Metacognitive awareness and the link with undergraduate examination performance and clinical reasoning

Paul Welch,Louise Young,Daniel Lindsay,Peter Johnson

doi:10.15694/mep.2018.0000100.1

Abstract

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.

Highlights

Clinical reasoning failures are a noteworthy cause of patient mortality and morbidity and result in approximately 40,000 deaths per year, as well as being the cause of 28.6% of malpractice claims in the USA (Newman-Toker & Pronovost, 2009; Saber Tehrani et al, 2013)
Mann-Whitney tests were performed to examine any differences in Metacognitive Awareness Inventory (MAI) scores between first and fifth year students
This study provides evidence that performance in both the Key Features Papers (KFP) and Objective Structured Clinical Examination (OSCE) examinations is correlated with performance in the Regulation of Cognition domain of the MAI

Summary

Introduction

Clinical reasoning failures are a noteworthy cause of patient mortality and morbidity and result in approximately 40,000 deaths per year, as well as being the cause of 28.6% of malpractice claims in the USA (Newman-Toker & Pronovost, 2009; Saber Tehrani et al, 2013). Doctors gather clinical data about a patient and make decisions based on the meaning they attribute to this information. These clinical reasoning skills can be defined as the "ability to sort through a cluster of features presented by a patient and to accurately assign a diagnostic label, with the development of an appropriate treatment strategy being the end goal" Helping medical students and junior doctors develop clinical reasoning skills is a central aim of medical education and requires knowledge and experience (Cutrer et al, 2013)

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