Confidence, Mindfulness and Worry Beliefs Shape How Medical Students Read to Learn

Every medical student knows the feeling: a dense English-language research paper, a highlighter running dry, and the creeping suspicion that the eyes have been moving across the page for twenty minutes while the brain checked out somewhere around the second sentence. A new cross-sectional study from Iran suggests that what separates strategic readers from passive ones is not simply intelligence or effort, but a distinctive psychological fingerprint involving self-belief, present-moment attention, and surprisingly specific beliefs about worry itself. The research, published in BMC Medical Education, offers one of the most granular portraits yet of how cognitive, motivational, attentional, and emotion-regulation factors converge on metacognitive awareness of reading strategies among students in the medical sciences.

Metacognitive awareness of reading strategies refers to a learner’s conscious knowledge and regulation of the mental moves that make academic reading work: planning before tackling a text, monitoring comprehension along the way, and repairing understanding when it breaks down. Decades of educational psychology have established that students who report high levels of this awareness tend to engage more deeply with English-language academic materials, a matter of no small consequence in medical fields where the primary literature is overwhelmingly published in English. What has remained murky is how this awareness relates, simultaneously, to the wider constellation of traits that students bring to the page, from their confidence in their own capabilities to the ways they regulate difficult emotions.

The study, conducted by Mohammad Hassan Seif, Mohammad Hosein Alborzi Haghighi, and Fahimeh Rajabi of Payame Noor University in Tehran, drew on 380 complete records from medical sciences students enrolled in a General English course. The dataset formed the medical sciences subgroup of a broader two-group parent study, and the researchers used a cross-sectional analytical design, meaning they measured all variables at a single point in time and modeled the statistical associations among them rather than tracking change over months or years. All participants provided electronic informed consent after reviewing an online information sheet, and the protocol was approved by the university’s research ethics committee in accordance with the Declaration of Helsinki.

What makes the analysis technically distinctive is its decision to work at the level of individual questionnaire dimensions rather than collapsing each instrument into a single total score. The team retained the manuscript’s observed-variable path framework but represented the multidimensional predictors by their established subscale scores: five dimensions from the Metacognitions Questionnaire-30, nine dimensions from the short form of the Cognitive Emotion Regulation Questionnaire, and three goal-orientation dimensions. In total, six linked path equations were estimated, with the three goal dimensions, general self-efficacy, mindfulness, and metacognitive awareness of reading and learning strategies treated as endogenous variables whose values the model attempted to explain. The three parallel goal-orientation disturbances were allowed to covary, but the researchers deliberately resisted the temptation to add residual covariances or data-driven paths suggested by modification indices, a restraint that keeps the model closer to its theoretical specification.

The headline result is that this dimension-specific model accounted for 38.4 percent of the variance in metacognitive awareness of reading strategies, a substantial share for a criterion as complex as strategic reading. Among the direct associations, general self-efficacy emerged as the strongest positive predictor, with a standardized coefficient of 0.379. Students who believed in their own capacity to organize and execute the actions required to manage reading tasks were markedly more likely to report planning, monitoring, and problem-solving strategies. Mindfulness followed with a coefficient of 0.207, suggesting that the capacity for nonjudgmental, present-moment attention is intertwined with the ability to notice when comprehension falters and to do something about it.

The emotion-regulation findings are where the study becomes genuinely counterintuitive. Positive beliefs about worry, a subscale of the Metacognitions Questionnaire-30 that captures the conviction that worrying is useful and helps one cope, showed a positive direct association with metacognitive awareness, at 0.201. Refocusing on planning, a cognitive emotion-regulation strategy that involves thinking about what to do next rather than dwelling on distress, was also positively associated, at 0.195, as was positive reappraisal, the practice of reinterpreting negative events in more constructive terms, at 0.133. In other words, a certain degree of productive worry, channeled into planning and reappraisal, traveled alongside stronger strategic reading awareness.

Yet the negative predictors tell an equally important story. Positive refocusing, which involves redirecting attention to pleasant thoughts instead of the actual problem, was negatively associated with metacognitive awareness at minus 0.178, hinting that avoidance dressed up as optimism may leave readers less practiced at confronting and repairing genuine comprehension failures. Cognitive confidence, the belief in the reliability of one’s own memory and judgments, was negatively associated at minus 0.167, a pattern consistent with the idea that overconfident readers may feel less need to monitor themselves. Performance orientation, a goal orientation centered on demonstrating ability relative to others, was also negatively associated at minus 0.167, while beliefs about the uncontrollability and danger of worry showed a negative association of minus 0.127. The contrast between positive beliefs about worry and beliefs in its uncontrollability underscores that it is not worry per se but how students appraise it that matters.

Beyond the direct paths, the researchers estimated indirect effects using a nonparametric bootstrap procedure with 5,000 resamples, a technique that builds an empirical sampling distribution for each indirect pathway without assuming normality. Several of these total indirect effects produced confidence intervals that excluded zero, indicating statistically robust indirect associations flowing through the model’s intermediate variables. The authors are careful, however, to frame these decompositions as exploratory. Because the data are cross-sectional, the model cannot establish that one factor temporally precedes another, and the indirect pathways should be read as conditional associations rather than causal mediation.

Global model fit was mixed, and the authors report it transparently. The chi-square statistic of 8.87 with three degrees of freedom yielded a p-value of .031, technically significant, while the comparative fit index of 0.998 and the standardized root mean residual of 0.008 were excellent. The root mean square error of approximation of 0.072 sat in an acceptable range, but the Tucker-Lewis index of 0.838 fell below conventional thresholds, a common artifact in low-degrees-of-freedom models where few constraints are imposed. The researchers present these indices as they are, without overclaiming, and emphasize that the value of the analysis lies in resolving an interpretive problem rather than in achieving perfect fit statistics.

That interpretive problem is the study’s most broadly instructive contribution. When multidimensional questionnaires are collapsed into total scores, dimensions that pull in opposite directions can cancel each other out or masquerade as a single uniform effect, obscuring patterns that matter for theory and practice. By re-estimating the original path framework at the dimension level, the team showed that associations within the Metacognitions Questionnaire-30, the Cognitive Emotion Regulation Questionnaire, and goal orientation were heterogeneous and sometimes opposite in sign. For educators in medical sciences, the practical implication is that interventions aimed at strengthening strategic reading may need to be equally specific: cultivating self-efficacy and planning-focused emotion regulation looks promising, while simply encouraging students to think happy thoughts, or to trust their first impressions of a text, may work against the very awareness that deep reading requires. For researchers, the message is methodological: the psychological architecture of learning is built from dimensions, and the blueprint only becomes visible when each beam is measured on its own terms.

Subject of Research: Metacognitive awareness of reading strategies and its psychological correlates among medical sciences students

Article Title: Learner-reported factors associated with metacognitive awareness of reading strategies among Iranian medical sciences students: a cross-sectional study

Article References: Seif, M. H., Haghighi, M. H. A., & Rajabi, F. (2026). Learner-reported factors associated with metacognitive awareness of reading strategies among Iranian medical sciences students: a cross-sectional study. BMC Medical Education. https://doi.org/10.1186/s12909-026-10568-1

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10568-1

Keywords: metacognition, reading strategies, medical education, self-efficacy, mindfulness, cognitive emotion regulation, goal orientation, path analysis, cross-sectional study, educational psychology, Iran, BMC Medical Education