Metacognitive team-based learning for creative problem-solving in Indian medical undergraduates: a single-arm pre-post quasi-experimental mixed-methods study

Abstract

Abstract Background Metacognitive and team-based strategies can strengthen problem-solving; however, many Indian medical undergraduates remain reliant on rote memorisation with limited exposure to structured, creativity-focused pedagogy. Structured interventions combining metacognitive training with collaborative, multidisciplinary teaching remain scarce in Indian undergraduate medical education. This study aimed to design, implement, and evaluate the Creative Problem-Solving Skills through Metacognition (CPSSM) module, a novel three-phase intervention for first-year MBBS students. Methods A single-arm, pre-post, quasi-experimental, mixed-methods study was conducted at AIIMS Rajkot, India, during the 2024–2025 academic year. After obtaining ethical clearance and prospective trial registration, all 50 first-year MBBS students were recruited by universal sampling and 49 completed the intervention. Participants underwent three sequential phases: integrated teaching, case-based discussion, and collaborative model-making, delivered by a multidisciplinary faculty team. They were allocated to ten heterogeneous groups by stratified, non-random allocation based on baseline Metacognitive Awareness Inventory cut-off bands. The pre-specified primary outcome was post-intervention problem-solving accuracy, and the secondary outcomes included self-perceived creativity, group metacognition, and domain knowledge. Quantitative data were analysed using t-tests and ANOVA, with effect sizes and 95% confidence intervals. Qualitative feedback was analysed using descriptive content analysis informed by the Braun and Clarke thematic framework. No comparison group was included; therefore, the findings are reported as associations rather than causal effects. Results Students with high baseline metacognitive awareness showed a significant within-group gain in problem-solving accuracy (28.59 to 30.87; mean difference = 2.28; p < 0.001; Cohen’s d = 1.53); the moderate-awareness group’s gain was smaller and non-significant. Female students outperformed males in problem-solving accuracy at both time points (pre-test: p < 0.01, d = 0.90). Self-perceived creativity was higher in the high metacognition group than in the moderate-metacognition group (59.09 vs. 52.72; p = 0.01). Thematic analysis identified teamwork, motivation, and growing confidence as the principal perceived gains, alongside coordination and resource-related challenges. Creativity was rarely cited spontaneously, despite being a primary intended outcome. Conclusions Participation in the CPSSM module was associated with modest gains in problem-solving accuracy, which was most evident among students with stronger baseline metacognitive awareness. These findings support the feasibility of structured, metacognition-driven, team-based learning in early medical education; however, controlled, multi-site studies are needed before broader effectiveness can be claimed. Trial registration Clinical Trials Registry–India, CTRI/2025/02/080559. This study was registered prospectively on February 14, 2025.