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This study explored the co-occurrences of self-regulated learning (SRL) strategies and medical reasoning (MR) processes as medical students accomplished diagnostic tasks in a computer-simulated environment. Particularly, we coded SRL and MR from students’ think-aloud protocols and analyzed their co-occurrences using Epistemic Network Analysis (ENA). Moreover, we compared the differences in the epistemic networks between levels of task complexity and levels of performance. The results demonstrated that self-reflection and reasoning co-occurred more frequently in the difficult task. In addition, the same co-occurrence was more frequent for students who achieved higher performance in the difficult task. Furthermore, we observed more co-occurrences of goal-directed diagnostic behaviors with monitoring and evaluation for high performers in the easy task. We discuss implications for future research.