Purpose
Metacognition—encompassing both the knowledge and regulation of cognition—is vital in medical education. However, few controlled studies explore whether instructional methods influence metacognitive development. This study compares Team-Based Learning (TBL) with lectures in enhancing metacognitive skills and explores the associations among metacognition skills, exam score, and prediction accuracy.

Methods
At Trinity Medical Sciences University, 112 Physiology students self-selected into TBL (n = 63) or lecture (n = 49) groups, attending 1–2 weekly sessions. Random attendees were excluded. The 52-item Metacognitive Awareness Inventory (MAI), using a 5-point Likert scale, assessed changes across three knowledge domains (declarative, procedural, conditional) and five regulation domains (planning, management, monitoring, debugging, evaluation). Final exam results and pre-/post-session prediction accuracy were collected and correlated with MAI scores.

Results
At term start, TBL students exhibited significantly higher scores than lecture peers in declarative knowledge (27.6 vs. 24.5; p<0.001), mentoring (25.9 vs. 23.9; p=0.004), and debugging (20.5 vs. 19.0; p=0.003). By term end the TBL group showed marked gains across all MAI subscales (avg. +4.4 points; p<0.001, d≥0.8), whereas the lecture group improved only in fewer areas—procedural knowledge (14.4 vs. 11.8; p<0.001), planning (23.0 vs. 21.5; p=0.002), and monitoring (25.0 vs. 23.9; p=0.002). Additionally, the TBL cohort maintained a notably higher score prediction accuracy than the lecture group. MAI scores correlated with academic performance (r=0.434) and score prediction accuracy (r=0.463 before, r=0.576 after).

Conclusion
TBL significantly outperformed lectures in improving all metacognitive domains, not just procedural knowledge, planning, and monitoring. These skills also correlated with exam scores and prediction accuracy, underscoring the value of collaborative learning in medical education.