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Practicing metacognition in medical school

4 min read

Metacognition is a strategy that can improve your learning in medical school. Metacognition means above cognition. In other words, metacognition is “learning about your learning”, or “knowing about what you know”, or “thinking about your thinking”.  For example, a person uses metacognition if they realise that they have more trouble learning A than B, or if they realise using another method is better for solving C.

Why Should You Learn About Learning?

By practising metacognition, you can pick the best way to learn in medical school. What works for you would not work for everyone else. Metacognition is the process of discovering how you learn best.

Students who use metacognition perform better on exams. They did this by evaluating their progress, creating study plans, picking the right tools, and modifying their learning strategies based on how effective they are.

A study in 1990 by Swanson discovered that metacognition could compensate for IQ and lack of prior knowledge when comparing fifth and sixth-grade students’ problem-solving. They found that students with high metacognition used fewer strategies, but solved problems better than students with low metacognition.

In medical school, there's tons of information that you need to digest and memorise. Using metacognition could help you find the best way for you to learn all this information.

Components of metacognition

There are three components of metacognition:

  1. Metacognitive knowledge
  2. Metacognitive regulation
  3. Metacognitive experience

Metacognitive knowledge is your knowledge about how you think, learn and make decisions—for example, knowing that you remember more information from what you read in the mornings compared to at night.

You can divide metacognitive knowledge into three different categories.-

  1. Declarative knowledge, which is the knowledge your yourself as a learner and the factors that influence your learning.
  2. Procedural knowledge, which is your knowledge about learning strategies.
  3. Conditional knowledge, which is knowing when to use declarative and procedural knowledge to learn better.

Metacognitive regulation refers to how you control your learning. For example, your metacognitive knowledge tells you that you learn better in the mornings, so you regulate this by blocking time in the morning for studying.

Metacognitive experience refers to your thoughts and feelings while learning. For example, you might feel tired and distracted when studying in the evening.

How to Apply Metacognition in Medical School

  1. Planning. Before you study, think about the strategies you will be using when learning. What are the things you need to know? How will you learn it? Are you going to use flashcards? Or are you going to practice it on patients?

    It’s also important to plan when and how long you study. You need to plan according to what works best for you. Planning requires your metacognitive knowledge.
  2. Monitor your learning When studying, monitor your progress. Be aware of your experiences and feelings when learning. Do you find this concept difficult or easy? Why do you think it’s difficult? Can you focus, or are you always distracted? How’s your progress?
  3. Evaluating After studying, reflect on your performance and evaluate the strategies you used. Use your reflections to make changes for your next learning session.

    The easiest way to use metacognition is to ask yourself questions about how you learn.
  • What do I already know about this topic?
  • How have I solved problems like this before?
  • What’s the best way to learn this fact, concept or procedure?
  • Are you learning the right things? The Pareto Principle state that 80% of the outcome comes from 20% of input. In medical school, 80% of what comes up in exams is 20% of what you learned. The key is to find out which 20% produces 80%  of the results.

You don’t need specific tools for metacognition. Pen and paper will do. However, some apps like Roam Research makes metacognition easy.

I practice metacognition by using interstitial journaling, where I jot down the time and my thoughts whenever I take breaks from studying. I would write about what I plan to do, how I’m feeling, and what ideas I have about what I learn.

Besides day to day reflection, I would reflect on my progress every Sunday. Thinking from personal experience is an essential kind of learning.

Mike Ebersold, a neurosurgeon, describes that he would reflect on his work whenever he went home. He would think about what happened and how to improve his performance. For example, Ebersold would reflect on how well a suturing went. Does he need to take a bigger bite with his needle, or a smaller bite? Then the next day, he would try out and see if it worked better. By reflecting, he revisited what he learned from reading and added his personal experience to it.

Reflection requires you to do cognitive activities that lead to better learning, such as retrieving knowledge from memory, connecting them to new experiences, and rehearsing what you might do differently in the future.

An easy method of reflection is by doing Plus Minus Journalling. It is a fast and straightforward journalling method created by Anne-Laure Le Cunff. You divide a piece of paper into three columns. At the top of each column, write “+” for “what worked”, “-“ for “what didn’t go so well”, and “->” for “what you plan to do next”.

Fill each column with what happened in the past week. I fill in mine with bullet points, and it takes me 5 minutes to do every week.

Plan, monitor, and reflect. The process of metacognition is a loop and is akin to experiments done by scientists. By practising this loop regularly, you can learn from your experiences and failures to create a system that works best for you.

You can also ask yourself questions regarding your time and tools.

  1. Is your studying schedule sustainable? Are you studying when you plan to? Are there any schedule clashes? Are you working at the right time? Experiment and tinker with the timing and duration of your learning.
  2. Are you using the right tools and resources? Do you enjoy studying with them? Is it easy to use them, or are they getting in the way?
  3. Are you getting support from the right people? Are there any experts you can ask for help?

To become an expert on something, we need to learn the facts, procedures and skills and practice them. However, we never think about learning how to learn. Using metacognition, you can use your experiences and failures to craft strategies that work best for you.

"Initially, the films we put together, they're a mess. It's like everything else in life—the first time you do it; it’s a mess. Sometimes it's labelled... "a failure" ... but that's not even the right word to use. It's just like, you get the first one out, you learn from it, and the only failure is if you don't learn from it, if you don't progress." - Ed Catmull, Pixar co-founder.
Effective LearningMedical School


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