How to Use Metacognition to Boost Your Medical Board Score
Have you ever wondered what physicians with the highest board scores do differently when they study?
Physicians with high-pass scores have developed effective ways of learning and have mastered a skill called metacognition–learn what it is and how you can use it to your advantage on medical board exams.
Many physicians spend most of their time reading to prepare for their medical boards. The assumption is that they can pass their boards if they read the material enough times. While repetitively reviewing content does help us learn, there are deeper learning strategies that help us remember content when we study.
Other physicians rely on question banks to prepare for their boards. With this method, you can more easily discover what you know and don’t know. You can also learn a lot by studying the question item distractors, and testing helps identify learning gaps, which call for further study.
A more desirable approach to preparing for medical boards is to use a combination of self-testing and reading. However, the order in which you do these tasks is important. You should test first, then study your learning gaps (questions you missed or don’t thoroughly understand). This may be counterintuitive, but it saves time and energy and is more efficient and effective.
But what else can physicians do to maximize their learning and retention when high-stakes exams are in the future?
METACOGNITION MAKES LEARNING VISIBLE
As stated, metacognition is understanding your own thinking and learning processes. Metacognitive skills include planning your learning, monitoring whether your current learning strategies are successful, and evaluating the results of your learning. Both content knowledge and metacognitive skills are essential for effective learning. Research shows that improving your metacognitive skills is associated with increased academic performance.
Weak learners tend to have underdeveloped metacognitive skills, leading to overconfidence in understanding the material. Weak learners may passively highlight a passage of a review book and believe that the highlighting means they will remember the content. They may also need to pay more attention to their time to study and review complex concepts.
On the other hand, stronger learners are more self-aware and recognize when they don’t know the material. They ensure they return to it and review it in various ways, using effective learning strategies.
Over the last three decades, learning science has identified specific strategies to help learners develop an awareness of their thinking processes as they learn. These techniques allow them to focus with greater intention, reflect on their existing knowledge versus information they still need to know, recognize errors in their thinking, and develop practices for effective learning. These strategies are called METACOGITIVE LEARNING STRATEGIES—practically speaking, it’s how people learn.
WHAT LEARNING STRATEGIES ARE INVOLVED IN METACOGNITION?
Metacognitive strategies help learners analyze the material they’re studying, reflect on their learning, and direct their work. Examples include:
- Self-questioning –before you study a specific topic, ask yourself what you know about it already, what questions you have, and what you hope to learn—this provides a context and a framework for new knowledge; it also involves pausing throughout a task to check your thoughts and actions consciously; self-questioning is critical to effective learning.
- Testing yourself (or retrieval practice) –self-testing requires more mental effort than rereading. It helps move knowledge from short-term to long-term memory and helps you remember up to 50% more than you would with re-reading alone; other methods include practice tests and flashcards—methods that ask you to assess your knowledge and check if it’s correct.
- Reflection – research has shown that reflecting on what we do (and do not) know, what we need to learn, and the most appropriate learning approach to use; can occur during or following a task; it can reduce anxiety and stress levels while boosting our results.
- Thinking Aloud – talk through your material; this encourages learners to reflect on what they are doing, think about how well they are doing it, and identify any areas that could be improved; learners can be proactive about identifying problems and correcting them.
- Taking Notes from Memory – engage actively with the reading material by pausing periodically to summarize what you read from memory; this strengthens your recall, which increases your chances of remembering and understanding the material.
- Graphic Organizers – create concept maps or graphic organizers to visualize material and see the connections between various concepts; words and images constitute dual coding, which strengthens neural connections in the brain.
- Active Reading Strategies – good readers make connections to prior knowledge and make inferences and predictions, which require constant attention and a questioning mindset.
- Figuring out how you learn – to better understand what learning strategies work best for you, make an appointment with an academic coach to reflect on what you have been doing and figuring out what works best for you.
- Spaced repetition – an effective study plan spaces out your information strategically to secure knowledge into your long-term memory; without reinforcement, studied information will decay exponentially; follow-up your study by self-testing a few days later using practice tests or flashcards.
- Interleaving practice – mix up related topics as opposed to studying them in a blocked fashion; mix up your flashcards, question bank exercises, and review topics by grouping things into clusters of topics; commonalities and differences across topics will appear through interleaving practice.
3 WAYS TO INTEGRATE METACOGNITION IN BOARD REVIEW
Changing one’s approach to board preparation is not easy. Still, the effort can be worth it when you realize the benefits—greater comprehension and retention of material and improved medical board scores.
Metacognition is gaining attention in the medical education research community. However, studies show that the use of metacognition among medical learners varies greatly and that few learners are explicitly taught metacognitive skills. Put simply, there are three steps for applying metacognition: planning, monitoring, and assessing.
PLANNING
Planning sets the stage for effective learning. Ask yourself: “What do I already know about this topic?” “How will I prepare to study it—what learning strategies will I use?” “How much time will I need?” Set learning goals with a timeline. The online board exam blueprint and the content outline can serve as a guide. Rather than start reading a review book, take a quiz to determine what you know/don’t know about this topic. Review the missed questions—make flashcards or a concept map to aid your learning. Retest on questions you missed in two to three days. Continue to review your learning gaps using a variety of learning strategies (listed above).
MONITORING
As you study, frequently stop and ask yourself: “Am I on the right track?” “Do I understand the material (i.e., can I explain it in detail from memory)? Reading content repeatedly gives the illusion that we know the material, but only when we test ourselves do we know for sure. Thinking aloud can help identify your learning gaps.
ASSESSING
At the end of your study, ask: “How confident am I that I understand the material?” “What went well?” “What obstacles did I encounter, and how did I/can I work through them?” “What was easiest for me to learn?” Why?” “What was most challenging for me to learn?” “Why?” “What will I do differently tomorrow?”
Medical boards are cognitive marathons. Achievement on board exams extends beyond cognitive skills; it also requires managing one’s thinking. Metacognition fosters excellence in learning because active learning strategies are robust, easily accessible, and broadly applicable. As medical knowledge continues to expand, metacognition is increasingly recognized as an essential skill for doctors to develop to enable them to identify their own learning needs and expand their academic potential.
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Linda L. Carr, Ph.D., Founder/Principal at Coaching for Medical Specialty Boards, is a medical educator and learning specialist who coaches physicians preparing for specialty boards through virtual, one-on-one coaching. Visit www.DrLindaCarr.org to learn more about her program and download her FREE Study Guide.
