Metacognitive awareness among doctor of physical therapy students: A mixed-methods investigation

Metacognitive awareness underpins critical thinking. Its development appears dependent on context, reflection, and experience. Metacognitive awareness in student physical therapists (SPTs) has not been reported.

To explore SPT metacognitive awareness and describe factors associated with its development.

An explanatory mixed-methods study assessed metacognitive awareness in 239 SPTs in 4 entry-level cohorts. The Metacognitive Awareness Inventory (MAI) measures knowledge of cognition (KOC) through declarative, procedural, and conditional knowledge, and regulation of cognition (ROC) through planning, information management, comprehension monitoring, debugging strategies, and evaluation. Data were collected before the first semester (incoming students) and during week 3, 9, and 16 of the 2022 spring semester (first-, second-, and third-year students). Fifteen semi-structured interviews were transcribed and theme coded, and a concept map was developed.

Total MAI (p = .218), KOC (p = .141), and ROC (p = .122) did not differ between time points. Declarative knowledge was greatest among incoming students (p < .001) and conditional knowledge increased between first-year (p = .009) and second-year (p = .038) SPTs. Total MAI (p = .039), planning (p = .048), and information management (p = .017) increased in second-year students. Themes of evolution, mind-set, strategy utilization, and calibration appeared related to metacognitive awareness.

Quantitative findings suggest overconfidence among incoming SPTs. Regulation of cognition improvements in second-year students support experiential learning opportunities. The impact of meaningful life events, content relevance, and contexts seemed to facilitate a shift from KOC to ROC. Student confidence, adaptability, self-assessment accuracy, study strategies, and reflection appeared to vary with metacognitive awareness suggesting that metacognitive awareness, and clinical reasoning, may be promoted by encouraging specific strategies.