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From Metacognition to Motivation – A Deeper Look into Why Smart Students Can Struggle in Med School

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We dig into some of the reasons smart students may be failing med school

In part 1 and part 2 of this blog post we examined the many different variables impacting student learning and success. Years of study by educational researchers have clearly determined that a student’s ability to succeed is not exclusively related to how hard they work or their motivation, rather it is dependent on a whole host of factors that are external and internal to the student. The BACEIS model, developed by Hartman and Sternberg in the early 90s, is a useful framework to explore these factors.1 In this post we will take a look at two subsystems of the internal supersystem, cognitive and affective domains, and how they can impact your learning and academic success. 

Cognition and Metacognition

Cognition is a general and familiar term describing processes related to attention, thought, memory, perception, and language. Although not explicit in the BACEIS model, executive function is a key component of this domain. Executive function is a set of complex cognitive processes that are activated to improve performance in difficult or demanding tasks, like studying for a neuroanatomy exam.2  In general these include the ability for students to avoid distraction, stay on task, achieve short term storage of information and demonstrate flexibility in processes needed to successfully complete the task.3 For students this translates into how well you can plan and prioritize what you have to do, manage your time, initiate a task, stay focused, and use different approaches to learning, especially if those that you are using aren’t working.  While commonly known chronic conditions like ADHD, anxiety and depression can impair executive function, temporary factors like fatigue, stress, drug and alcohol use can as well. It is also likely that most people are on a spectrum of executive function “perand those at the lower end can struggle with learning and academic success. The good news is that if any of these factors are in place or executive function skills are lacking, steps can be taken to minimize their impact. This is especially true with the strategies and approaches necessary to overcome a lack of executive function skills. These are best taught by qualified learning specialists with experience in this area.

Metacognition is a term that you might not be familiar with, although it’s importance in learning cannot be understated. Simply put metacognition encompasses our awareness of how we think and learn or more simply put our ability to think about how we think.4  There are three components to metacognition, knowledge, monitoring and control.5 Metacognitive knowledge encompasses our beliefs and knowledge about how we learn. From a practical standpoint this includes our knowledge of different study strategies or approaches to managing your time.  Metacognitive monitoring describes our ability to estimate the effectiveness of our learning. Being able to accurately gauge the success of  your daily learning and whether you are ready for an assessment is a great example of this component of metacognition.  Metacognitive control describes our ability to self-regulate learning using our knowledge of learning strategies and perceived level of knowledge. Being able to choose and effectively use evidence-based learning strategies in your study or modifying how you prepare for exams based on previous performance are great examples of metacognitive control.  As you can see a high degree of metacognitive awareness is critical for student success in high pressure, health professions programs. Students that lack this awareness can struggle with their learning. In fact, many of the students I work with have deficits in this area.  The good news is that there are a number of tools that can measure student metacognition and strategies for improving it but for each specific tools and expert advice and direction are needed and recommended.

Affective Domain

The affective domain in the BACEIS model encompasses a student’s motivation, attitudes about learning and ability to self-regulate feelings and emotions. There seems to be quite a significant connection between a student’s level and type of motivation and the amount of self-efficacy and determination that they bring to their study.6 The research also suggests that the type of motivation that student’s bring to their learning can have a significant impact on their academic success.7 Intrinsically motivated learners tend to be me more successful and value learning for the sake of learning. Externally motivated students tend to experience more academic difficulty and are driven primarily by factors like achieving good grades, peer or parental pressure or fear of failure. Amotivated students tend to believe that they have little control over their learning or their grades.8 They may have given up because of repeated failure. Changing your locus of motivation can be difficult but focusing on autonomy, mastery and purpose can help. I have found with my students that teaching them a systematic approach to studying, using evidence-based approaches like retrieval practice and spacing that can help them to track and regulate their learning reduces their pre-exam anxiety, helps them to master concepts more quickly and effectively and helps to shift their focus from worrying about grades to wondering how what they are learning can make them better practitioners!

Interested in learning more about how we can help you improve your study habits and the way you approach medical education? Check out the STATMed Study Skills Class!

Ready to improve your studying and get better results? Get in touch!

1. Hartman H, Sternberg RJ. A Broad BACEIS for Improving Thinking. I. Instr Sci. 1993;21:401-425.

2. Roebers CM, Feurer E. Linking Executive Functions and Procedural Metacognition. Child Dev Perspect. 2016;10(1):39-44. doi:10.1111/cdep.12159

3. Miyake A, Friedman NP, Emerson MJ, Witzki AH, Howerter A, Wager TD. The Unity and Diversity of Executive Functions and Their Contributions to Complex “Frontal Lobe” Tasks: A Latent Variable Analysis. Cognit Psychol. 2000;41(1):49-100. doi:10.1006/cogp.1999.0734

4. Flavell J. Metacognition and Cognitive Monitoring A New Area of Cognitive—Developmental Inquiry. Am Psychol. 1979;Vol. 34(10):906-991.

5. Dunlosky J. Metacognition. SAGE; 2008.

6. Schunk DH. Self-efficacy and academic motivation. Educ Psychol. 1991;26:207-223.

7. Vallerand RJ, Pelletier LG, Blais MR, Briere NM, Senecal C, Vallieres EF. The Academic Motivation Scale: A Measure of Intrinsic, Extrinsic, and Amotivation in Education. Educ Psychol Meas. 1992;52(4):1003-1017. doi:10.1177/0013164492052004025

8. Deci EL, Vallerand RJ, Pelletier LG, Ryan RM. EDUCATIONAL PSYCHOLOGIST, 26(3 & 4), 325-346  Copyright O 1991, Lawrence Erlbaum Associates, Inc.  Motivation and Education: The  Self-Determination Perspective  Edward L. Deci  University of Rochester  Robert J. Vallerand  University of Quebec at Montreal  LUG G. Pelletier  University of Ottawa  Richard M. Ryan  University of Rochester. Educ Psychol. 1991;26(3 & 4):325-346.

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