency development may confuse students and hinder its use.</p> <p>Coaches' support was perceived as important in supporting students by providing guidance, reassurance and scaffolding. These findings are consistent with prior research: coaching aids students in interpreting feedback and developing learning strategies (van der Vleuten, Lindemann, and Schmidt [<reflink idref="bib27" id="ref48">27</reflink>]), while coaching also guides students' systematic reflection and teaching students how to reflect on feedback and learning materials (King, Schuwirth, and Jordaan [<reflink idref="bib10" id="ref49">10</reflink>]). This study further highlights the multifaceted nature of the support coaches provide, aligning with the findings of Rich et al. ([<reflink idref="bib17" id="ref50">17</reflink>]). Their support extends beyond academic learning to areas such as planning and maintaining a work-life balance. Coaches' in-depth understanding of students enables them to offer this support in a systematic way. Results also indicate students' trust in coaches, likely because coaches promote autonomy and allow students control over their learning. This autonomy fosters a safe environment in the coach-student relationship, which resonates with findings by Schut et al. ([<reflink idref="bib20" id="ref51">20</reflink>]).</p> <p>Elective and authentic learning tasks significantly enhance student motivation, planning, and self-reflection. These findings align with previous literature. Kusurkar et al. ([<reflink idref="bib11" id="ref52">11</reflink>]) found that authentic learning fosters intrinsic motivation and deeper engagement, providing autonomy in task selection and promoting active learning. This active involvement encourages greater ownership of the learning process and stimulates students' motivation, which is an essential part of SRL. Similarly, elective learning tasks allow students to tailor their educational experiences to their personal needs and career goals, fostering reflective practice, as supported by Greenfield et al. ([<reflink idref="bib6" id="ref53">6</reflink>]). Our findings further corroborate that both authentic tasks and elective choices enhance student motivation, planning and reflection phases of SRL. Previous research has predominantly examined PA in clinical settings, where learning tasks are inherently authentic, but where there is limited exploration of the impact of allowing students the freedom to select their learning tasks (Lee et al. [<reflink idref="bib12" id="ref54">12</reflink>]). This study contributed additional evidence regarding this aspect.</p> <p>Continuous low-stakes assessments can inadvertently create unexpected stress for some students. Results of this study indicate that the absence of pass/fail decisions creates uncertainty at the start, prompting some students to feel they must achieve perfection with each task, as every assessment influences the outcome of high-stakes assessment at the end. This aligns with findings in the case study by Baartman, Baukema, and Prins ([<reflink idref="bib1" id="ref55">1</reflink>]), where students often feel pressured to 'redo' tasks until they meet standards. To better achieve the intended function of PA, it is important to help students expand their perception of assessment: from focusing solely on 'assessment of learning' to also embracing 'assessment for learning'. This shift involves rethinking educational philosophy and transforming the assessment culture. Supporting this process requires ensuring that students understand the purposes and processes of assessment (Schellekens et al. [<reflink idref="bib18" id="ref56">18</reflink>]).</p> <p>The online curriculum setting may enhance the collection of assessment information in e-portfolios. Results show that e-portfolios help students aggregate, monitor, and reflect on assessments. This finding aligns with what Sein et al. ([<reflink idref="bib22" id="ref57">22</reflink>]) found, which emphasises the importance of e-portfolios in collecting extensive data necessary for high-stakes decision-making. Contrary to critiques that feedback in clinical settings can be non-specific and lack context (Misra et al. [<reflink idref="bib14" id="ref58">14</reflink>]), this study found that students were impressed with how specific the narrative feedback is; some even struggled with aggregating and interpreting the overwhelming amount of narrative feedback. This is likely because the online environment enforces digital collection and recording of assessments. As Schuwirth and Van der Vleuten ([<reflink idref="bib21" id="ref59">21</reflink>]) described, this generates a steady flow of information that learners can use to guide and self-regulate their learning with PA. Thus, the online setting may enhance the specificity and depth of assessments, supporting students' learning effectively.</p> <p>Practical implications of this study include the following. First, in PA, students often face challenges in interpreting assessments and making evaluative judgments on their e-portfolios due to the richness and complexity of narrative feedback. Teaching faculty may need to provide more structured support to guide students in this process. Second, in PA, curriculum designers could enhance students' motivation by allowing greater autonomy in the selection of learning tasks and by embedding these tasks within authentic learning contexts. Third, although autonomy in PA can foster SRL, some students may initially struggle to manage this independence. Teaching faculty could consider offering scaffolding and guidance during this transitional phase to support students' adjustment.</p> <p>Despite the contributions, this study has some limitations. First, as it focuses on a part-time, hybrid master's program for healthcare professionals, the findings may not be fully generalizable to full-time, in-person programs or other educational and cultural contexts. Second, the study only explored students' perspectives, omitting insights from other stakeholders, such as teaching faculty and administrators, who could provide a more comprehensive understanding of PA's impact. Third, we employed custom-designed research instruments (a questionnaire and interview guide) specifically tailored to explore students' perceptions, rather than using previously validated tools. Although Cronbach's alpha values were reported, they provide limited evidence of reliability, and the psychometric properties of the instruments warrant further investigation.</p> <hd id="AN0189651305-20">Disclosure statement</hd> <p>No potential conflict of interest was reported by the author(s).</p> <hd id="AN0189651305-21">Appendix 1. Interview guide</hd> <p></p> <hd id="AN0189651305-22">Demographic questions</hd> <p>1. What is your age?</p> <ulist> <item>2. What is your native language and nationality?</item> <item>3. What is your educational background?</item> <item>4. What is your professional background?</item> <item>5. How many years of experience do you have as an educator?</item> <item>6. Which MHPE site do you join?</item> <item>7. Which year did you start MHPE?</item> </ulist> <hd id="AN0189651305-23">Introduction questions</hd> <p>8. What is your general learning experience in MHPE?</p> <hd id="AN0189651305-24">Transition questions</hd> <ulist> <item>9. What are your experiences with programmatic assessment in MHPE? (new features: electives, authentic tasks, e-portfolio, feedback, coaching)</item> <item>10. What motivated you to join MHPE?</item> </ulist> <p>We renewed the MHPE program and introduced common and elective learning tasks, the different roles (researcher, designer, leader), and introduced an e-portfolio and introduced various sources of feedback and a coaching system to enhance you to self-direct your learning (select particular learning tasks, monitor your performance and set goals for further development). We have a few questions. (A brief introduction to Ottawa 2020 12 consensus principles of programmatic assessment (Heeneman et al. [<reflink idref="bib7" id="ref60">7</reflink>]) and three phases of self-regulated learning.)</p> <hd id="AN0189651305-25">Core questions</hd> <ulist> <item>11. Setting goals before learning is important because it gives you an orientation of what you want to learn. For example, by knowing the criteria of tasks or judging the difficulty of tasks. What is your experience about planning for your learning in MHPE? How does this enhance or hinder your learning and Why? Can you give an example?</item> <item>12. You may also use strategies to monitor or evaluate yourself while you are learning. For example, by managing the time and environment or seeking for help when you get stuck. What is your experience with monitoring in MHPE? How does this help or hinder your learning and why? Can you give an example?</item> <item>13. After completing the learning tasks in MHPE, you may also assess your performance; think about your learning plan, select future tasks by yourself in MHPE. For example, based on what you want to obtain from MPHE, competencies that you want to develop or your personal interests. What are your experiences with self-reflection and setting new goals in MHPE? How does this help or hinder your learning? Can you give an example?</item> </ulist> <hd id="AN0189651305-26">Conclusion questions</hd> <p>14. Do you have anything else that just came to your mind to add that we did not discuss before?</p> <ref id="AN0189651305-27"> <title> References </title> <blist> <bibl id="bib1" idref="ref1" type="bt">1</bibl> <bibtext> Baartman, L. K. J., H. Baukema, and F. Prins. 2023. " Exploring Students' Feedback Seeking Behavior in the Context of Programmatic Assessment." Assessment & Evaluation in Higher Education 48 (5): 598 – 612. doi: 10.1080/02602938.2022.2100875.</bibtext> </blist> <blist> <bibl id="bib2" idref="ref2" type="bt">2</bibl> <bibtext> Braun, V., and V. Clarke. 2006. " Using Thematic Analysis in Psychology." Qualitative Research in Psychology 3 (2): 77 – 101. doi: 10.1191/1478088706qp063oa.</bibtext> </blist> <blist> <bibl id="bib3" idref="ref3" type="bt">3</bibl> <bibtext> Charlton, N., and R. Newsham-West. 2024. " A Conceptual Model for Program-Level Assessment." Higher Education Research & Development 43 (8): 1721 – 1736. doi: 10.1080/07294360.2024.2364094.</bibtext> </blist> <blist> <bibl id="bib4" idref="ref4" type="bt">4</bibl> <bibtext> Creswell, J. W., and J. D. Creswell. 2018. Research Design: Qualitative, Quantitative, and Mixed Methods Approaches (5th ed.). Newcastle upon Tyne : SAGE.</bibtext> </blist> <blist> <bibl id="bib5" idref="ref5" type="bt">5</bibl> <bibtext> de Jong, L., H. Bok, L. Schellekens, W. Kremer, F. Jonker, and C. Vleuten. 2022. " Shaping the Right Conditions in Programmatic Assessment: How Quality of Narrative Information Affects the Quality of High-Stakes Decision-Making." BMC Medical Education 22 (1): 592. doi: 10.1186/s12909-022-03257-2.</bibtext> </blist> <blist> <bibl id="bib6" idref="ref13" type="bt">6</bibl> <bibtext> Greenfield, J., K. Qua, R. Prayson, and S. B. Bierer. 2023. " It Changed How I Think"—Impact of Programmatic Assessment Upon Practicing Physicians: A Qualitative Study. Medical Science Educator 33 (4): 963 – 974. doi: 10.1007/s40670-023-01829-5.</bibtext> </blist> <blist> <bibl id="bib7" idref="ref10" type="bt">7</bibl> <bibtext> Heeneman, S., L. H. de Jong, L. J. Dawson, T. J. Wilkinson, A. Ryan, G. R. Tait, N. Rice, D. Torre, A. Freeman, and C. P. M. van der Vleuten. 2021. " Ottawa 2020 Consensus Statement for Programmatic Assessment - 1. Agreement on the Principles." Medical Teacher 43 (10): 1139 – 1148. doi: 10.1080/0142159X.2021.1957088.</bibtext> </blist> <blist> <bibl id="bib8" idref="ref19" type="bt">8</bibl> <bibtext> Heikkinen, S., M. Saqr, J. Malmberg, and M. Tedre. 2023. " Supporting Self-Regulated Learning with Learning Analytics Interventions: A Systematic Literature Review." Education and Information Technologies 28 (3): 3059 – 3088. doi: 10.1007/s10639-022-11281-4.</bibtext> </blist> <blist> <bibl id="bib9" idref="ref22" type="bt">9</bibl> <bibtext> Järvenoja, H., S. Järvelä, and J. Malmberg. 2020. " Supporting Groups' Emotion and Motivation Regulation during Collaborative Learning." Learning and Instruction 70 : 101090. doi: 10.1016/j.learninstruc.2017.11.004.</bibtext> </blist> <blist> <bibtext> King, S. M., L. W. T. Schuwirth, and J. H. Jordaan. 2022. " Embedding a Coaching Culture into Programmatic Assessment." Education Sciences 12 (4): 273. doi: 10.3390/educsci12040273.</bibtext> </blist> <blist> <bibtext> Kusurkar, R. A., C. Orsini, S. Somra, A. R. Artino, Jr., H. E. M. Daelmans, L. J. Schoonmade, and C. van der Vleuten. 2023. " The Effect of Assessments on Student Motivation for Learning and Its Outcomes in Health Professions Education: A Review and Realist Synthesis." Academic Medicine: Journal of the Association of American Medical Colleges 98 (9): 1083 – 1092. doi: 10.1097/acm.0000000000005263.</bibtext> </blist> <blist> <bibtext> Lee, J., S. Campbell, M. Choi, and J. Bae. 2022. " Authentic Learning in Healthcare Education: A Systematic Review." Nurse Education Today 119 : 105596. doi: 10.1016/j.nedt.2022.105596.</bibtext> </blist> <blist> <bibtext> McArthur, J. 2023. " Rethinking Authentic Assessment: Work, Well-Being, and Society." Higher Education 85 (1): 85 – 101. doi: 10.1007/s10734-022-00822-y.</bibtext> </blist> <blist> <bibtext> Misra, S., W. Iobst, K. Hauer, and E. Holmboe. 2021. " The Importance of Competency-Based Programmatic Assessment in Graduate Medical Education." Journal of Graduate Medical Education 13 (2 Suppl): 113 – 119. doi: 10.4300/JGME-D-20-00856.1.</bibtext> </blist> <blist> <bibtext> Panadero, E. 2017. " A Review of Self-Regulated Learning: Six Models and Four Directions for Research." Frontiers in Psychology 8 : 422. doi: 10.3389/fpsyg.2017.00422.</bibtext> </blist> <blist> <bibtext> Ramanadhan, S., A. C. Revette, R. M. Lee, and E. L. Aveling. 2021. " Pragmatic Approaches to Analyzing Qualitative Data for Implementation Science: An Introduction." Implementation Science Communications 2 (1): 70. doi: 10.1186/s43058-021-00174-1.</bibtext> </blist> <blist> <bibtext> Rich, J., S. Fostaty Young, C. Donnelly, A. Hall, J. Dagnone, K. Weersink, J. Caudle, E. Van Melle, and D. Klinger. 2020. " Competency‐Based Education Calls for Programmatic Assessment: But What Does This Look like in Practice? " Journal of Evaluation in Clinical Practice 26 (4): 1087 – 1095. doi: 10.1111/jep.13328.</bibtext> </blist> <blist> <bibtext> Schellekens, L. H., H. G. J. Bok, L. H. de Jong, M. F. van der Schaaf, W. D. J. Kremer, and C. P. M. van der Vleuten. 2021. " A Scoping Review on the Notions of Assessment as Learning (AaL), Assessment for Learning (AfL), and Assessment of Learning (AoL)." Studies in Educational Evaluation 71 : 101094. doi: 10.1016/j.stueduc.2021.101094.</bibtext> </blist> <blist> <bibtext> Schellekens, L. H., M. F. Van der Schaaf, L. K. J. Baartman, C. P. M. Van der Vleuten, W. D. J. Kremer, and H. G. J. Bok. 2024. " Students' Perceptions of the Assessment Programme's Impact on Self-Regulated Learning: A Multiple-Case Study." Assessment & Evaluation in Higher Education 49 (8): 1074 – 1090. doi: 10.1080/02602938.2024.2343317.</bibtext> </blist> <blist> <bibtext> Schut, S., E. Driessen, J. van Tartwijk, C. van der Vleuten, and S. Heeneman. 2018. " Stakes in the Eye of the Beholder: An International Study of Learners' Perceptions within Programmatic Assessment." Medical Education 52 (6): 654 – 663. doi: 10.1111/medu.13532.</bibtext> </blist> <blist> <bibtext> Schuwirth, L., and C. Van der Vleuten. 2011. " Programmatic Assessment: From Assessment of Learning to Assessment for Learning." Medical Teacher 33 (6): 478 – 485. doi: 10.3109/0142159X.2011.565828.</bibtext> </blist> <blist> <bibtext> Sein, A., H. Rashid, J. Meka, J. Amiel, and W. Pluta. 2021. " Twelve Tips for Embedding Assessment for and as Learning Practices in a Programmatic Assessment System." Medical Teacher 43 (3): 300 – 306. doi: 10.1080/0142159X.2020.1789081.</bibtext> </blist> <blist> <bibtext> Tai, J., R. Ajjawi, D. Boud, P. Dawson, and E. Panadero. 2018. " Developing Evaluative Judgement: Enabling Students to Make Decisions about the Quality of Work." Higher Education 76 (3): 467 – 481. doi: 10.1007/s10734-017-0220-3.</bibtext> </blist> <blist> <bibtext> Timmerman, A. A., and J. Dijkstra. 2017. " A Practical Approach to Programmatic Assessment Design." Advances in Health Sciences Education: Theory and Practice 22 (5): 1169 – 1182. doi: 10.1007/s10459-017-9756-3.</bibtext> </blist> <blist> <bibtext> Torre, D., L. Schuwirth, and C. Van der Vleuten. 2020. " Theoretical Considerations on Programmatic Assessment." Medical Teacher 42 (2): 213 – 220. doi: 10.1080/0142159X.2019.1672863.</bibtext> </blist> <blist> <bibtext> van der Gulden, R., S. Heeneman, A. W. M. Kramer, R. F. J. M. Laan, N. D. Scherpbier-de Haan, and B. P. A. Thoonen. 2020. " How is Self-Regulated Learning Documented in e-Portfolios of Trainees? A Content Analysis." BMC Medical Education 20 (1): 205. doi: 10.1186/s12909-020-02114-4.</bibtext> </blist> <blist> <bibtext> van der Vleuten, C., I. Lindemann, and L. Schmidt. 2018. " Programmatic Assessment: The Process, Rationale and Evidence for Modern Evaluation Approaches in Medical Education." The Medical Journal of Australia 209 (9): 386 – 388. doi: 10.5694/mja17.00926.</bibtext> </blist> <blist> <bibtext> van der Vleuten, C. P., L. W. Schuwirth, E. W. Driessen, J. Dijkstra, D. Tigelaar, L. K. Baartman, and J. van Tartwijk. 2012. " A Model for Programmatic Assessment Fit for Purpose." Medical Teacher 34 (3): 205 – 214. doi: 10.3109/0142159x.2012.652239.</bibtext> </blist> <blist> <bibtext> Westbroek, H. B., L. van Rens, E. van den Berg, and F. Janssen. 2020. " A Practical Approach to Assessment for Learning and Differentiated Instruction." International Journal of Science Education 42 (6): 955 – 976. doi: 10.1080/09500693.2020.1744044.</bibtext> </blist> <blist> <bibtext> Zimmerman, B. 2008. " Investigating Self-Regulation and Motivation: Historical Background, Methodological Developments, and Future Prospects." American Educational Research Journal 45 (1): 166 – 183. doi: 10.3102/0002831207312909.</bibtext> </blist> <blist> <bibtext> Zimmerman, B. J. 2002. " Becoming a Self-Regulated Learner: An Overview." Theory into Practice 41 (2): 64 – 70. doi: 10.1207/s15430421tip4102_2.</bibtext> </blist> <blist> <bibtext> Zimmerman, B. J., & Campillo, M. (2003). Motivating Self-Regulated Problem Solvers. In The Psychology of Problem Solving, edited by J. E. Davidson and R. J. Sternberg, 233–262). Cambridge University Press. doi: 10.1017/CBO9780511615771.009.</bibtext> </blist> </ref> <aug> <p>By Xian Liu; Diana Dolmans; Maryam Asoodar; Zhien Li and Daniëlle Verstegen</p> <p>Reported by Author; Author; Author; Author; Author</p> <p></p> <p>Xian Liu is a PhD student at the School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University. His research interests include assessment, feedback, self-regulated learning and teacher education.</p> <p>Diana Dolmans is a Full professor in the field of health professions education innovation and research. She is the chair of the Department of Educational Development and Research at Maastricht University. Her research focuses on key success factors of innovative curricula in higher education, including problem-based learning, faculty development and quality culture.</p> <p>Maryam Asoodar is an Assistant Professor at the School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University. Her research focuses on instructional design and e-learning.</p> <p>Zhien Li is a PhD student at the School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University. His research interests include simulation and technology in education.</p> <p>Daniëlle Verstegen is an Associate Professor at the School of Health Professions Education (SHE), Faculty of Health, Medicine and Life Sciences, Maastricht University. She is the SHE Educates leader, SHE management team member and the director of the Master of Health Professions Education (MHPE). Her work focuses on the relationship between instructional design and context, including adaptation to learning needs, stakeholder perceptions and local conditions.</p> </aug> <nolink nlid="nl1" bibid="bib21" firstref="ref6"></nolink> <nolink nlid="nl2" bibid="bib18" firstref="ref7"></nolink> <nolink nlid="nl3" bibid="bib24" firstref="ref8"></nolink> <nolink nlid="nl4" bibid="bib28" firstref="ref9"></nolink> <nolink nlid="nl5" bibid="bib13" firstref="ref12"></nolink> <nolink nlid="nl6" bibid="bib27" firstref="ref15"></nolink> <nolink nlid="nl7" bibid="bib15" firstref="ref16"></nolink> <nolink nlid="nl8" bibid="bib30" firstref="ref17"></nolink> <nolink nlid="nl9" bibid="bib25" firstref="ref18"></nolink> <nolink nlid="nl10" bibid="bib31" firstref="ref20"></nolink> <nolink nlid="nl11" bibid="bib29" firstref="ref21"></nolink> <nolink nlid="nl12" bibid="bib32" firstref="ref23"></nolink> <nolink nlid="nl13" bibid="bib20" firstref="ref28"></nolink> <nolink nlid="nl14" bibid="bib19" firstref="ref29"></nolink> <nolink nlid="nl15" bibid="bib26" firstref="ref31"></nolink> <nolink nlid="nl16" bibid="bib10" firstref="ref32"></nolink> <nolink nlid="nl17" bibid="bib14" firstref="ref33"></nolink> <nolink nlid="nl18" bibid="bib16" firstref="ref36"></nolink> <nolink nlid="nl19" bibid="bib23" firstref="ref47"></nolink> <nolink nlid="nl20" bibid="bib17" firstref="ref50"></nolink> <nolink nlid="nl21" bibid="bib11" firstref="ref52"></nolink> <nolink nlid="nl22" bibid="bib12" firstref="ref54"></nolink> <nolink nlid="nl23" bibid="bib22" firstref="ref57"></nolink>
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  Label: Title
  Group: Ti
  Data: How to Close the Learning Circle? Students' Perspectives on How Programmatic Assessment Influences Self-Regulated Learning in a Global Online Programme
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Xian+Liu%22">Xian Liu</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-4247-6088">0000-0002-4247-6088</externalLink>)<br /><searchLink fieldCode="AR" term="%22Diana+Dolmans%22">Diana Dolmans</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-4802-1156">0000-0002-4802-1156</externalLink>)<br /><searchLink fieldCode="AR" term="%22Maryam+Asoodar%22">Maryam Asoodar</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-6044-6790">0000-0001-6044-6790</externalLink>)<br /><searchLink fieldCode="AR" term="%22Zhien+Li%22">Zhien Li</searchLink> (ORCID <externalLink term="https://orcid.org/0009-0007-2223-8940">0009-0007-2223-8940</externalLink>)<br /><searchLink fieldCode="AR" term="%22Daniëlle+Verstegen%22">Daniëlle Verstegen</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-6811-175X">0000-0001-6811-175X</externalLink>)
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  Label: Source
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  Data: <searchLink fieldCode="SO" term="%22Assessment+%26+Evaluation+in+Higher+Education%22"><i>Assessment & Evaluation in Higher Education</i></searchLink>. 2025 50(8):1207-1222.
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  Data: Routledge. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 16
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2025
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research<br />Tests/Questionnaires
– Name: Audience
  Label: Education Level
  Group: Audnce
  Data: <searchLink fieldCode="EL" term="%22Higher+Education%22">Higher Education</searchLink><br /><searchLink fieldCode="EL" term="%22Postsecondary+Education%22">Postsecondary Education</searchLink>
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Student+Attitudes%22">Student Attitudes</searchLink><br /><searchLink fieldCode="DE" term="%22Graduate+Students%22">Graduate Students</searchLink><br /><searchLink fieldCode="DE" term="%22Student+Evaluation%22">Student Evaluation</searchLink><br /><searchLink fieldCode="DE" term="%22Learning+Strategies%22">Learning Strategies</searchLink><br /><searchLink fieldCode="DE" term="%22Independent+Study%22">Independent Study</searchLink><br /><searchLink fieldCode="DE" term="%22Foreign+Countries%22">Foreign Countries</searchLink><br /><searchLink fieldCode="DE" term="%22Allied+Health+Occupations+Education%22">Allied Health Occupations Education</searchLink><br /><searchLink fieldCode="DE" term="%22Feedback+%28Response%29%22">Feedback (Response)</searchLink><br /><searchLink fieldCode="DE" term="%22Coaching+%28Performance%29%22">Coaching (Performance)</searchLink><br /><searchLink fieldCode="DE" term="%22Portfolios+%28Background+Materials%29%22">Portfolios (Background Materials)</searchLink><br /><searchLink fieldCode="DE" term="%22Personal+Autonomy%22">Personal Autonomy</searchLink><br /><searchLink fieldCode="DE" term="%22Pass+Fail+Grading%22">Pass Fail Grading</searchLink>
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Netherlands%22">Netherlands</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1080/02602938.2025.2513008
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0260-2938<br />1469-297X
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Programmatic assessment (PA) is widely implemented in higher education and is theorised to support self-regulated learning (SRL). However, its mechanisms remain unclear. This study explored students' perceptions of PA's impact on SRL in a part-time, predominantly online Master's programme for healthcare professionals worldwide. A pragmatic exploratory mixed-methods approach was employed, integrating quantitative data (survey, N = 46) and qualitative data (interviews, N = 14) collected concurrently with equal emphasis. Quantitative findings showed an overall positive perception of PA. Thematic analysis of interviews identified five key themes: (1) Intermediate feedback provides immediately useful directions for learning, but final feedback is more difficult to use and act upon. (2) Coaches are important in supporting students by providing guidance, reassurance and scaffolding on where to go next. (3) E-portfolios help aggregate data points to monitor competency development and uncover strengths and weaknesses. (4) Autonomy in choosing work-relevant tasks enhanced students' motivation, planning and reflection. (5) The lack of pass-fail decisions in PA creates uncertainty at first but ultimately it stimulates students to regulate their own learning process. While students reported overall satisfaction, challenges still existed, including initial uncertainty, processing narrative feedback and integrating e-portfolios. Structured faculty support may enhance PA's effectiveness in promoting SRL.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2026
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1491808
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1491808
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    Identifiers:
      – Type: doi
        Value: 10.1080/02602938.2025.2513008
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 16
        StartPage: 1207
    Subjects:
      – SubjectFull: Student Attitudes
        Type: general
      – SubjectFull: Graduate Students
        Type: general
      – SubjectFull: Student Evaluation
        Type: general
      – SubjectFull: Learning Strategies
        Type: general
      – SubjectFull: Independent Study
        Type: general
      – SubjectFull: Foreign Countries
        Type: general
      – SubjectFull: Allied Health Occupations Education
        Type: general
      – SubjectFull: Feedback (Response)
        Type: general
      – SubjectFull: Coaching (Performance)
        Type: general
      – SubjectFull: Portfolios (Background Materials)
        Type: general
      – SubjectFull: Personal Autonomy
        Type: general
      – SubjectFull: Pass Fail Grading
        Type: general
      – SubjectFull: Netherlands
        Type: general
    Titles:
      – TitleFull: How to Close the Learning Circle? Students' Perspectives on How Programmatic Assessment Influences Self-Regulated Learning in a Global Online Programme
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            NameFull: Xian Liu
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            NameFull: Zhien Li
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            NameFull: Daniëlle Verstegen
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              Y: 2025
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              Value: 0260-2938
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              Value: 50
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