Exam wrapper and metacognition for undergraduate surgery students in exam preparation

Kishore Kumar Kannan, Ramula Muthammal


Background: An exam wrapper is a structured debrief­ing questionnaire tailored to help the students understand their performance in the examination and help them to plan and develop improvement strat­egies. Exam wrappers give students a structured reflection about how they performed in a particular exam and act as a useful tool to perform better in the next exam. This mixed-method study was conducted to assess the impact of exam wrapper on metacognitive skills of surgery students and to assess the perception of students on its application in exam preparation.

Methods: Metacognition was assessed using the metacognitive inventory questionnaire for students learning surgery. Nonparametric Friedman test was used to analyze quantitative data and qualitative data which were collected from four identified focus groups students who completed the exam wrapper sessions.

Results: Students who used the exam wrapper throughout the se­mester demonstrated appreciable improvement in metacog­nition (p=0.013). Focus group data showed that students found the exam wrapper useful and effective. The analysis revealed the students' trust that, the faculties can make a change, complementary to conventional teaching-learning methods and reflecting the exam paper helps them to perform better.

Conclu­sions: Medical students in surgery perceive this tool as use­ful and their application of exam wrapper as an effective tool in metacognition. This type of metacognitive intervention needs to be adopted across different departments for exam wrapper to be more engaging and direct students towards self-directed learning.


Metacognition, Surgery students, Exam preparation, Self directed learning

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