Evaluating the Value of Eye-Tracking Augmented Debriefing in Medical Simulation—A Pilot Randomized Controlled Trial

Aim: To examine the relationship between reflective thinking and metacognitive awareness to help medical students to be independent learners who can control their learning and improve their professional performance.
 Study Design: It is a cross-sectional correlational study.
 Place and Duration of the Study: This study was conducted at the Faculty of Medicine-Suez Canal University in August 2018.
 Methodology: This is a cross-sectional correlational study; the study population included the undergraduate medical students in all study years at the Faculty of Medicine, Suez Canal University. The sample was 264 randomly selected students by using a cluster sampling technique. The instruments that were used for data collection were the Metacognitive Awareness Inventory (MAI) to measure students’ metacognitive awareness levels, Reflection-in-Learning Scale (RLS) to measure the students’ reflective learning levels.
 Results: The descriptive statistics of both MAI and RLS total scores of students in the six study years revealed that students have mean total MAI total scores = 178 ± 26 and have mean total RLS total scores = 60 ± 13.
 The Spearman's correlation between the metacognitive awareness and the reflective learning skills of medical students revealed that there was a statistically significant high positive correlation between the metacognitive awareness and the reflection in the learning of FOM-SCU students (p= 0.699, p-value<0.0001).
 Multiple regression analysis revealed that the weighted combination of the predictor variables explained approximately 50% of the variance of reflection in learning.
 Conclusion: It is concluded from this study that the students at the Faculty of Medicine, Suez Canal University have fair to good metacognitive awareness and partial to ample reflective abilities. There is a significantly high positive relationship between metacognitive awareness and the reflective learning skills of medical students.

Exploring cognitive processes and their influence upon the enhancement of higher-order thinking skills has yielded significant insights into how individuals learn, process, and utilise information. The current study’s aim is to investigate the relationship between self-efficacy and critical thinking through the mediating roles of metacognitive awareness and reflective thinking. The academic self-efficacy scale, the critical thinking scale, the metacognitive awareness inventory, and the reflective thinking scale were administered to a total of 246 university students as data collection tools. The correlation analysis found that all the variables are positively related to each other, and the regression analysis showed that self-efficacy, metacognitive awareness, and reflective thinking can significantly predict critical thinking. Examining how metacognitive awareness and reflective thinking could affect the link between self-efficacy and critical thinking using Structural Equation Modelling (SEM) revealed that both metacognitive awareness and reflective thinking were important as partial mediators, which helped boost the positive impact of self-efficacy on improving critical thinking skills. Implications and recommendations are further discussed.

This study examined whether cognitive load moderates the relationship between metacognition and critical thinking among students in Indonesia. A total of 201 undergraduate and diploma students participated by completing an online questionnaire using the Indonesian version of the Metacognitive Awareness Inventory (MAI), the Leppink et al. adaptation of the Cognitive Load Scale, and the Sosu adaptation of the Critical Thinking Disposition Scale. Results showed that metacognition had a significant positive effect on critical thinking (p<.001), explaining approximately 47-50% of the variance across models. However, intrinsic, extraneous, and germane cognitive load did not significantly moderate this relationship. The interaction between metacognitive awareness and critical thinking disposition remains stable across varying levels of perceived cognitive load. These findings highlight metacognition as a robust predictor of critical thinking disposition and suggest that perceived cognitive load may not substantially alter this relationship at the dispositional level. Rather than contradicting Cognitive Load Theory, the results refine its applicability by indicating that cognitive load effects may be more observable in performance-based contexts. Future research may explore whether cognitive load exerts stronger moderating effects on performance-based critical thinking tasks under experimentally manipulated conditions.

Purpose: The purpose of this study was to explore various theories about metacognition, especially the measurement of metacognition using the Metacognition Awareness Inventory (MAI) and its relation to problem solving. The goal of this research is to describe the validity of the metacognition ability instrument in solving mathematical problems that require metacognition awareness. Theoretical Framework: Problem solving is an essential part of the mathematics learning process. Metacognition becomes an important issue along with the trend of 21st century learning. Metacognition is important in achieving student cognitive learning outcomes, specifically in increasing the effectiveness of learning strategies. Many methods have been used to assess metacognition, including questionnaires, interviews, analysis of thinking-aloud protocols, observations, awareness-raising tasks, diaries, and autobiographies. The Metacognition Awareness Inventory is one tool for determining the level of student metacognition (MAI). Method: Various studies related to metacognition have been carried out. This is a descriptive leather research to assess and obtain a valid quality instrument to characterize metacognitive ability in solving mathematical problems. Five Evaluation Experts in Mathematics Education validated the instruments. Expert judgment is used to validate constructs using the Objective Concruence Index assessment. MAI are also empirically validated by using 157 high school students as respondents. Results: According to the results and research findings, MAI has eight indicators: 1) declarative knowledge, 2) procedural knowledge, 3) conditional knowledge, 4) planning, 5) information management, 6) monitoring, 7) debugging, and 8) evaluation. Cronbach's alpha = 0.671) was declared reliable for measuring students' metacognitive awareness. To obtain a truly valid instrument, several points of the MAI statement on the components must be improved: (1) procedural knowledge; (2) planning; and (3) information management. Furthermore, performance assessment through student activities or activities during learning is required to confirm MAI results and students' metacognitive knowledge. Conclusions: MAI meets the construct validity criteria, especially in terms of content validation and internal consistency (reliability), by maintaining 51 statements from the original questionnaire. Overall, MAI that has been compiled is valued valid and reliable to be used as a metacognition assessment instrument in solving mathematical problems. It can be concluded that the MAI is a valid instrument in measuring metacognition in problem solving.

This study was conducted to discover the effects of reciprocal teaching (RT) on metacognitive awareness and reading comprehension in junior college students. The Metacognitive Awareness Inventory (MAI) was used to identify metacognitive awareness, and the General English Proficiency Test (GEPT) was used to evaluate reading comprehension. Two reading courses with 77 students taught using RT were treated as the experimental group, and 30 students from a non-RT reading course constituted the control group. The results showed statistically significant differences in MAI scores (conditional knowledge and debugging strategy) and reading comprehension between the 2 groups. Although RT had a significant impact on only 2 out of 8 MAI scales, the experimental group had higher overall mean scores on the 8 MAI components than the control group. However, unlike RT, the MAI failed to have a statistically significant impact on enhancing students’ reading scores. Thus, metacognitive awareness might affect text comprehension, but metacognitive awareness did not influence the levels of reading comprehension students achieved in this study.

Since practicing engineers are hired, retained, and rewarded for solving problems, engineering students should learn how to solve workplace problems . Therefore, we designed and implemented several problem-solving learning environments (PSLEs) for the junior course entitled Kinetics and Homogeneous Reactor Design at Universidad de las Americas Puebla. Metacognition has been shown to be important for the solution of more open-ended and wellstructured problems. Flavell 5 distinguished two characteristics of metacognition: knowledge of cognition (KC) and regulation of cognition (RC). In order to support student metacognitive processing while learning to solve kinetics and homogeneous reactor design problems, the instructor created a supportive social environment in the course and inserted a series of question prompts during PSLEs, as a form of coaching where the problem to be solved was represented as a case, and cases were used in various ways (worked examples, case studies, structural analogues, prior experiences, alternative perspectives, and simulations) as instructional supports. The Metacognitive Awareness Inventory (MAI) designed by Schraw and Dennison was utilized as a pre(first day of classes) post(last day of classes) test. MAI is a 52-item inventory to measure adults’ metacognitive awareness. Items are classified into eight subcomponents subsumed under two broader categories, KC and RC. Furthermore, in order to assess metacognitive awareness during problem-solving activities, students had to answer the corresponding problem as well as approximately 2-3 embedded problem-solving prompts (from Jonassen) and 4-6 embedded metacognitive prompts (from MAI). Results for the pre-post MAI exhibited a significant (p<0.05) increase in student metacognitive awareness. This increase was also noticed by means of the embedded MAI prompts while solving different kinds of problems (such as story problems, decision-making problems, troubleshooting, and design problems) throughout the course, in which students also improved the quality of their embedded problem-solving answers and corresponding grades. Promoting metacognitive awareness and skills could be a valuable method for improving learning and student performance during kinetics and homogeneous reactor design problemsolving, as has been previously reported for professional educators and dental hygiene students.

This article was migrated. The article was not marked as recommended. Theory:Metacognitive awareness is a component of self-regulated learning and helps us to understand and control our thinking and learning. Thinking about thinking is also an important aspect of the clinical reasoning process for medical practitioners. Hypotheses: This pilot study researched the link between metacognitive awareness and undergraduate examination performance. The Metacognitive Awareness Inventory (MAI) is a validated 52 item survey instrument for measuring metacognitive awareness. It has eight sub-scales grouped into two domains: Knowledge of Cognition and Regulation of Cognition. It was hypothesised that MAI scores would increase between first and fifth-year undergraduate medicine students and secondly that MAI scores would correlate with undergraduate examinations results. Method:Medical students at James Cook University, Australia were invited to complete the MAI and consented to give access to their examination scores. Results:The results of this pilot study found that metacognitive awareness was not significantly different between first and fifth-year undergraduates in this sample. For first-year medical undergraduates there were correlations between the Knowledge of Cognition domain and their end of year examination results, but not with the Regulation of Cognition domain. For fifth-year students there were correlations between both the Knowledge and Regulation of Cognition domains and their end of year examination results. Conclusion:This study identified that metacognitive awareness is not significantly different between first and fifth-year medical students. This may cause concern given that the study identified the importance of both MAI domains in undergraduate medical examinations. This study should be repeated on a larger scale and may confirm that raising metacognitive awareness levels among students is desirable. Increasing metacognitive awareness may raise examination performance and better prepare students for developing clinical reasoning skills.

Medical students are expected to improve critical thinking, clinical reasoning and problem solving skills. These cognitive attributes need to be supported with metacognitive skills. Students with better metacognitive ability will be able to synergize their learning with self-reflection strategies to achieve learning target. One of the tools to assess students’ metacognitive skills is Metacognition Awareness Inventory (MAI). This study is aimed to validate Indonesian MAI in the academic stage of undergraduate medical education and was done on May-June 2014 at faculty of medicine Universitas Malahayati Bandar Lampung. This study used cross-sectional design consisted of 3 stages: language adaptation, pilot study and validation study. Validation study involved 1200 medical students. Factor analysis was conducted to identify factors of MAI. Language adaptation and pilot study produced Indonesian MAI which contains the same number of items. There were 757 MAI questionnaires eligible for analysis. Extraction of the 51-item MAI using principal component analysis (PCA) produced 5 factors which were cognitive preparation, supervision, management, strategy and evaluation. The Cronbach alpha value for the whole Indonesian MAI was 0.904. Indonesian MAI complies to construct validity criteria, specifically content validity and internal consistency. MAI is useful as an instrument to assess metacognitive ability in the academic stage of undergraduate medical education.

Introduction: By virtue of the nature of their work, emergency medicine physicians and residents experience high cognitive load and stress, which are known to affect physician performance and patient outcomes. However, the contribution of cognitive load has not previously been measured during the clinical work of emergency physicians. The objectives of this study were to measure cognitive load and stress in emergency physicians and residents during clinical work, evaluate the relative contribution of multiple factors on cognitive load, and to determine the effect of experience on these results. Methods: This observational study was conducted at an academic Canadian Urgent Care Centre from July to August 2018. Emergency medicine residents and staff physicians completed a survey while on shift to evaluate measures of cognitive load and acute stress. Patient acuity and the number of active patients for each physician, hours worked and patients in the waiting room were recorded. Correlational analyses and multivariable linear regression were performed to evaluate the effect of each predictor on measures of overall cognitive load. Results: A total of 131 questionnaires were completed by 42 physicians (87 questionnaires from 26 staff physicians and 44 questionnaires from 16 residents). Results showed that staff physicians carried a significantly higher patient load compared to residents (p &amp;lt; 0.001). There were no differences in mean overall cognitive load (p = 0.25), acute stress (p = 0.17) or measured subcomponents of cognitive load between the two groups. Perceived case difficulty and acute stress were strong predictors of overall cognitive load, while level of distraction did not correlate with the other outcomes. The number of patients in the waiting room predicted acute stress in staff physicians, while the number of higher acuity patients was a significant predictor in residents. Conclusion: Measures of overall cognitive load and acute stress were strongly correlated in the clinical setting. Different factors affect cognitive load and acute stress in staff physicians compared to residents. Appreciating these differences may help medical educators understand the cognitive challenges faced by learners in a clinical context, and aid in the design of cognitive and educational strategies to help mitigate these challenges and reduce stress.

Assessing Metacognition During Problem-Solving in Two Senior Concurrent CoursesMetacognition refers to people’s abilities to predict their performances on various tasks and tomonitor their current levels of mastery and understanding1. Flavell2, 3 distinguished twocharacteristics of metacognition: knowledge of cognition (KC) and regulation of cognition (RC).KC includes knowledge of the skills required by different tasks, strategic knowledge and self-knowledge. RC includes the ability to monitor one’s comprehension and to control one’slearning activities. There is a considerable amount of data that supports the value of ametacognitive approach to instruction4. It includes an emphasis on learning with understandingand on problem solving, but part of the emphasis is on understanding the cognitive andemotional processes involved in these kinds of activities1-5. We designed and implementedseveral problem-solving learning environments6, 7 (PSLEs) for two chemical engineering seniorconcurrent courses entitled Kinetics and Homogeneous Reactor Design and Mass Transfer UnitOperations I at University ABC. In order to support a metacognitive approach to instruction, theteacher of both courses created a supportive social environment and inserted a series of questionprompts during PSLEs as a form of coaching, where the problems to be solved were representedas cases that were utilized in several ways (worked examples, case studies, structural analogues,prior experiences, alternative perspectives, and simulations) as instructional supports6, 7.The Metacognitive Awareness Inventory (MAI) designed by Schraw and Dennison8 was utilizedas a pre- (first day of classes) post- (last day of classes) test. MAI is a 52-item inventory thatmeasures adults’ metacognitive awareness. Items are classified into eight subcomponentssubsumed under two broader categories, KC and RC. Furthermore, in order to assessmetacognitive awareness during problem-solving activities, students had to answer thecorresponding problem as well as 2-3 embedded problem-solving prompts7 and 4-6 embeddedmetacognitive prompts (from MAI). MAI prompts were chosen based on the level of complexityof the problem and the type of knowledge and skills required to solve it. A final design challengewas used to simultaneously assess student attainment of learning outcomes for both courses,through the synthesis and analysis of the reaction and separation stages in a chemical plant.Students were asked to carry out a presentation of their solution methodology, obtained resultsand conclusions for this challenge. Presentations were videotaped to be further examined.Results for the pre-post MAI exhibit a significant (p0.05) in MAI. Analysis of final presentations allowed to identify students’ abilities to solvecomplex problems as well as their argumentative and metacognitive skills. The vast majority ofstudents attained expected both courses’ learning outcomes at an acceptable level.[1] Bransford, J.D., Brown A.L. and Cocking, R.R. 2000. How People Learn. Brain, Mind, Experience and School. Expanded Edition. Washington D.C.: National Academy Press.[2] Flavell, J. 1976. Metacognitive aspects of problem-solving. In L. B. Resnick (Ed.), The Nature of Intelligence (pp. 231–236). Hillsdale, NJ: Lawrence Erlbaum Associates.[3] Flavell, J. 1979. Metacognition and cognitive monitoring: A new area of cognitive- developmental inquiry. American Psychologist, 34(10): 906–911.[4] Bransford, J.D., Vye, N. and Bateman, H. 2002. Creating High-Quality Learning Environments: Guidelines from Research on How People Learn. In P. Albjerg Graham, N.G. Stacey (Eds.), The Knowledge Economy and Postsecondary Education: Report of a Workshop. Washington D.C.: National Academy Press.[5] XXX [For blind review purposes]. 2013. Proceedings of the 2013 ASEE Annual Conference and Exposition, Atlanta, GA, June 23 – 26.[6] Jonassen, D. H., Strobel, J., and Lee, C. B. 2006. Everyday problem solving in engineering: Lessons for engineering educators. Journal of Engineering Education, 95(2): 1–14.[7] Jonassen, D. H. 2011. Learning to Solve Problems: A Handbook for Designing Problem- Solving Learning Environments. Routledge: New York.[8] Schraw, G., and Dennison, R. S. 1994. Assessing metacognitive awareness. Contemporary Educational Psychology, 19: 460-475.

The 2013 curriculum requires students to demonstrate metacognitive proficiency. The alignment of knowledge and metacognitive awareness can assist students in achieving the learning objectives in the national curriculum. This study aimed to ascertain whether there was a correlation between metacognitive knowledge and metacognitive awareness among students. This study employed a correlational design research methodology. The instruments used to gather data including a set of 5 questions involved in testing students’ metacognitive knowledge. Meanwhile, The Metacognition Awareness Inventory (MAI) which comprised of 52 items was employed to assess metacognitive awareness. The correlation between metacognitive knowledge and awareness can be measured using the Product Moment correlation coefficient. The findings of this study indicated that there was a positive correlation between metacognitive knowledge and awareness yet it was relatively low (0.110).

The present study sought to investigate the probable link between Iranian English translation studies students’ metacognitive awareness, self-regulation, and gender. Furthermore, the role of educational level of translation students in metacognitive awareness and self-regulation was explored. For the purpose of the study, a sample of 230 M.A and B.A senior English translation students comprised the participants of the research. They were asked to complete two questionnaires of Metacognitive Awareness Inventory (MAI) and Self-regulation Trait (SRT).The Metacognitive Awareness Inventory (MAI) was developed by Schraw and Dennison (1994) and consists of 52 statements. It measures two components of metacognition: metacognitive knowledge and metacognitive regulation. Metacognitive knowledge comprises three subscales: Declarative knowledge, Procedural knowledge, and Conditional knowledge. Metacognitive regulation consists of five subscales: Planning, Information management, Monitoring, Debugging, and Evaluation. The self-regulation trait (SRT) questionnaire was designed by O'Neil and Herl (1998). It was developed based on Zimmerman's self –regulation model. It consists of 32 Likert-scale questions. The scale seeks to measure metacognition and motivation dimensions. Each dimension comprises two sub-scales. Meta-cognition covers the constructs of planning and self-monitoring, and motivation contains effort and self-efficacy. Independent samples t -tests were run to investigate the role of gender and educational level in the level of translation students’ metacognitive awareness and self-regulation. The results of t -test demonstrated that there are not any differences between male and female translation students regarding metacognitive awareness and self-regulation. It was also found that there is a negative significant impact of educational level on total metacognitive awareness, and some components of metacognitive awareness: declarative knowledge, conditional knowledge, and evaluation. In other words, MA students were shown to have higher levels of metacognitive awareness in comparison with their BA counterparts. Finally, no significant differences between educational level and self-regulation were obtained. Keywords: Gender; Educational Level; Metacognitive Awareness, Self-regulation, Translation studies

Effect of a Nursing Comprehensive Skill Training Course (NCST-C) on Nursing Students' Metacognitive Awareness: A Quasi-experimental Study

Metacognition is understood as the knowledge and regulation of one’s own cognitive activity that deals with one’s agency over mental processes in a conscious and deliberate way. However, the role culture plays on individuals’ experiences of metacognition and metacognitive awareness is not well understood. Thus, the present study explored the influence of culture on self-report metacognitive awareness (via the Metacognitive Awareness Inventory) and objective absolute metacognitive monitoring accuracy (i.e., a comparison of individuals’ confidence in performance judgments against actual performance) across three academic domains (vocabulary, probabilities, and paper folding [assesses visual-spatial reasoning]) in a sample of 366 undergraduate students from four countries (China, Colombia, Spain, and the U.S.). Results revealed that metacognitive awareness is not a universally conceptualized construct. Not only were correlational patterns distinct across cultures, but there were significant differences among the four cultures in both a finer- and coarser-grained analysis. Further, results of objective absolute monitoring accuracy indicated that, incongruent with the self-report findings, participants from the Chinese sample exhibited significantly poorer absolute monitoring accuracy in vocabulary and paper folding, but that participants from all four countries manifested similar absolute monitoring accuracy in a probabilities task. These findings have profound repercussions for how culture influences theory, applied research, measurement, and practice regarding metacognitive awareness and absolute metacognitive monitoring accuracy.

The study was an investigation of teachers’ attitude and metacognitive awareness as determinants of their Perceived Professional Competence in Social Studies among post primary schools in Kogi, Nigeria. The study adopted correlational survey research design. The population comprised 3,957 Upper Basic Social Studies teachers from 1937 Universal Basic Education schools in Kogi East for 2019/2020 academic session with a sample of 980. The three instruments used are Social Studies Teachers’ Competency Scale (SSTCS), Social Studies Teachers’ Attitudinal Disposition (SSTAD) and Teachers’ Metacognitive Awareness Inventory (TMAI) with reliability coefficients of 0.88, 0.76 and 0.75 respectively. From the analysis it was found that teachers’ attitude towards Social Studies F(1,469) = 1.158; p = 0.000 &lt; 0.05 and teachers’ metacognitive awareness F(1,469) = 15.638; p = 0.000 &lt; 0.05 have significant contributions to their Perceived Professional Competence in public secondary schools. It was also found that teachers’ attitude towards Social Studies F(1,507) = 0.920; p = 0.038 &lt; 0.05 and metacognitive awareness F(1,507) = 1.487; p = 0.023 &lt; 0.05 had significant contributions to their Perceived Professional Competence in private secondary schools. Social Studies teachers’ metacognitive awareness and attitude towards Social Studies jointly also contributed significantly to their Perceived Professional Competence in public secondary schools F(2,468) = 8.234; p = 0.000 &lt; 0.05 as well as in private secondary schools F(2,506) = 1.087; p = 0.038 &lt; 0.05. It was recommended among others that the State Ministry of Education should employ only teachers that are professionally qualified and certified to teach Social Studies.