|LETTER TO THE EDITOR
|Year : 2014 | Volume
| Issue : 2 | Page : 225-226
Metacognition in medical education
Ipekek Gonullu1, Muge Artar2
1 Department of Medical Education and Informatics, Ankara University, School of Medicine, Turkey
2 Department of Educational Psychology, Ankara University, School of Education, Turkey
|Date of Web Publication||31-Oct-2014|
3 F-3 Blok No: 44, 06530 Ankara
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Gonullu I, Artar M. Metacognition in medical education. Educ Health 2014;27:225-6
Metacognition is awareness and control of one's learning or the knowledge and thinking about one's own or another's thoughts, feeling, and values. It can be classified into two main components as knowledge of cognition and regulation of cognition, which are both viewed as important for effective learning. Knowledge of cognition refers to what individuals know about their own cognition or about cognition in general. Regulation of cognition refers to a set of essential skills that help students control their learning. Essential skills included are planning, monitoring, and evaluation.
Rapidly changing and growing medical knowledge, continuous changes in healthcare delivery systems and growing differences in patient population demand competent doctors who can address and manage complexity. Metacognition is a concept that attempts to capture the essence of adapting to change and uncertainty. Medical students must be prepared to cope with the uncertainty and evolving understanding inherent in medical practice.  Past research has demonstrated that academically successful students use metacognitive strategies, notably identify their goals, self-monitoring, self-questioning, reasoned choice of their behaviors, and self-assessing. Moreover, students can be taught to improve metacognitive proficiency through repeated guided practice. , In medicine, besides its general definition, metacognition is checking diagnostic thinking for possible bias, seeing the illness from a patient's perspective, or assessing what one needs to know about a treatment option. Medical students are not simply learners but they are expected to be medical experts who should focus on their capabilities to continuously assess, monitor, and improve their performance.  As a result, metacognitive awareness is crucial in medical education and for the medical profession. The ability to direct and regulate one's own learning experience is essential for success.
Cutting and Saks reviewed important principles of learning to determine what was most relevant to improving medical student learning, guiding faculty toward more effective teaching, and in designing a curriculum.  One of the learning principles they defined was "promoting metacognition", which they believed was essential to foster deep and durable learning. Metacognition helps the student to learn in-depth, remember the knowledge easily and to choose and use accurate strategies, in addition to realizing his/her strengths and weaknesses. The focus of educators and curriculum specialists should be on this issue with curriculum development studies needed to improve metacognition.
In curriculum development for medical schools, medical educators should focus on learning to learn and higher-order thinking procedures in addition to content. This will result in development of metacognitive skills and enhance the awareness of metacognition. Promoting general awareness of the importance of metacognition, improving knowledge of cognition, improving regulation of cognition, and fostering environments that promote metacognitive awareness will increase metacognition in classroom settings. According to Tanner, the facilitator's role in this process rests with the types of questions asked.  Additionally, educators should serve as role-models in terms of the importance of metacognition. Faculty can also support metacognition by modeling the process of thinking aloud when reasoning through clinical problems and making clinical decisions. This can be done during group instruction, at the bedside, and in relating one-to-one with a student. Feedback to students on their thinking processes and use of resources will promote metacognition. 
Promoting metacognition begins with building an awareness among learners that metacognition exists, differs from cognition, and increases academic success. The next step is to teach strategies, and more importantly, to help students construct explicit knowledge about when and where to use strategies. After this, a flexible strategy repertoire can be used to make careful regulatory decisions that enable individuals to plan, monitor, and evaluate their learning.  In curriculum development of medical schools, medical educators should focus on these skills in order to develop students' metacognitive proficiency. By providing opportunities for learners to become metacognitive and strategic, instructors can foster students' deep understanding of content areas, which should result in higher achievement .
Medical school faculty can foster the development of medical expertise by enabling their students to develop metacognitive capabilities through adapting the following teaching strategies: (1) Reflective writing and reading exercises that focus on narratives; (2) interactive teaching styles that facilitate reflection, self-assessment, and perspective-taking; (3) feedback designed to improve self-assessment as well as performance, and (4) modeling metacognition.  These four teaching strategies, which help in developing metacognition, can be used in problem-based learning, which helps students develop self-directed learning skills, reflection, and self-assessment along with effective problem-solving skills and intrinsic motivation.
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