Metacognition: The Secret Weapon for GP Students

Imagine that you are learning a new skill, such as playing a musical instrument or a clinical skill. At first, the skill may seem difficult and overwhelming. But as you practice, you start to get better. You learn from your mistakes and you develop new strategies for learning.  What is happening behind the scenes? You are using metacognition. You are thinking about your own learning process and you are making adjustments as needed. You are monitoring your progress, identifying your strengths and weaknesses, and setting goals for yourself.  Metacognition is a powerful tool that can help you to learn more effectively in any situation.

What is metacognition learning and benefits of this for student learning?

Metacognition is the ability to think about your own thinking. It's about being aware of how you learn, what strategies work best for you, and how to adjust your learning approach as needed. Metacognition is essential for effective learning, and it has a number of benefits for medical students, including:

• Improved learning outcomes: Research has shown that students who use metacognitive strategies tend to perform better academically.

• Increased self-awareness: Metacognition can help students to become more aware of their strengths and weaknesses as learners. This can help them to identify areas where they need to improve and to develop more effective learning strategies.

• Enhanced self-regulation: Metacognition can help students to take control of their own learning. They can learn to set goals, monitor their progress, and evaluate their performance. This can help them to become more independent and self-directed learners.

Metacognitive strategies can be divided into three categories:

• Planning: This involves setting goals, identifying prior knowledge, and selecting appropriate learning strategies.

• Monitoring: This involves paying attention to one's own understanding, identifying areas of difficulty, and adjusting learning strategies as needed.

• Evaluation: This involves reflecting on one's learning, identifying what went well and what could be improved, and setting new goals.

Here are some examples of metacognitive strategies for learning:

• Goal setting: Students can set specific and achievable learning goals for each placement.

• Learning plans: Students can develop learning plans that outline the activities they will undertake to achieve their learning goals.

• Self-questioning: Asking yourself questions about the material you are learning can help you to monitor your understanding and identify areas where you need more practice.

• Reflective journaling: Encourage students to keep a reflective journal where they can write about their learning experiences, identify areas of difficulty, and set goals for improvement.

• Summarizing: Summarizing what you have learned in your own words can help you to consolidate your understanding and identify any gaps in your knowledge.

• Making connections: Making connections between new information and what you already know can help you to learn more deeply and meaningfully.

• Reflecting: Taking some time to reflect on your learning after you have completed a task can help you to identify what went well, what could be improved, and what you need to do next.

• Feedback: Provide students with regular feedback on their learning and their use of metacognitive strategies.

• Educate students about metacognition: Explain to students what metacognition is and why it's important for learning. Provide them with examples of metacognitive strategies and how they can be used in a medical education context.

• Model metacognitive thinking: Show students how to use metacognitive strategies in your own work. For example, you could think aloud about your own learning process as you are interacting with a patient or as you are reviewing a case study.

• Provide opportunities for students to practice using metacognitive strategies: Give students opportunities to apply metacognitive strategies to their own learning on GP placements. For example, you could ask them to reflect on their learning experiences, to set goals for their placements, or to develop learning plans.

Here are some tips for using metacognitive strategies for learning:

• Be intentional about your learning. What do you want to learn? How will you know when you have learned it?

• Be aware of your own learning process. What strategies work best for you? What are your strengths and weaknesses as a learner?

• Be flexible. Be willing to adjust your learning strategies as needed.

• Monitor your understanding regularly. Ask yourself questions, summarize what you have learned, and make connections to what you already know.

• Reflect on your learning regularly. What went well? What could be improved? What do you need to do next?

Here are some ways that you can apply the above to enable a medical student to use metacognitive strategies in a debriefing session after seeing a patient:

• Ask the student to reflect on their own learning process. What did they learn from the patient encounter? What areas did they find challenging? What areas would they like to improve on?

• Help the student to identify opportunities to apply metacognitive strategies during the patient encounter. For example, the student could have used self-questioning to monitor their understanding of the patient's history and physical exam, or they could have used summarizing to consolidate their learning.

• Provide the student with feedback on their use of metacognitive strategies. Did they identify opportunities to use metacognitive strategies? Did they use them effectively? If not, what could they do differently next time?

Here is an example of how you could debrief with a medical student using metacognitive strategies:

You: "So, how did you feel about that patient encounter?"

Student: "I felt a little bit overwhelmed. There was a lot of information to take in, and I wasn't sure where to start."

You: "That's understandable. It can be tough to see a patient for the first time. What did you do to try to manage your workload?"

Student: "I tried to take notes on the patient's history and physical exam. I also asked the patient some clarifying questions."

You: "Great. Those are both good strategies. What do you think you could have done differently to make the encounter easier on yourself?"

Student: "I think I could have used self-questioning more effectively. For example, I could have asked myself questions like, 'What are the most important things to find out from this patient?' and 'What are the most likely diagnoses?'"

You: "That's a great idea. Self-questioning can be a very helpful metacognitive strategy. It can help you to focus your attention on the most important aspects of the patient encounter."

Student: "I also think I could have summarized the patient's history and physical exam more often. This would have helped me to consolidate my learning and to make sure that I understood everything correctly."

You: "That's another great idea. Summarizing is another very helpful metacognitive strategy. It can help you to identify any gaps in your understanding and to make sure that you are on the right track."

Questions to ask students:

• What did you learn from this patient encounter?

• What were the most challenging aspects of the encounter?

• What could you have done differently to make the encounter easier on yourself?

• What are the most important things to take away from this encounter?

• How can you apply what you learned to your clinical practice?

• What resources or support do you need to be successful?

Reflection, reflexivity and metacognition are related but distinct concepts that can help us understand and improve our learning processes. Here is a brief comparison and contrast of these terms:

• Reflection is an act of looking back in order to process experiences. It can help us learn from our successes and failures, identify our strengths and weaknesses, and develop new insights and perspectives. Reflection can take many forms, such as writing, talking, blogging, or vlogging.

• Reflexivity is a type of reflection that focuses on becoming aware of our biases and prejudices that may affect our learning. It involves challenging our assumptions and considering other viewpoints. Reflexivity can help us overcome our blind spots, avoid stereotypes, and appreciate diversity.

• Metacognition is a type of reflection that involves thinking about our thinking in order to grow. It involves monitoring, regulating, and evaluating our cognitive processes and strategies. Metacognition can help us become more self-directed, independent, and effective learners.

Final thoughts 

Metacognition is a powerful way to improve learning. This means being aware of your own thinking and learning processes.

We can already do a lot to support students with metacognition. One quick and practical approach is to encourage them to ask two questions:

1. What are the key assumptions I am making?

2. Are these assumptions valid?

By asking these questions, students can become more aware of their own thinking and identify any areas where they need to improve.

References

‌Exploring medical students’ metacognitive and regulatory dimensions of diagnostic problem solving. (2019). Medical Education Online. [online] doi:https://doi.org/10.1080//10872981.2023.2210804. 

Metacognition. (2023, September 2). In Wikipedia. https://en.wikipedia.org/wiki/Metacognition

Teaching and Learning in Medicine. (2021). What Were You Thinking? Medical Students’ Metacognition and Perceptions of Self-Regulated Learning. [online] Available at: https://www.tandfonline.com/doi/full/10.1080/10401334.2021.1889559 [Accessed 21 Oct. 2023].

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