Metacognition in the Middle: Mismatch between Anticipated and Actual Exam Grades of Allied Health Anatomy Students

Abstract

Introduction: Accurate evaluation of one's knowledge and performance is a key metacognitive skill critical to success in the classroom. Students who lack this skill may over-estimate their knowledge and under-prepare for exams, resulting in poor academic performance. Therefore, the purpose of this study was to assess the ability of allied health students to evaluate their exam performance in an anatomy course to identify which groups, if any, need support with this skill. Methods In an IRB-approved study, first-year physician assistant (PA), physical therapy (PT), and occupational therapy (OT) students (n=129) participated in a doctoral-level anatomy course. This course covered human anatomy through asynchronous lectures and synchronous virtual labs (due to COVID). Students’ anatomical knowledge was assessed via four exams throughout the course. Prior to the start of the course and again at the end, students were invited to complete a de-identified pre-survey including the Metacognitive Awareness Inventory (MAI), a 52-item survey that assesses metacognition. Throughout the course, students were asked to reflect on their exam performances (anticipated grade, actual grade, and satisfaction) using a modified Likert scale. For analyses, students were divided into terciles based on their mean combined exam performance. Reflections and MAI scores were then compared across terciles in SPSS using Kruskal-Wallis H test. Results Average exam scores of high (93%±2.0), middle (86%±2.7), and low-performers (74%±4.6) were significantly different from each other (p<0.01). A total of 113 (88%) and 59 (46%) students completed the pre- and post-surveys, respectively, resulting in 52 matched pairs (40%). Overall, students significantly improved their metacognition (p<0.01). Reflection participation ranged from 67% to 97%. When asked how their actual grade measured against their anticipated grade, high- and middle-performers’ anticipated grades were similar to each other but significantly higher than those of low-performers (p<0.01 for three exams). High-performers reported significantly greater exam satisfaction than middle- and low-performers on two exams (p<0.01). The performance terciles scored similarly across all metacognition subcategories in the post-survey except declarative knowledge, the factual knowledge of structures and concepts that provides the foundation for higher-order thinking (p=0.01). Conclusion In this study, middle-performers appear to have the greatest mismatch between their anticipated grade, actual grade, and exam satisfaction when compared to high- and low-performers. These students anticipate strong exam performances, but appear to fall short, leaving them less satisfied. This metacognitive disconnect may be related to how students evaluate their knowledge. Students seem to evaluate their progress based on their declarative knowledge, which may not accurately represent their ability to apply that knowledge. Significance Metacognitive activities that improve student self-evaluation skills should be implemented in anatomy courses to minimize the metacognitive disconnect between anticipated and actual exam performance.