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.