From Self-directed to Self-determined: Reframing Learner Activity in Early Medical Education

Abstract

Self-directed learning (SDL) has been an articulated goal of medical education for decades but is often operationalized in practice as self-paced learning within a fixed curriculum. In this short communication, I highlight the need to move beyond standard competency models in preclinical medical education. I propose adopting heutagogy (self-determined learning) instead. Under this approach, students have the autonomy to choose their own learning pathways, collaborate on how they are assessed, and actively develop the skills to navigate unfamiliar clinical challenges. I argue that this ability to learn what is not yet known is a distinct and necessary capability, quite different from traditional competency. A proposed framework, negotiated learning pathways, is described to embed a heutagogical structure into the 1 ^st year of medical school within the current competency guardrails, along with a pilot evaluation design, capitalizing on the existing preclinical SDL literature. I contend that this change is most important in the early years, before habits of dependence on externally imposed learning goals have been well established.