Self-regulated learning profiles including test anxiety linked to stress and performance: A latent profile analysis based across multiple cohorts.

Introduction: Medical educators aim to understand why students differ in performance and stress. While performance and stress are associated with student demographics, school factors and aspects of self-regulated learning (SRL), it remains unclear how these elements interact within individuals. This multi-cohort study identified SRL profiles among medical students and explored their associations with performance and stress. Additionally, we examined the identified profiles' associations with gender, migration status and assessment policy.

Methods: We used latent profile analysis (LPA) to identify profiles on Motivated Strategies for Learning Questionnaire (MSLQ) scores of six cohorts (2014-2019) of Year 1, first semester medical students (n = 1894) in a Dutch medical school. We used nine MSLQ subscales that measure test anxiety (TA), self-efficacy, deep learning, resource management and value. The university's assessment policy varied, demanding students to obtain 100% or 75% of Year 1 credits to remain enrolled. We defined optimal performance as obtaining all credits at the end of Year 1. Two cohorts completed the Perceived Stress Scale (PSS-14, n = 409) in the 2nd semester.

Results: We identified three distinct student profiles: 693/1894(36.6%) were classified as TASRL, 661/1894(34.9%) as TASRL and 540/1894(28.5%) as TASRL. Females were more likely to belong to TASRL profiles compared to males (effect size [ES] Cramer's V = .13, small). Migration background was not associated with these profiles. The TASRL profile was more prevalent under the 100% assessment policy (ES Cramer's V = .10, negligible). TASRL students demonstrated lower stress levels (PSS = 23.9 out of 56) compared to TASRL students (PSS = 28.7, ES Cohen's d = .62, medium) and TASRL students (PSS = 28.2, ES Cohen's d = .51, medium). Performance differed among the three profiles (ES Cramer's V = .16, small): 82.5% optimal performance in the TASRL, 71.9% in the TASRL and 65.2% in the TASRL profile.

Discussion: Three distinct SRL student profiles associated with gender, academic performance and perceived stress were identified. Test anxiety had additional value in distinguishing subgroups with differential academic performance and stress. These profiles may aid educators to inform personalised support strategies for novice learners.