Pengaruh Pembelajaran Reflektif dan Metakognisi terhadap Penalaran Klinik Mahasiswa Program Profesi Dokter

Eti Poncorini Pamungkasari(1*), Amitya Kumara(2), Armis Armis(3), Ova Emilia(4)

(1) Fakultas Kedokteran Universitas Sebelas Maret, Surakarta
(2) Fakultas Psikologi Universitas Gadjah Mada, Yogyakarta
(3) Fakultas Kedokteran Universitas Gadjah Mada, Yogyakarta
(4) Fakultas Kedokteran Universitas Gadjah Mada, Yogyakarta
(*) Corresponding Author


Background: Most clinical students still have difficulties in clinical reasoning process. Previous study mentioned that reflection and metacognition are factors could influence clinical reasoning. This study aimed to measure the effect of reflection, metacognition, age, sex, duration of clinical rotation, duration of undergraduate program taken by students, and students’ final remark on undergraduate program to students’ clinical reasoning.

Method: This study was a quasi-experimental pretest postest control group design, conducted at RSUD Dr Moewardi Surakarta. We selected 185 clinical students by purposive sampling technique. The study used the Metacognitive Awareness Inventory (‘the MAI’), Motivation scale on Motivated Strategies for Learning Questionnaire (‘the MSLQ’), and Script Concordance Test as instruments. The analyses used multiple linier regressions.

Results: The intervention of reflection learning increased clinical reasoning 1,11 unit (p=0,319); The increase of 1 unit score metacognition decreased clinical reasoning 0,01 score (p=0,806), increasing one semester duration of undergraduate program decreased clinical reasoning 1,17 score (p=0,297), increasing students’ final remark on undergraduate program increased clinical reasoning 15,98 score (p=0,006), female students had 1,97 lower score of clinical reasoning than male (p=0,103), increasing one month of duration clinical rotation increased clinical reasoning 0,01 score (p=0,958), increasing one score of motivation increased clinical reasoning 0,01 score (p=0,529).

Conclusion: Clinical learning and metacognition can not influence clinical reasoning significantly. Clinical teacher and clinical students should be familiarized with reflection learning. Further researches are needed to exploring influencing factors to clinical reasoning.


Clinical reasoning, reflection learning, metacognition

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  1. Fink-koller B. The Integration of Clinical Reasoning in Osteopathy [Master thesis] . Austria: Donau Universitat Krems. 2007.
  2. Audetat M, Lubarsky S, Blais J, Charlin B. Clinical Reasoning: Where Do We Stand on Identifying and Remediating Difficulties? Creative Education. 2013; 4 (6A): 42-48.
  3. Lee A, Joint GM, Lee AKT, Ho AMH, Groves M, Vlantis AC, Ma RCW, Fung CSC, Aun CST. Using Illness Scripts to Teach Clinical Reasoning Skills to Medical Students. Fam Med . 2010; 42(4): 255-261.
  4. Tan SM, Ladyshewsky RK, Gardner P. Using Blogging to Promote Clinical Reasoning and Metacognition in Undergraduate Physiotherapy Fieldwork Programs. Australasian Journal of Educational Technology. 2010; 26(3): 355-368.
  5. Flavell JH. Metacognition and Cognitif Monitoring. American Psychologist. 1979; 34 (10): 906-911.
  6. Amin Z, Eng KH. Basics in Medical Education. Singapore: World Scientific Publishing Co.Pte.Ltd ; 2003.
  7. Bruning RH, Schraw GJ, Norby MM Ronning, RR. Cognitive Psychology and Instruction. Fourth Edition. New Jersey; Pearson Merrill Prentice Hall; 2003.
  8. Dawson TL. Metacognition and learning in Adulthood. Paper in response to tasking from ODNI/CHCO/IC Leadership Development Office. Developmental Testing Service, LLC. 2008.
  9. Omrod JE. Human Learning. Fifth Edition. New Jersey: Pearson Education; 2009.
  10. Turan S, Demirel O. In what level and how medical students use metacognition? A case from Hacettepe University. Procedia Social and Behavioral Sciences 2: 948–952; 2010.
  11. O’Brien B, Cooke M, Irby DM. Perceptions and Attributions of Third-Year Student Struggles in Clerkships: Do Students and Clerkship Directors Agree?. Acad. Med. 2007;Vol 82; 970-978.
  12. Koole S, Dornan T, Aper L, Scherpbier A, Valcke M, Cohen-Schotanus J, Derese A. Does reflection have an effect upon case-solving abilities of undergraduate medical students? 2012.BMC Medical Education; 12 (75).
  13. Sandi-Urena GS. Design and Validation of a Multimethod Assessment of Metacognition and Study of the Effectiveness of Metacognitive Intervention. [Dissertasion]. Clemson University. South Carolina (Amerika). 2008.
  14. Brockbank A, McGill I. Facilitating Reflective Learning in Higher Education. Second Edition. Mc-Graw Hill: London; 2007.
  15. Papadimos TJ. Reflective Teaching and Medical Students: Some Thoughtful Distillation Regarding John Dewey and Hannah Arendt. Philosophy, Ethics and Humanities in Medicine. 2009; 4 (5).
  16. Atherton JS. Learning and Teaching; Reflection and Reflective Practice. 2011 [cited 25 January 2012]. Available from
  17. Kember D, Jones A, Loke AY, McKay J, Sinclair K, Tse H, Webb C, Wong AKY, Wong MWL, Yeung E. Reflective Teaching and learning in the Health Professions. Oxford: Blackwell Science Ltd; 2001.
  18. Greenwood H. The Role of Reflection in Single and Double Loop Learning. Journal of Advanced Nursing. 1998; 27: 1048–1053.
  19. Farrel TSC. Reflecting on Reflective Practice: (Re)Visiting Dewey and Schon. TESOL Journal. 2012; 3(1): 7-16.
  20. Nandi PL, Chan JNF, Chan CPK, Chan P, Chan LPK. Undergraduate Medical Education: Comparison of Problem-based Learning and Conventional Teaching. HKMJ. 2000; 6 (3): 301-306.
  21. Goss B, Reid K, Dodds A, McColl G. Comparison of Medical Students’ Diagnostic Reasoning Skills in a Traditional and a Problem Based Learning Curriculum. International Journal of Medical Education. 2011; 2: 87-93.
  22. Rasekh ZE, Ranjbary R. Metacognitive Strategy Training for Vocabulary Learning. TESL-EJ. 2003; 7 (2).
  23. Boris G, Hall T. Critical Thinking and Online Learning: a Practical Inguiry Perspective in Higher Education. 20th Annual Conference on Distance Teaching and Learning. 2005.
  24. Cubukcu F. Enhancing Vocabulary Development and Reading Comprehension Through Metacognitive Strategies. Issues in Educational Research. 2008; 18(1).
  25. Shokrpour N, Zareii E, Zahedi S, Rafatbakhsh M. The Impact of Cognitive and Metacognitive Strategies on Test Anxiety and Students’ Educational Performance. European Journal of Social Sciences. 2011; 21 (1):177.
  26. Prihartanto FSI. Studi Validitas dan Reliabilitas Script Concordance Test pada Lulusan Dokter Baru Fakultas Kedokteran Universitas Airlangga [Thesis]. Program Pasca Sarjana Universitas Gadjah Mada. Yogyakarta (Indonesia). 2011.
  27. Kuiper RA, Pesut DJ. Promoting Cognitive and Metacognitive Reflective Reasoning Skills in Nursing Practice: Self-regulated Learning Theory. Journal of Advanced Nursing. 2004; 45 (4): 381–391.
  28. Barrow M, McKimm J, Samarasekera DD. Strategies for Planning and Designing Medical Curricula and Clinical Teaching. South-East Asian Journal of Medical Education. 2010; 4(1): 2-7.
  29. Mitchell M, Regan-smith M, Fisher M, Knox I, Lambert D. A New Measure of the Cognitive, Metacognitive, and Experiential Aspects of Residents' Learning. Academic Medicine. 2009; 84(7): 918-926.
  30. Quirk M. Intuition and Metacognition in Medical Education. Springer Publishing Company. New York. 2006.
  31. Hays R. Self-directed Learning of Clinical Setting. Medical Education. 2009; 43(6): 505-506
  32. Chang C. Effects of Reflection Category and Reflection Quality on Learning Outcomes During Web-based Portfolio Assessment Process: A Case Study of High School Students in Computer Application Course. TOJET. 2011; 10(3): 101-114
  33. Dye D. Enhancing Critical Reflection of Students During Clinical Internship Using The Self-S.O.A.P Note. IJAHSP. 2005; 3(4).
  34. Hsu L, Hsieh S. Factors Affecting Metacognition of Undergraduate Nursing Students on Blended Learning Environment. International Journal of Nursing Practice. 2013. DOI: 10.1111/ijn.12131.
  35. Abstract. Shen C, Liu H. Metacognitive Skills Development: A Web-based Approach in Higher Education. TOJET. 2011.10 (2).
  36. Stephen SM, Singh XP. Learning Grammar Autonomously through Metacognitive Strategies: An Experiment. Journal of NELTA. 2010; 15(1-2): 146-150.
  37. Desoete A. Evaluating and Improving the Mathematics Teaching-Learning Processes Through Metacognition. Electronic Journal of Research in Educational Psychology. 2007; 13. 5(3): 705-730.
  38. Gok T. The General Assessment of Problem Solving Processes and Metacognition in Physics Education. Eurasian J. Phys. Chem. Educ. 2010; 2(2): 110-122.
  39. Ngoziibe H. Metacognitive Strategies on Classroom Participation and Student Achievement in Senior Secondary School Science Classrooms. Science Education Internationa . 2009; 20 (1/2): 25-31.
  40. Coutinho SA. The Relationship Between Goals, Metacognition, and Academic Success. Educate~ 2007; 7 (1): 39-47.
  41. Muir F. The Understanding and Experience of Students, Tutors and Educators Regarding Reflection in Medical Education: a Qualitative Study. International Journal of Medical Education. 2010; 1: 61-67.
  42. Universitas Sebelas Maret. Peraturan Rektor Universitas Sebelas Maret Nomor: 553/ H27/ PP/ 2009 Tentang Pembelajaran Berbasis Kompetensi Dalam Sistem Kredit Semester Universitas Sebelas Maret. Surakarta. 2009.
  43. Norman G. Research in Clinical Reasoning: Past History and Current Trends. Medical Education. 2005


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