Assessment of Learner Metacognition in a Professional Pharmacy Elective Course

By Steuber, Taylor D.; Janzen, Kristin M. et al. | American Journal of Pharmaceutical Education, December 2017 | Go to article overview

Assessment of Learner Metacognition in a Professional Pharmacy Elective Course


Steuber, Taylor D., Janzen, Kristin M., Walton, Alison M., Nisly, Sarah A., American Journal of Pharmaceutical Education


INTRODUCTION

Metacognition was originally defined by psychologist John Flavell as "knowledge and cognition about cognitive phenomena as well as monitoring of one's own memory, comprehension, and cognitive enterprises." (1) It has since been described in a variety of manners. Metacognition is a higher-order mental process used to plan, monitor, and evaluate one's awareness of information processing and performance, and denotes critical selfrecognition of thinking, learning, and doing. (2,3) Simply defined, metacognition is thinking about one's thinking. (4) Instilling metacognitive skills is vital in preparing the next generation of pharmacy students to face challenges after graduation, as the health care field continues to transform at an exceedingly fast pace and the need for continuous relearning and mastery of material is necessary. Not surprisingly, in Standards 2016, the Accreditation Council for Pharmacy Education (ACPE) emphasizes the need to develop independent, lifelong learners. (5) Key Element 4.1 (self-awareness) states, "the graduate is able to examine and reflect on personal knowledge, skills, abilities, beliefs, biases, motivation, and emotions that could enhance or limit personal and professional growth." (5)

To become experts in their respective fields, students must be presented with metacognitive approaches embedded in the curriculum, which enable them to develop self-assessment strategies in the face of rapidly changing conditions. Overall, pharmacy students tend to lack metacognitive skills and tend to make inaccurate judgements of their performance. (6,7) Austin and Gregory examined pharmacy students' ability to assess their clinical knowledge and communication skills in a clinical simulation setting. (6) The investigators found that students overestimated their performance, although those who performed better had a tendency to predict their scores with more accuracy. Schneider and colleagues had similar findings after administering a 50-question multiple-choice exam and asking students to identify up to 10 items they knew they answered incorrectly and predict their overall exam performance. (7) The authors found that higher performing students were more likely to identify items they answered incorrectly on the exam. Additionally, students tended to underpredict their summative examination performance regardless of their actual performance, which contrasts the findings from Austin and Gregory. This creates gaps in education, as students are generally unable to apply metacognitive skills, self-assess, and decipher what they know from what they do not know.

Fortunately, metacognition is not an innate skill, but can be a learned process if certain methods are employed. Several educational approaches to enhance learner metacognition across a variety of disciplines have been described in the literature. Van Vliet and colleagues found that a flipped-class pedagogy in a bachelor of psychobiology program enhanced learner metacognition. (8) Providing concrete mechanisms and memory strategies was successful in an undergraduate psychology class. (2) Turan and colleagues discovered improved metacognitive awareness and self-regulated learning skills in medical students undergoing a problem-based learning curriculum. (9) Additionally, Tsingos-Lucas and colleagues describe how online reflective activities and modules as well as self-directed learning activities enhanced undergraduate pharmacy students' perception of their reflective thinking ability, an important component of metacognition. (10) However, limitations to these interventions exist. Designing flipped classrooms or problem-based learning courses may require significant curriculum overhaul or course revision. Developing online reflective activities and modules necessitates significant time and resource allocation and may involve repeated student exposure to be successful long-term. Finally, memory strategies may only provide lasting memory of information that is relevant at a given point in time. …

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