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Promote metacognition for better learning

Thinking about thinking

Metacognition is the process of monitoring the cognitive processes of learning and problem solving and it involves checking of status of knowledge in the specific problem. Metacognition is cognition about cognition or thinking about thinking. It is a kind of self-auditing or self-critical evaluation of in the process of learning or problem solving. Metacognitive skills are especially helpful for monitoring progress of problem solving. If the progress is not satisfactory the person changes the course to reach the goal.

John Flavell of Stanford University is regarded as a pioneer researcher in metacognition. He was influenced by the work of the developmental psychologist and philosopher Jean Piaget. In his 1976 article, Flavell recognized that metacognition consisted of both monitoring and regulation aspects. It was here that the term metacognition was first formally used in the title of his paper. He defined metacognition as follows: "In any kind of cognitive transaction with the human or non-human environment, a variety of information processing activities may go on. Metacognition refers, among other things, to the active monitoring and consequent regulation and orchestration of these processes in relation to the cognitive objects or data on which they bear, usually in service of some concrete goal or objective." 

Many forms of metacognition

Metacognition can take many forms. It includes knowledge about when and how to use particular strategies for learning or for problem solving. Metamemory, defined as knowing about memory and mnemonicstrategies, is an especially important form of metacognition. Some evolutionary psychologists hypothesize that metacognition is used as a survival tool, which would make metacognition the same across cultures.

 Flavell (1976) also identified three metacognitive processes that children gradually acquire in the context of information storage and retrieval. These are:

 (a) The child learns to identify situations in which intentional, conscious storage of certain information may be useful at some time in the future.

 (b) The child learns to keep current any information which may be related to active problem-solving, and have it ready to retrieve as needed.

 (c) The child learns how to make deliberate systematic searches for information which may be helpful in solving a problem, even when the need for it has not been foreseen. 

In cognitive neuroscience, metacognitive monitoring is viewed as a function of the prefrontal cortex. This part of the brain receives signals from other cortical regions. Through feedback loops the prefrontal cortex implements control over all cognitive and learning processes. Metacognition has been used to describe one's own knowledge that we will die.

Components of metacognition

Metacognition is classified into three components:

1. Metacognitive knowledge is what individuals know about themselves and others as cognitive processors. It is also called metacognitive awareness.
2. Metacognitive regulation is the regulation of cognition and learning experiences through a set of activities that help people control their learning.
3. Metacognitive experiences are those experiences that have something to do with the current, on-going cognitive endeavor.

Metacognition refers to a higher level of thinking that involves active control over the process of thinking that is used in learning situations. Planning the way to approach a learning task, monitoring comprehension, and evaluating the progress towards the completion of a task: these are skills that are metacognitive in their nature. Similarly, maintaining motivation to see a task to completion is also a metacognitive skill. The ability to become aware of distracting stimuli – both internal and external – and sustain effort over time also involves metacognitive or executive functions.

The theory that metacognition has a critical role to play in successful learning means it is important that it be demonstrated by both students and teachers. Students who demonstrate a wide range of metacognitive skills perform better on exams and complete work more efficiently. They are self-regulated learners who utilize the "right tool for the job" and modify learning strategies and skills based on their awareness of effectiveness. Individuals with a high level of metacognitive knowledge and skill identify blocks to learning as early as possible and change "tools" or strategies to ensure goal attainment. Persons endowed with metacognition are aware of their own strengths and weaknesses, the nature of the task at hand, and available "tools" or skills. A broader repertoire of "tools" also assists in goal attainment. When "tools" are general, generic, and context independent, they are more likely to be useful in different types of learning situations.

Another distinction in metacognition is executive management and strategic knowledge. Executive management processes involve planning, monitoring, evaluating and revising one's own thinking processes and their products. Strategic knowledge involves knowing what (knowledge of facts ), knowing when and why (knowledge of conditions and contexts) and knowing how (knowledge of procedures or methods). Metacognition in executive management and strategic knowledge are needed to self-regulate one's own thinking and learning.

Finally, there is a distinction between domain general and domain-specific metacognition. Domain general metacognition refers to one which is applied to all cases of goal setting. Domain specific refers to metacognition which is applied in particular subject or content areas, such as editing an essay or verifying one's answer to a mathematics problem.

Metacognitive strategies

Being engaged in metacognition is a salient feature of good self-regulated learners. Groups reinforcing collective discussion of metacognition are a salient feature of self-critical and self-regulating social groups. The activities of strategy selection and application include those concerned with an ongoing attempt to plan, check, monitor, select, revise, evaluate, etc. Metacognition is 'stable' in that learners' initial decisions derive from the pertinent fact about their cognition through years of learning experience. Simultaneously, it is also 'situated' in the sense that it depends on learners' familiarity with the task, motivation, emotion, and so forth. Individuals need to regulate their thoughts about the strategy they are using and adjust it based on the situation to which the strategy is being applied. At a professional level, this has led to emphasis on the development of reflective practice, particularly in the education and health-care professions.

Metacognition helps people to perform many cognitive tasks more effectively.  Strategies for promoting metacognition include:

Self-questioning (e.g. "What do I already know about this topic? How have I solved problems like this before?")

Thinking aloud while performing a task, and making graphic representations (e.g. concept maps, flow charts, semantic webs) of one's thoughts and knowledge. The physical act of writing plays a large part in the development of metacognitive skills.

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Yet Another Drug Company Fined for Off Label Marketing of Psych Medication

Since I started this blog way back in March of 2010, I have posted several times about big Pharma companies being fined for the off-label marketing of various psychiatric medications. Well, the hits just keep on coming.

The Consumerist was one of several news sources to recently report that: 

"New York Attorney General Eric Schneiderman announced the settlement Thursday resolving allegations that Bristol-Myers Squibb improperly marketed and promoted the drug Abilify.

Abilify — the brand name for the prescription drug aripiprazole – is a second-generation antipsychotic prescription drug, commonly, commonly referred to as “atypical antipsychotics,” that were originally used to treat schizophrenia.

According to the states’ complaint, which was also filed today, BMS engaged in off-label marketing, which is the promotion of drugs for uses that are not FDA-approved.

For example, the complaint claims that BMS improperly promoted Ability for pediatric use and for use in elderly patients with symptoms consistent with dementia and Alzheimer’s disease.

This, despite the fact that in 2006, Abilify received a “black box” warning stating that elderly patients with dementia-related psychosis who are treated with antipsychotic drugs have an increased risk of death.

Additionally, the complaint alleges that BMS violated state consumer protection laws by misrepresenting and minimizing the risks of the drug including metabolic and weight gain side effects and by misrepresenting the findings of scientific studies.

Under the proposed agreement, BMS is prohibited from promoting Ability from off-label uses; making false or misleading claims about the drug; compensating health care providers for attended promotional activities; using grant funds to promote Ability; and providing samples of the medication to health care providers who do not intend to use it for labeled purposes."

Bristol-Myers Squibb settled the claims with 43 states for a total of 19.5 million dollars. That sounds like a lot of money, but for big drug companies, it is actually a paltry sum. Fines like that are considered a cost of doing business

As readers know, I am rabidly against the use of antipsychotic medications in non-psychotic children, which is unfortunately becoming more and more common. However, I must admit I have negative feelings about that black box warning regarding the use of any (not just Abilify) antipsychotic medication in patients in nursing homes with advanced dementia due to Alzheimer's disease or other severe brain conditions. 

Things have gotten to the point where docs are afraid to prescribe these medications even in such patients who are actively psychotic with hallucinations and/or paranoid delusions, for which there are no other effective treatments.

Even in non-psychotic demented patients, antipsychotic meds are often the best agents for controlling assaultive behavior in this population. Unlike other sedatives, they do so while only minimally exacerbating memory and cognitive deficits in these people. Our society seems to want to pay nursing assistants only the minimum wage to take care of our impaired family members as they age. Long-term facilities are very expensive as it is. Not only that, but we under-staff them as well. While there may be psychosocial interventions which would reduce assaultive patients with dementia, we do not want to pay people to provide them.

Given those conditions, what is left? Medications, that's what. Do we really want to expose underpaid and overworked caretakers to dangerous aggressive behavior from patients who basically have no life anyway - just to prevent a tiny percentage of them from dying a little sooner due to the medications' cardiovascular side effects? Time to either pay up or shut up.

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