Career-long learning: Relationship between cognitive and metacognitive skills

Objectives: Physicians need metacognitive skills including reflection and goal generation for effective lifelong learning (LLL). These skills are not readily assessed and may not correlate with cognitive skills. We examined early-career physicians' metacognition and relationships between metacognitive skills, cognitive skills, and orientation toward LLL. Methods: Pediatric fellows at UCSF document career progress in annual Individual Development Plans (IDPs). To assess metacognitive skills, we scored narratives in IDPs with a Reflective Ability Rubric (RAR) and goal setting with a SMART Goal Rubric (SMART-GR: consists of global IDP score and four IDP domain subscores). To assess cognitive skills, we collected American Board of Pediatrics scores (ABP), and to measure orientation toward LLL, fellows completed the Jefferson Scale (JeffSPLL). We used Spearman's correlation to examine relationships between scores. Results: About 57/66 (86%) fellows participated. Mean scores were: RAR 2.4 ± 1.3 (scale 0-6); SMART-GR global IDP 2.8 ± 1.0, (1-5); JeffSPLL 46.3 ± 3.9 (14-56); and ABP 559.4 ± 75.7. RAR scores correlated significantly with SMART-GR scores but metacognitive measures did not correlate with ABP scores. Conclusions: Our study suggests early-career physicians may have limited metacognitive skills; cognitive and metacognitive skills do not correlate; and orientation toward LLL does not predict metacognitive skills. Thus, we need improved methods to teach and assess metacognition.