Monday, August 28, 2017

Metacognition & Medical Education

I was at the UC Riverside Conference on Teaching, Learning and Research this past weekend at Palm Desert and it was fantastic. One particular new information that I learned was about metacognition,  which is thinking about thinking.

Metacognition is a self reflection of one’s current position, future goals, strategies, and perceived outcomes. The most important aspect about metacognition is it can improve application of skills, character and knowledge beyond the realm that they were learned. In other words, metacognition facilitates “preparedness”. (Church, Rumbold, and Sandars 2017)

This was in the workshop for power writing to help build resilience in medical students.

Why is metacognition important?  
The speaker propose that the idea of introspection and  answering the 5 W's for why we are doing what we're doing can really help make sense of life and build a foundation that will help us face challenges.  “Being psychologically prepared can promote management of negative emotion, distractions and under confidence, thus optimizing performance despite immense pressures of career defining moment” (Church, Rumbold, and Sandars 2017).  Medical school is very stressful and it is followed by an equally stressful training years in residency and fellowship.  Individuals who have insight and perspective often can stay afloat and even thrive more effectively than those who don't. Metacognition is felt to be one of the underlying pillars for critical thinking.  

What are the steps to metacognition?
  • Acquire the knowledge
  • Apply the knowledge to new context and scenarios
  • Gradually add new information a thought process known as concept map

This is an example of a construct a map on photosynthesis. It builds a model for how photosynthesis works and is considered a metacognitive tool, which is considered more effective than active retrieval for Meaningful learning.  (Chevron 2014)

There are four types of knowledge and the levels are in order of high level thought process:
  • factual :  basic elements that we have to remember
  • conceptual :  classification and categories, principles and generalizations, theories, models and structures
  • procedural :  how to do something
  • Metacognitive: Cognition in general and awareness of its own cognition

There are six cognitive categories for each of the knowledge types:
  • Remember
  • understand
  • apply
  • analyze
  • evaluate
  • create

Can it be taught?
 It turns out metacognition is a skill that can be learned and developed with appropriate training. It is important to explain to the students what metacognition is, why it's important and how it is used  for lifelong learning. There is a WWW&H rule (what to do, when, why, and how). (Chevron 2014). At UC Riverside, medical students have regular sessions where they  have “power write” sessions, which is essentially journaling with a specific objective in mind. During the power write sessions, they get leading questions. For example, the question may be to talk about a patient encounter and describe what  the student felt and why he or she felt it.  The students are encouraged to write continuously without worrying about punctuation and grammar. The author shows that over time the students become more cohesive and rather than focusing on the what and when of the situation,  senior students beginning to think about why things are what they are.  The skill is most useful during the third and fourth year of medical school when they are most stressed. By  allocating time for introspection, students are more prepared to face stressful environments. It's really great to see that UC Riverside has integrated this into the curriculum to help students face the harsh but rewarding realities of the medical profession.

How do you  Integrate metacognition into learning?  
I spend over 100 hours every year teaching medical students and I wanted to know how I can incorporate these into my lectures and encourage learning. Metacognition can be used not only to deal with stressful  encounters but can be used to improve learning. The presenter suggested that every 20 minutes during my lectures I take a five-minute break and ask  the students to summarize what they just learned. The act of summarizing what they just learned  forces the students to think about the material and then summarize it which is a form of metacognition.  There are different layers of metacognition. The more primitive layer is asking what happened and when it happened. These are objective and clear. The higher-level order of metacognition it has to do with why.  The responses to why I am doing what I'm doing or not  factual nor are they objective. It's a subjective form of introspection and is the highest level form of metacognition.


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