'Overcoming and owning challenges': A qualitative study exploring the manifestation of agency in learners.

Introduction: Educators strive to engage learners with their learning. At the heart of this process is empowering individuals to intentionally participate in educational opportunities afforded to them i.e. agentic learning (AL). Significant knowledge gaps remain in how best to promote AL in medical education. Increasingly, simulation is being used to research pedagogical phenomena. In our study, we used simulation as a context to address the following research question: How does individuals' agency manifest in their learning, and what conditions act as enablers for its development?

Methods: Twelve medical students were recruited for this qualitative study. An acute medical simulation-based exercise was used as a learning context. Following the simulations, semi-structured interviews were conducted. Recordings of interviews, and simulation pre-briefs and debriefs were transcribed and thematically analysed using template analysis, drawing upon the Transformative Agency through Double Stimulation framework - to guide our analysis.

Results: We constructed six themes that capture how AL manifests and is promoted. Learners invariably encounter challenges that impede progress in their learning. Such challenges can spur learners to think and act agentially. Feedback provides a mirror for learners to gain self-knowledge, deepening their commitment to take ownership of their actions and effect change. This process is enhanced by allowing learners to enact and embody new knowledge. Upholding learners' professional credibility and harnessing the social practice of learning - provides conditions for AL to flourish.

Discussion: AL in medical education helps learners shift from pretending to becoming their future professional selves. By crafting sufficient and facilitated challenges, learners are allowed to 'hold the tension' between creatively resolving challenges and upholding their professional credibility. This process is shaped by participation in a social group and can be influenced by the transformation of activities within this group. Embodying changes provides a deep-seated message that learners can carry to their future.