Evaluation of Metacognition and Study Strategies in First Year Medical Students

Introduction Metacognition refers to awareness of one's own knowledge and is fundamental for physicians to have. It encompasses how one plans when approaching a learning task, monitors comprehension, and reflects on understanding and performance. As medicine evolves, it is critical that medical students and physicians have insight into their limitations and knowledge deficiencies. Diagnostic and treatment errors are one of the leading causes of death, and overconfidence, or a lack of metacognition, is often to blame. Metacognitive skills must be developed not only to achieve higher academic performance, but also to link medical knowledge to clinical thinking, emphasize critical thinking, and enhance reflection. Aims The purpose of this study was to examine metacognitive skills of first year medical students and evaluate the influence these skills have on academic performance. We hypothesized that there would be a significant relationship between higher metacognition and academic performance. Methods At the end of the first year, Medical College of Georgia students (n=119 out of 191) completed a survey consisting of the Metacognitive Awareness Inventory (MAI), which assesses knowledge and regulation about cognition (possible score: 61–305), and questions about study strategies. Students were divided into tertiles based on metacognition results (low: 160.8 ± 13.1, n=41; middle: 185.5 ± 5.6, n=39; high: 214.7 ± 15.7, n=39). One‐way ANOVA with Tukey’s posthoc analysis was used to compare metacognition scores with academic performance in basic science components (Anatomy, Biochemistry, Development, Histology, Physiology, Neuroscience), and systems‐based modules (Cell & Molecular Basis of Medicine, Tissue/Musculoskeletal, Cardiopulmonary, Gastrointestinal‐Nutrition, Genitourinary, Head/Neck & Special Senses, Medical Neuroscience & Behavioral Health), as well as the frequency of study strategies used. IRB approval was obtained from Augusta University. Results Students with high metacognition scores performed significantly better in the curriculum (overall grade: 86.5 ± 5.1) than the middle (overall grade: 83.6 ± 4.8) and low tertiles (overall grade: 81.2 ± 5.0) (p<0.05). The highest metacognitive tertile scored significantly higher in every basic science component compared to the lowest tertile (p<0.05) and significantly better than the middle tertile for all of the anatomical science components (p<0.05). Medical students in the highest metacognitive tertile performed significantly higher than the lowest tertile in every systems‐based module except the first, Cell & Molecular Basis of Medicine (p<0.05). The highest metacognitive tertile was significantly more likely to peer teach and take notes from memory than the lowest tertile (p<0.05). Additionally, a significant difference in frequency of reviewing at spaced intervals existed between all tertiles (p<0.05). Conclusions This preliminary study found that higher metacognition positively impacts academic performance and should be actively fostered. Medical students would likely benefit from further development of their metacognition skills as part of the formal curriculum. Future research will examine the relationship between metacognition and academic performance throughout the clinical years.