What Were You Thinking? Medical Students' Metacognition and Perceptions of Self-Regulated Learning

Metacognition and Self-Efficacy in Action: How First-Year Students Monitor and Use Self-Coaching to Move Past Metacognitive Discomfort During Problem Solving

Stronger metacognitive regulation skills and higher self-efficacy are linked to increased academic achievement. Metacognition and self-efficacy have primarily been studied using retrospective methods, but these methods limit access to students' in-the-moment metacognition and self-efficacy. We investigated first-year life science students' metacognition and self-efficacy while they solved challenging problems, and asked: 1) What metacognitive regulation skills are evident when first-year life science students solve problems on their own? and 2) What aspects of learning self-efficacy do first-year life science students reveal when they solve problems on their own? Think-aloud interviews were conducted with 52 first-year life science students across three institutions and analyzed using content analysis. Our results reveal that while first-year life science students plan, monitor, and evaluate when solving challenging problems, they monitor in a myriad of ways. One aspect of self-efficacy, which we call self-coaching, helped students move past the discomfort of monitoring a lack of understanding so they could take action. These verbalizations suggest ways we can encourage students to couple their metacognitive skills and self-efficacy to persist when faced with challenging problems. Based on our findings, we offer recommendations for helping first-year life science students develop and strengthen their metacognition to achieve improved problem-solving performance.

A mixed-methods SWOT analysis of a medical student Balint group programme

BACKGROUND

Balint groups use case-based discussions to explore, reflect on, and enhance the clinician-patient relationship. They facilitate the development of empathy and reflective practice and reduce burnout. This study aimed to explore how the benefits of a traditional Balint group format can be accessed and optimised for medical students during a one-year pilot programme.

METHODS

Eight medical student Balint groups ran for six weeks during 2022-2023, with 90 students participating. Themes were identified from student feedback using qualitative content analysis. Group leaders kept reflective session notes and used these alongside student feedback to undertake a strengths, weaknesses, opportunities, and threats analysis.

RESULTS

Strengths of the programme were emotional containment, learning to reflect, and community identity. Weaknesses were themed as strange situations, dragging along, and facilitator as an object. Opportunities were identified in expanding the scope and sharpening focus. Psychological defences and the engagement dilemma threatened the future success of the Balint group programme.

DISCUSSION

Medical student Balint groups provide a unique space to combine learning and emotional support with personal, professional and community development. However, the traditional Balint group format may need adapting to be widely accessible to undergraduate learners. Sustainably integrating Balint groups into the medical school curriculum requires ongoing engagement work at both an individual and organisational level.

Promoting metacognition in an allied health anatomy course

Metacognition, the ability to self-regulate one's learning and performance, has been shown to improve student outcomes. Anatomy is recognized as one of the toughest courses in allied health curricula, and students could benefit from metacognitive activities. The purpose of this study was to explore the changes in metacognition of allied health students in an anatomy course and identify which groups need support with this skill. First-year physician assistant (MPAS), physical therapy (DPT), and occupational therapy (OTD) students (n = 129) were invited to participate. At the beginning and end of the course, students completed a questionnaire including the metacognitive awareness inventory (MAI) that assesses metacognition. Students were also asked to reflect on their examination performances using a modified Likert scale and participated in reflective discussion boards to encourage development of metacognitive skills, which were thematically analyzed. Paired metacognition scores had increased significantly by the end of the course. However, middle-performers anticipated high grades and were less satisfied with their grade, indicating a disconnect in their metacognition compared to high- and low-performers. Students' receptiveness to modifying study strategies to improve performance declined throughout the course; by mid-way through, they relied more on existing strategies. Increasing time constraints were frequently cited as a major factor when considering study strategies and modification of such strategies. To maximize the effectiveness of metacognitive activities, they should be positioned early in the course when students are most receptive. In addition, middle performers may benefit from additional support to improve metacognition.

Developing low-achieving medical students' self-regulated learning using a combined learning diary and explicit training intervention

INTRODUCTION

The development of self-regulated learning (SRL) is an essential educational component of remediation for low-achieving students. The aim of this study was to design, implement, and evaluate a longitudinal SRL intervention combining both a structured learning diary and explicit SRL training in a cohort of low-achieving undergraduate medical students.

MATERIALS AND METHODS

A mixed methods quasi-experimental study was conducted, with a pretest-posttest study in the intervention group and comparison of the GPA and course grade of the intervention group with a historical comparison group. A questionnaire and focus group explored the participants' perceptions about the intervention.

RESULTS

The SRL scores (total and rehearsal, organization, critical thinking, metacognitive regulation, time management and environment management) and course grade of participants were significantly improved in the intervention group. The course grade of participants was significantly higher than the comparison group but the GPA was not significantly different. Overall, the participants were positive about the intervention.

CONCLUSIONS

This study was the first in medical education to evaluate the effectiveness and user acceptability of an SRL intervention that combined a structured learning diary and explicit SRL training in low-achieving medical students. Further research is recommended in different contexts and with larger number of students.

Nursing students' self-directed learning experiences in web-based virtual simulation: A qualitative study

BACKGROUND

Since the start of the COVID-19 pandemic, virtual reality simulation, including web-based simulation, has increased in nursing education. This study explored nursing students' self-directed problem-solving in web-based virtual simulation experiences.

METHOD

Convenience sampling yielded 16 Korean senior nursing students who had experienced clinical practice in the last semester. Data were collected from August 2020 to January 2021 through in-depth Zoom video interviews and organized using NVivo version 12.0. Thematic analysis was applied to analyze the data.

RESULTS

The following four themes were identified from nursing students' learning experiences during the web-based virtual simulations: "self-awareness of a lack of nursing competency in virtual reality," "applying new learning strategies learned from failure," "voluntary learning behavior," and "cognitive shift toward a holistic understanding." Web-based virtual simulations activated various cognitive and metacognitive factors of self-directed learning, and the system's prompt feedback and students' reflections facilitated learning effects. Nursing students corrected their cognitive errors while learning from their failures and mistakes and gained a holistic view of nursing practice.

CONCLUSION

In this study, web-based self-directed learning activated the metacognition of nursing students in a virtuous cycle. The virtual environment with no actual harm to the patient has become a space for learners to experience a sense of confidence, achievement, and satisfaction. Web-based virtual simulation can be an effective teaching method to improve nursing students' self-directed learning abilities and nursing competency.

Sense of Coherence as a Mediator in the Association Between Empathy and Moods in Healthcare Professionals: The Moderating Effect of Age

While empathy is considered a critical determinant of the quality of medical care, growing evidence suggests it may be associated with both one’s own positive and negative moods among healthcare professionals. Meanwhile, sense of coherence (SOC) plays an essential role in the improvement of both psychological and physical health. Reportedly, individual SOC reaches full stability after around age 30. The aim of this study was first to evaluate the mediatory role of SOC on the association between empathy and individual moods among 114 healthcare professionals in a general hospital, and then to examine the moderating effect of age on this association. Participants completed a range of self-report demographic questionnaires, Empathy Process Scale (EPS), the 13-item Antonovsky’s SOC, and Profile of Mood States (POMS). Findings showed that SOC mediated the relations between empathy (EPS) and both POMS-Vigor (POMS-V: self-vigor mood) and POMS-Depression (POMS-D: self-depression mood). Notably, moderated mediation analysis revealed that there was a significant interaction (age × SOC) on self-vigor mood (POMS-V) in healthcare professionals. The indirect effect of empathy (EPS) on self-vigor mood (POMS-V) through SOC was significant at over mean age “32.83.” Although there was no significant interaction with age regarding the indirect effect of empathy (EPS) on self-depression mood (POMS-D), in the sub-category level analysis of empathy (EPS), we found a significant interaction item [age × empathy for other’s negative affect (EPS-N)] on SOC. This indirect effect was also significant at over mean age “32.83.” Taken, together, the current study highlighted the significant mediator of SOC on that empathy amplifies self-vigor mood and attenuates self-depression mood as a protective factor among the Japanese healthcare professionals. Some components of these processes may depend on the moderating role of age, indicating that we may need to consider the SOC development with age for more effective empathy performance interventions among healthcare professionals.

Undergraduates' Experiences with Online and in-Person Courses Provide Opportunities for Improving Student-Centered Biology Laboratory Instruction

Biology laboratory courses with hands-on activities faced many challenges when switched to online instruction during the COVID-19 pandemic. The transition back to in-person instruction presents an opportunity to redesign courses with greater student input. Undergraduates in an ∼350-student laboratory course were surveyed about their preferences for online or in-person instruction of specific laboratory course components. We predicted that students who have taken a virtual laboratory course prefer keeping some of the components online. We also hypothesized that their preferences are affected by their experience with online-only or with both online and in-person instruction. The results showed that students would like to move the laboratory component and group meetings back to in-person instruction, even if they never experienced college-level in-person courses. Also, many components, including the lectures, exams, assignment submission, and office hours are preferred to be held online. Surprisingly, students who have only taken online courses would rather give group presentations in person, while those who experienced both online and in-person instruction were undecided. Group presentations were the only component where the preference of the two groups significantly differed. Self-assessed learning gains showed that students performed very well in both the online semesters and the in-person semesters. Therefore, the preferences measured in this study were likely developed based on students' future expectations and personal gains, and not only on their metacognitive decisions and academic performances. This study provides considerations for redesigning components of laboratory courses to be more student-centered after the pandemic.