Navigating Metacognitive Disorientation: Medical Students' Experiences of Complex Tasks

Medical training is full of challenging moments due to the increasing volume and complexity of medical knowledge and skills. Thus, an understanding of how learners experience moments of knowledge deficits is important. This study sought to gain insight into medical students' metacognitive reflections when they encounter knowledge gaps.

In July 2023, 12 medical students from five cohorts at a private US medical school were recruited via email after providing informed consent. This constructivist study analyzed participants' thoughts and emotions when confronted with a complex clinical scenario using think-alouds and debriefing interviews. Interviews were recorded, transcribed and analyzed using Braun and Clark's thematic coding approach.

Our analysis suggests that while participants had disorienting metacognitive experiences in the face of challenging clinical scenarios, they also displayed awareness of their limitations. This awareness was accompanied by a sense of responsibility and efficacy to address those limitations. Additionally, participants' knowledge deficits were characterized by disorganized reasoning and feelings of uncertainty, which for some could then grow into frustration, embarrassment and various kinds of emotional discomfort. Participants reported feeling ill-equipped to move past these moments.

Given that medical students must engage in complex tasks that highlight their knowledge gaps, metacognitive reflection training can provide the tools learners need to regulate emotions. Specifically, training in monitoring, regulation and control could equip students to manage discomfort and stay engaged in effortful learning. This insight will be helpful in determining how to design and teach layered metacognitive reflection skills within medical curricula.