Metacognition is, as the name aptly suggests, thinking about thinking, and is a form of self-directed learning. Self-directed learning is a cyclical, iterative process that involves deliberate and critical reflection into your own thinking and learning, followed by making tweaks and adjustments, followed by more reflection, and so on. Through metacognition and self-directed learning, you examine your strengths and weaknesses so that you may improve and grow.

Please note that “strengths” and “weaknesses” are not fixed traits, nor are they limitations imposed on your abilities. They are simply predispositions. For example, you may self-identify as a visual learner and feel that your auditory learning is “weaker” than your visual learning; this does not mean you are incapable of or inept at auditory learning. 

Improvements can come about naturally and subconsciously, consisting of intuitive adjustments in response to prior experiences: maybe you didn’t do much deliberate self-reflection after the first few times you threw a ball, but you probably still improved intuitively. (Or, maybe you’re a baseball all-star and you’ve done lots of metacognitive reflection on ball-throwing, but hopefully you still get what I mean!).

 In contrast, metacognition is purposeful reflection, and becomes self-directed learning when combined with methodical fine-tuning for the purpose of improvement. If these concepts are new to you, please don’t be intimidated!

You have been using forms of metacognition and self-directed learning all your life—one of the many reasons that you made it into medical school!

Was there a level in a video game that you played over and over, tweaking just a few steps and getting the timing just right until you beat the level? Or, a piano sonata that required you to play a troublesome movement repeatedly, with minute modifications to each attempt until it sounded just right? What about a cookie recipe that took you five tries, adjusting proportions of ingredients (in response to taste-testing!) before attaining baked perfection?

See, you have been doing plenty of metacognition and self-directed learning!

Metacognition and self-reflection are not a “shortcut”—there is no substitute for time and effort. That being said, you will find that your studying becomes more effective if you:

• ● Continually monitor your performance,
• ● Understand your strengths and weaknesses,
• ● Evaluate your learning styles. In doing so, your studying will become more enriching, efficient, and effective.

The self-directed learning framework

Self-directed learning can be broken down into several core steps. You may find these steps to be intuitive, as you likely have   incorporated many aspects of them into your study habits already. (Reference: How Learning Works)

1. 1.  Assess the task
2. 2.  Evaluate your strengths & weaknesses
3.  3. Plan your actions
4.  4. Apply strategies and monitor your performance
5.  5. Reflect and adjust your actions if needed

Let’s look at some examples from medical education. The below questions represent general examples of how you can apply self-directed learning and metacognition to your studying.

1. 1.  Assess the task:

• ● What material am I studying?
• ● What are my specific study goals for this material?

2. 2.  Evaluate strengths & weaknesses:

• ● What aspects of the material do I understand well?
• ● What aspects of the material do I find challenging?
• ● What aspects of the material do I have trouble remembering? (Please note: material that you have a hard time remembering can be very different from what you find to be conceptually difficult material!)

3. 3.  Plan

• ● What resources am I currently using to study this material?
• ●  Do I need more resources to master the topic?
• ● How long will I study for?

4. 4.  Apply strategies and monitor performance

• ● How will I assess my knowledge and level of comfort with the material? (e.g., question bank, flashcards, or even an in-class or shelf exam)

5. 5.  Reflect and adjust if needed

• ● How did that exam go overall?
• ● What areas did I understand and/or remember well, and what areas do I still have difficulty with?
• ● Is my understanding and recollection of the material at a level that I expected? Were there areas that surprised me (both for things I did well & things I still need help on)?

Reflect, Big & Small

You should frequently think about your thinking and learn about your learning. In other words, find consistent ways to evaluate your performance and to reevaluate your study techniques.

Reflect immediately and often. Incorporate asking small-scale reflective questions into the end of each study session. Think about these as little “check-its” with yourself.

• ● Was the resource I just used helpful? Was the format (auditory, visual, etc.) of the study resource a well-presented way to learn this particular material?
• ● What worked well? What worked less well?
• ● How was my study progress? How long did my studying take? Did I complete what I set out to complete?
• ● How should my studying today impact my next study session? What should I do differently next time? What resources should I use? Should I continue using my current strategies?

Don’t worry about making big, dramatic adjustments in response to one study session. Self-directed learning is a cyclical process in which you will continually tweak and refine your studying. And, don’t worry about getting it “perfect”—you’ll always be making changes!

Reflect at major checkpoints. In addition to frequent small-scale reflections, you’ll want to ask bigger-picture questions regarding your medium-term and long-term performance, particularly as they relate to “checkpoints” (after a rotation, after an exam, after a long practice test).

• ● How did the neurology block go? How did I perform on the class exam? How did I perform on the practice tests? Did I learn the material well enough for the boards?
• ● How was my Step I practice test? What areas did I score well in? What areas should I keep studying? What kinds of questions am I prone to misread? What are different ways I can tackle the same question? What can I learn from the answer key explanation?

Monitor Your Progress & Performance

In addition to reflective questions, you should strongly consider using self-assessment instruments—metrics and methods to  track both completion and competence formally. These may encompass both small details (e.g., number of flashcards completed per day) as well as broader goals (e.g., % of cardiology questions correct on a practice test). Monitoring will help you to best understand which study strategies are working well, and which aren’t. Practice questions can be particularly insightful, since they function as little self-assessments on their own. Flashcards may also serve as mini self-assessments, particularly for memorization-based terms and facts.

You can then reflect on the knowledge gained from such self-assessments.

• ● How did I do on my shelf exam? Were there aspects that were easier or harder than expected? Was there anything that was surprising? What resources ended up being the most effective? What resources ended up being the most “high-yield” and efficient?
• ● What subjects should I study further based on the practice exam I just took?
• ● I did two weeks of flashcards; which topics seem to be down pat, and which am I still shaky on? Are there certain features about the shaky topics that make them more challenging for me?

Furthermore, the use of tracking and monitoring tools can help ease the burden of your metacognitive reflection. Many of your study resources will already have built-in assessments, and may even propose amendments to your study strategies! When you finish sections in a question bank, you often can visualize a breakdown of your performance stratified by topic or question type. Some flashcard platforms are personalized and adaptive: they even can  present particular flashcards to you more often if you have previously gotten them wrong.

Monitoring will help you to best understand which study strategies are working well, and which aren’t. You can then reflect on the knowledge gained from such self-assessments.

You may not fully “know what you don’t know” just by reflecting, and these metrics can help to give a more objective picture of your performance. Practice questions and exams can expose unrealized gaps in knowledge and uncover misconceptions.

Consider the use of a study planning tool or service that can similarly help you to evaluate the actual time you spend studying and help you to monitor your completion.

Be Deliberate

Create dedicated space in your study plan for formal check-ins with yourself. It may be very tempting to reward yourself with a break immediately at the end of a question bank session (and perhaps to add some Netflix or TikTok!). Defer gratification just for a few more minutes, and ask yourself the self-reflective questions! Yes, it’s tough—you’re tired and you have been studying hard! But, the metacognitive reflection that you perform will help your studying immensely. Give yourself time to think about your thinking—this is time well-spent!

Study Buddies

It sounds funny, but your self-directed learning can also involve others! Yes, it is your own performance and your own knowledge that you are reflecting on, but outside perspectives can help to accelerate and facilitate your insights. Your peers and friends can be moral support, and they may also provide valuable guidance and inspiration. Chat with your peers about your study journey, and don’t be afraid to ask for feedback.

You might glean study wisdom from your classmates. What strategies work well for your friends? Have they used any strategies or resources that you haven’t thought to use?

Outside perspectives can help to accelerate and facilitate your insights. Your peers and friends can be moral support, and they may also provide valuable guidance and inspiration.

Please note that getting inspiration isn’t about replicating what anyone else is doing—you have to figure out what works best for you, but sometimes that process is aided by others!

Growth Mindset!

You may already be familiar with the term growth mindset, the outlook that you will grow from challenges and setbacks, and that it’s okay to make mistakes! You can think of self-directed learning as making your growth mindset actionable. Your growth will be accelerated when you thoughtfully engage with yourself through self-reflection, understand your mistakes, seek guidance, and try new study strategies. When you get a question wrong on a practice (or an actual) test, use that as an opportunity to cement your knowledge.

Your self-reflection should not involve beating yourself up over your mistakes!  Evaluate your learning without punishing yourself for “poor” performance. Overdoing the self-criticism is an easy trap to fall into, as a conscientious medical student—so steer clear!

Think Big!

You’ll probably spend a lot of time thinking about studying. But think big—there’s no limit to how meta you can go! Are you making time for breaks? Are you spending time on hobbies? Are you spending quality time with loved ones? Are you feeling burned out? What strategies have helped you achieve the elusive work-life balance, if only fleetingly? Be similarly deliberate, thoughtful, and iterative about cultivating these other parts of yourself. Use your self-reflective abilities to nurture your whole self, not just the studious test-taker part of you. And, when you care for your whole self, your studying will benefit too!