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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 2  |  Issue : 1  |  Page : 23-26

Assessing metacognitive abilities of postgraduate medical students


1 Department of Psychiatry, Seth GSMC and KEM Hospital, Mumbai, Maharashtra, India
2 Department of Psychiatry, LTMMC and LTMGH, Mumbai, Maharashtra, India

Date of Web Publication8-May-2018

Correspondence Address:
Neena S Sawant
Department of Psychiatry, Seth GSMC and KEM Hospital, Parel, Mumbai - 400 012, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aip.aip_46_17

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  Abstract 


Background: Metacognition is essential to successful learning, especially in the field of medicine because it enables individuals to better manage their cognitive skills and determine weaknesses that can be corrected by constructing new cognitive skills. This study was undertaken to study the difference in the metacognitive abilities toward learning in the clinical and nonclinical disciplines of medicine. Methods: Four hundred and sixty-eight residents were contacted, 442 consented, 373 completely filled pro formas were received, and two groups, namely, clinical (n = 275) and nonclinical (n = 128) were formed. Data were collected with the help of a semi-structured questionnaire and the metacognitive assessment inventory. It has two broad domains-knowledge about cognition and regulation of cognition with each having 3 and 5 subdomains, respectively. Results: The two broad domains of MAI revealed a highly significant difference with the students of nonclinical disciplines having higher knowledge about cognition (t = 1.46, P < 0.014) and regulation of cognition (t = 3.13, P < 0.0019) as compared to their clinical peers. All subdomains of knowledge about cognition showed highly significant differences. Planning and evaluation subdomains of regulation of cognition were significant in the nonclinical group. The other subdomains of information management, debugging strategies, and comprehension monitoring were not significant. Discussion: The nonclinical disciplines showed better ability for factual knowledge, use of critical thinking, knowledge about how to implement and when, and why to use learning procedures as compared to their clinical counterparts. Planning, goal setting, with an analysis of performance was also much better in the students of nonclinical disciplines. Conclusion: This study highlights the need to inculcate in medical postgraduates self-learning using their metacognitive abilities so that learning would become more focused and improvement in skills would take place.

Keywords: Knowledge, medical postgraduates, metacognition, self-learning


How to cite this article:
Sawant NS, Parkar SR, Sharma A. Assessing metacognitive abilities of postgraduate medical students. Ann Indian Psychiatry 2018;2:23-6

How to cite this URL:
Sawant NS, Parkar SR, Sharma A. Assessing metacognitive abilities of postgraduate medical students. Ann Indian Psychiatry [serial online] 2018 [cited 2018 Nov 14];2:23-6. Available from: http://www.anip.co.in/text.asp?2018/2/1/23/232045




  Introduction Top


In today's times, pursuing medical education has become a task as it entails several entrance examinations for undergraduate as well as postgraduate studies. Learning in medical colleges is based on the principles of adult learning which is a type of self-regulated learning (SRL). SRL has been defined as an active, constructive process by which the learners set goals, monitor their learning, and control their motivation, behavior, and cognition.[1]

Metacognition is essential to successful learning, especially in the field of medicine because it enables individuals to better manage their cognitive skills and to determine weaknesses that can be corrected by constructing new cognitive skills.[2] In a branch like medicine where new research is added every day, the learner has to be able to assimilate this fact into his/her everyday practice which could be dealing with patients or getting information on the disease process. Recent research indicates that metacognitively aware learners perform better than unaware learners, allowing individuals to plan, sequence, and monitor their learning in a way that directly improves the assimilation of knowledge to develop problem-solving skills.

Metacognitive learning strategies are divided into three components: monitoring of learning processes, knowledge about cognition, and regulation of the learning processes.[3]

There are several ways of defining metacognition. It may be considered as “the ability to reflect on, understand, and control one's learning”[2] or as “Awareness of one's own thinking, awareness of the content of one's conceptions, an active monitoring of one's cognitive processes, an attempt to regulate one's cognitive processes in relationship to further learning, and an application of a set of heuristics as an effective device for helping people organize their methods of attack on problems in general.”[4] Metacognition is recognized as an increasingly important cognitive factor in educational, cognitive, and developmental psychology.[5],[6] As the goal of education is to promote and develop self-regulated learners,[7] many studies have been conducted to investigate metacognition in students' performance in different subject areas.[8],[9]

In India, there are very few studies on assessing the metacognitive abilities of medical postgraduate students on improving their learning outcomes. We hypothesized that students pursuing clinical disciplines would be more aware about learning and improving their skills as they continuously deal with patients as compared to those pursuing nonclinical disciplines. Hence, this study was undertaken to study the difference in the metacognitive abilities toward learning in the clinical and nonclinical disciplines of medicine.


  Methods Top


The study was initiated in a tertiary care hospital over a period of 3 months after ethics committee approval. All residents studying in their 1st, 2nd, and 3rd year of residency programme in a tertiary care public hospital and medical college were included in the study after obtaining written informed consent.

One of the investigators went door-to-door in the residents' hostel buildings of the hospital to inform them about the nature of the study and distribute the questionnaires. Those who gave written informed consent were included in the survey. The questionnaires were distributed and collected by the investigator after 30–45 min on same day.

There are about 775 residents studying in this tertiary care public hospital and medical college. Four hundred and sixty-eight residents were contacted during the study duration, 442 consented for the study and 373 completely filled pro formas were received. Sixty-nine pro formas were incomplete and so were discarded. The participants were divided into two groups, namely, clinical and nonclinical depending on the discipline they were pursuing for their postgraduate studies. The clinical group (n = 275) included disciplines such as medicine, obstetrics and gynecology, pediatrics, anesthesia, psychiatry, dermatology, ENT, ophthalmology, radiology, preventive, and social medicine and surgery. The nonclinical group (n = 128) included disciplines such as anatomy, physiology, biochemistry, pathology, pharmacology, forensic medicine, and microbiology.

Tools

Semi-structured pro forma

A semi-structured pro forma was designed to collect information on the demographic variables, namely, age, sex, marital status, year of residency, discipline, etc.

Metacognitive assessment inventory

Metacognitive awareness inventory was first designed by Schraw and Dennison in 1994.[2] It is a long, comprehensive scale assessing various facets of metacognition. It is a 52-item scale which effectively covers various aspects of metacognition in-depth and can also be used to obtain scores for individual areas of metacognition, such as monitoring, planning, comprehension, and so on. It has two broad domains, i.e., knowledge about cognition and regulation of cognition and 6 subdomains. Thus, it gives a total score and domain score. Participants respond to each item on a 7-point scale ranging from strongly disagree (1) to strongly agree (7). It has a reliability of 95% and validity of 93%. It has been used worldwide for the assessment of metacognition in various studies.


  Results Top


The demographic variables revealed the mean age to be around 26 ± 2.2 years in the clinical group and 26 ± 1.48 years in the nonclinical group, respectively. There was a male preponderance in both the groups with 134 (55%) and 70 (55%) male postgraduate students in the clinical and nonclinical groups with the male-to-female ratio being 1.2:1. Although most of the postgraduates were unmarried, only 59 (24%) and 46 (36%) of the clinical and nonclinical postgraduate students, respectively, were married.

When all the postgraduate students were assessed for their metacognitive abilities on the metacognitive assessment inventory, then a highly statistical difference was seen with the nonclinical disciplines having higher total scores on knowledge about cognition as compared to the postgraduate students of clinical branches (t = 6.5, P = 0.0001). Similarly on all the subdomains of knowledge about cognition the students of the nonclinical disciplines scored significantly higher than those of clinical disciplines, namely, procedural knowledge (t = 7.823.89, P = 0.0001), conditional knowledge (t = 3.89, P = 0.0001), and declarative knowledge (t = 2.26, P = 0.024) which were all statistically significant [Table 1].
Table 1: Metacognitive assessment of postgraduate medical students in clinical and nonclinical disciplines

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Similarly, when regulation of cognition was assessed significant differences were seen in the total scores where again the nonclinical disciplines scored higher than the clinical disciplines (t = 3.13, P = 0.0019). On the various subdomains of regulation of cognition, planning (t = 4.38, P = 0.0001) and evaluation (t = 2.04, P = 0.04) only showed significant differences with the nonclinical disciplines doing better than the clinical disciplines. However, on the other subdomains of information systems, communication, and debugging strategies, no statistical differences were seen [Table 1].


  Discussion Top


Demographic variables

There were no significant differences seen in the demographic variables; hence, both the groups were comparable. Various other Indian studies have reported a higher mean in age group of the resident doctors, more male doctors,[10] and a lower marriage rate [11] than our study. The current status of medical postgraduation in India is such that now due to entrance examinations at state and national levels for postgraduation there is an increase in the age of the student before he/she gets admission. This also affects their marital status.

Metacognition

Knowledge about cognition

The postgraduate students of the nonclinical disciplines scored significantly higher than those of clinical disciplines on all the subdomains of knowledge about cognition. Knowledge of cognition refers to one's own understanding of one's cognition. This cognitive knowledge includes three subcomponents: declarative knowledge (about one self as a learner and about the mind), procedural knowledge (about how to do and implement a learning procedure, i.e., strategies), and conditional knowledge (knowledge as to when and how to use declarative and procedural knowledge).[2],[6],[12] These three elements are therefore regarded as the building blocks of conceptual knowledge and are of great importance to a learner.

Our results show that the nonclinical students were better as they probably followed the principles of self-learning and were better equipped than the postgraduate students of the clinical disciplines. It also reflects that in clinical branches majority of the time is spent in seeing patients based on the existing knowledge, but new learning does not seem to be happening at all times. Majority of the students belonging to clinical disciplines do not follow any structured format for learning or relearning. The students belonging to the nonclinical disciplines probably could be more oriented to a structured format in the form of regular presentations, seminars, and journal activities. Several authors have found a relationship between metacognition, locus of control, and motivation which in turn affects academic achievement.[9],[13],[14] This is important as medicine is a branch which is constantly evolving which needs the learner to assimilate all the domains of knowledge about cognition.

It is not possible to teach everything to the students in medicine. Many universities in India follow a summative examination assessment than regular formative assessments. Due to this many students are not motivated to assimilate the conceptual knowledge for better understanding of the subject.

Regulation of cognition

The nonclinical postgraduates had better regulation of cognition than the clinical postgraduates which reflected their better ways of using their basic knowledge to their advantage. There is a consensus among researchers that it consists of planning, monitoring, and evaluating one's cognition as three major subcomponents. However, it is also regarded as including information management and debugging.[2] Planning includes activities such as identifying and selecting appropriate strategies or setting goals and allocating resources before learning takes place. Information management consists of skills and strategies employed to process information. Monitoring means the continuing assessment of one's learning or strategy use. Debugging includes strategies to correct comprehension or performance. Finally, evaluation refers to appraising one's processes and products (learning), and revisiting and revising learning goals.[2] Pintrich has also given other examples of cognitive regulation which may include setting subgoals, asking oneself questions, checking one's errors, rereading a sentence or text one does not understand, and going back and “repairing” one's mistake in a calculation.[3] This type of regulation would be the ultimate goal in the learning process where the learner uses strategies to improve on his existing knowledge.

In the field of medicine regulation of cognition would be very important in all aspects of skill training such as history taking, communication, psychomotor, and attitudinal. Which would result in the overall development of the learner. Both aspects of metacognition are essential for the holistic growth of the learner.[2],[9],[12] This would result in producing mastery over the subject with a remarkable improvement in consultation skills.

Kassab et al.[15] found in their study that metacognitive regulation played a pivotal role in directly mediating core of SRL activities including cognitive strategies (elaboration and organization) and resource management strategies (help-seeking, time and study environment, and effort regulation). Koole et al.[16] in their study found medical students with high reflection scores did better on case solving. Reflection includes the ability to relive an experience, analyze it critically, and come up with conclusions after careful exploration of alternatives.[17],[18],[19]

The examination patterns in our country do not include the assessment of the various skills needed to be an efficient doctor. Hence, we find the students lacking in planning or strategizing for improving their existing skills. Many times although the students may feel that their knowledge or awareness of the subject may be deficient but due to absence of regular assessments or the motivation to surpass and develop the necessary skills, students do not achieve the regulation of cognition.


  Conclusion Top


This study highlights the need to inculcate in medical postgraduates self-learning using their metacognitive abilities so that learning would become more focused and improvement in skills would take place.

All institutes have a Medical Education Unit (MEU) to improve the standards of teaching by faculty. However, there is a need to also make the students aware and improve the learning process which can be regularly conducted by the MEU in the form of workshops or refresher courses for the postgraduate students so that the academic motivation improves and we get clinically sound postgraduate doctors.

Limitations

We did not correlate between academic achievement and metacognition to look for differences in both groups. In addition, academic motivation with metacognition can be assessed to throw more light on the subject. Although our sample size was large, the clinical discipline population was less than the nonclinical disciplines. Hence, further studies with a proportionate sample size are needed.

Acknowledgment

We would like to acknowledge Dr. Avinash Supe Dean and Director (ME and MH), Seth GSMC and KEM Hospital, Mumbai, for granting us permission to conduct the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Pintrich PR. A conceptual framework for assessing motivation and self-regulated learning in college students. Educ Psychol Rev 2004;16:385-407.  Back to cited text no. 1
    
2.
Schraw G, Dennison RS. Assessing metacognitive awareness. Contemp Educ Psychol 1994;19:460-75.  Back to cited text no. 2
    
3.
Pintrich PR. The role of metacognitive knowledge in learning, teaching and assessing. Theory Pract 2002;41:219-25.  Back to cited text no. 3
    
4.
Hennessey MG. Metacognitive aspects of students' reflective discourse: Implications for intentional conceptual change teaching and learning. In: Sinatra GM, Pintrich PR, editors. Intentional Conceptual Change. 1st ed. New Jersey: Lawrence Erlbaum Associates, Inc.; 2003. p. 103-32.  Back to cited text no. 4
    
5.
Schraw G. Promoting general metacognitive awareness. In: Hartman HJ, editor. Metacognition in Learning and Instruction: Theory, Research and Practice. 1st ed. Dordrecht: Kluwer Academic Publishers; 2001. p. 3-16.  Back to cited text no. 5
    
6.
Pintrich PR, Wolters CA, Baxter GP. Assessing metacognition and self-regulated learning. In Schraw G, Impara JC, editors. Issues in the Measurement of Metacognition. Lincoln, NE: University of Nebraska-Lincoln; 2000. p. 43-97.  Back to cited text no. 6
    
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Sperling R, Howard B, Staley R, DuBois N. Metacognition and self-regulated learning constructs. Educ Res Eval 2004;10:117-39.  Back to cited text no. 7
    
8.
Pishghadam R, Khajavy GG. Intelligence and metacognition as predictors of foreign language achievement: A structural equation modeling approach. Learn Individ Differ 2013;24:176-81.  Back to cited text no. 8
    
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Vrugt A, Oort FJ. Metacognition, achievement goals, study strategies and academic achievement: Pathways to achievement. Metacogn Learn 2008;3:123-46.  Back to cited text no. 9
    
10.
Shashikantha SK, Sheethal MP. Prevalence of depression among post graduate residents in a tertiary health care institute, Haryana. Int J Med Sci Public Health 2016;5:2139-42.  Back to cited text no. 10
    
11.
Sawant N, Deshmukh S. A clinical study of emotional disturbances & stressors in resident medical doctors. Indian J Psychol Med 2005;26:42-51.  Back to cited text no. 11
    
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Schraw G. Promoting general metacognitive awareness. Instr Sci 1998;26:113-25.  Back to cited text no. 12
    
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Young A, Fry JD. Metacognitive awareness and academic achievement in college students. J Scholarsh Teach Learn 2008;8:1-10.  Back to cited text no. 13
    
14.
Landine J, Stewart J. Relationship between metacognition, motivation, locus of control, self-efficacy and academic achievement. Can J Couns 1998;32:200-12.  Back to cited text no. 14
    
15.
Kassab SE, Al-Shafei AI, Salem AH, Otoom S. Relationships between the quality of blended learning experience, self-regulated learning, and academic achievement of medical students: A path analysis. Adv Med Educ Pract 2015;6:27-34.  Back to cited text no. 15
    
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Koole S, Dornan T, Aper L, Scherpbier A, Valcke M, Cohen-Schotanus J, et al. Does reflection have an effect upon case-solving abilities of undergraduate medical students? BMC Med Educ 2012;12:75.  Back to cited text no. 16
    
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Mamede S, Schmidt HG. The structure of reflective practice in medicine. Med Educ 2004;38:1302-8.  Back to cited text no. 17
    
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Plack MM, Greenberg L. The reflective practitioner: Reaching for excellence in practice. Pediatrics 2005;116:1546-52.  Back to cited text no. 18
    
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Korthagen F, Vasalos A. Levels in reflection: Core reflection as a means to enhance professional growth. Teach Teach Theory Pract 2005;11:47-71.  Back to cited text no. 19
    



 
 
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