Realistic Implementation of Metacognitive Activities in an Allied Health Anatomy Course

Abstract

Introduction Metacognition, the ability to plan, monitor, and assess one's understanding and performance, has been shown to improve student learning outcomes. Anatomy is often recognized as one of the toughest courses in professional health care curricula, and students enrolled in such courses could potentially benefit from metacognitive activities. Therefore, the purpose of this study was to explore the changes in metacognition of allied health students as they progress through a gross anatomy course. Methods First-year physician assistant (PA), physical therapy (PT), and occupational therapy (OT) students (n=129) participating in a doctoral-level anatomy course were invited to participate in this IRB-approved study. The course was conducted entirely online due to COVID and consisted of asynchronous lectures and virtual synchronous laboratory sessions. Students’ anatomical knowledge was assessed with four exams. At the beginning and end of the course, students were invited to complete a de-identified pre-/post-survey including the Metacognitive Awareness Inventory (MAI), a 52-item survey that assesses metacognition. Pre- and post-MAI scores were analyzed in SPSS using Spearman's rho, Wilcoxon Signed Rank, and Kruskal-Wallis H tests. Throughout the course, students were then asked to participate in reflective discussion boards to encourage development of metacognitive skills. Topics included study strategies, comprehension monitoring, exam reflections, and advice for future students. Discussion board posts were thematically analyzed by two researchers, with coding disagreements discussed to consensus. Results A total of 113 (88%) and 59 (46%) students completed the pre- and post-surveys, respectively, resulting in 52 matched pairs (40%). As a whole, students significantly increased their metacognition scores after completion of the course (p<0.01). Several specific findings were noted, for example that PA students were found to monitor their learning less frequently compared to PTs and OTs (p=0.03). Discussion board participation ranged from 97% to 22%, with a steady decline over time. Qualitative analysis of discussion board posts revealed students reported changing their study strategies the most between Exams 1 and 2, after which they relied on existing strategies. Students frequently cited time constraints, time management, and volume of material as major factors that made anatomy difficult to learn. Indeed, students understood the educational value of the discussion boards but chose not to participate to prioritize studying the course content. Conclusion Overall, students were more receptive to metacognitive activities and modifying study strategies early in the course. As time progressed, receptiveness decreased, mainly due to time constraints. At this point, students tended to “double-down” on strategies that worked previously rather than continuously monitor and modify their approach to studying. Significance To maximize effectiveness, metacognitive activities peripheral to the course content should be positioned early in the course when students are more receptive. Students will then be well-equipped to learn but can focus their limited time on course content.