know. And that may seem simple but there's a very big difference between understanding

a concept as it is explained to you compared to being able to explain that concept to somebody

else.

When I first started to teach professional students, they would ask me how can I do better

on your exam and I would say, study. And they would say, I'm studying day and night and

I would say, study harder. Or they would say, I went into the test and I knew the material

but as soon as I sat down in the room, the material vaporized. Well, it didn't vaporize

but I wasn't very good at articulating a strategy that was helpful for them. But I've come to

understand the gap between what students consider to be knowing the material and what I really

mean when I say study harder. Students learn the material as it appears on the page, in

the order that it appears without really any context. What they should try to do is pull

that material off the page and look at from all angles. Meaning, for instance, Rhodococcus

pneumonia, thinking back to immunology, how does immunology impact Rhodococcus and how

does the fact that it's an intracellular organism change your drug choice. And then they need

to think about what they have learned within that week, how is Rhodococcus pneumonia

different from other forms of pneumonia? Or how is it similar? And then they need to think

forward. Of the information that's on this page, what will be helpful to me when I'm

trying to diagnose this disease. Or making a treatment decision. Or advising a client

for how to prevent the disease in the future. So metacognition is really critical for success

in the third and fourth year, that's the tipping point. Because in the first year, there isn't

that much material to reach back for and clinics is really a long ways off. And in the second

year, there's a little bit more but in the third year, you need to reach back to those

first two years and you need to think about how you would use it in the future. And when

you put the material in that context, it's a lot easier to remember for an exam and in

the future.

In the last five minutes of every lecture, I pose a question to the students, asking

them to apply the material that they learned today in a clinical way. They respond in an

essay format through K-State Online. I then review every student response and compile

the results to present to the class during the first five minutes of lecture the next day.

I share a number of categories of responses. The best response or the correct answer. There's

a category that I call "also good," which means those are not the answers I had in mind

when I answered the question but they are correct answers and they are actually very

creative answers. The next category, misconceptions, are incorrect answers and this gives me an

opportunity to help clarify that material for the students and to reflect on the lecture

the day before and think about why that material may not have been clear for the students.

And the last category I call "answer the question that was asked," and this case students provided

a diagnosis rather than a clinical sign and this gives me a chance to emphasize to the

students how important it is to listen carefully to the question and always answer the question

that is asked. From clinicians, from colleagues and from clients.

This particular exercise in metacognition helps the students see how the material might

be used in the clinical setting and helps me to understand the material that was not

well understood by the students the day before. It gives me a chance to review that material.

At the end the semester, we polled the students about the exercise and the responses were

surprisingly detailed about how this exercise impacted their learning. I like this first

response, "I would even discuss the question with classmates later in the day, which I

doubt I would have done with the material had we not had the exercise." The second student

said the exercise is "more firmly situated in my long-term memory." This third said I

pay more attention during lecture wondering what Dr. Rush would ask. And this last one

is almost the definition of metacognition, it "often showed me that even though I think

I got it, apparently I was still missing something and had to go back and figure out what I missed."

So now instead of telling students to study harder, I now can tell them to study smarter

and I can actually give them some strategies that will help them make better use of their

study time, to perform better on exams and hopefully to remember the information in the

future.