The Metacognitive Enhancement Triad model enhances learning outcomes in first-year emergency medicine residents.

Introduction: This study evaluated the Metacognitive Enhancement Triad (MET) model, integrating peer-assisted learning (PAL), problem-based learning (PBL), and practice-enhanced cognitive learning (PCL), for improving first-year residents' learning outcomes and National Medical Licensing Examination (NMLE) performance. Methods: A quasi-experimental study was conducted at a tertiary academic medical center. 24 first-year residents received conventional training (pre-intervention), while 22 received the MET intervention (post-intervention). The MET model comprised: (1) PAL groups formed by diagnostic assessment; (2) Constructivist PBL sessions led by mentors; (3) Clinical rotations restructured to align with NMLE content (PCL). Primary outcomes were NMLE scores and pass rates. Secondary outcomes were self-reported competencies and satisfaction measured on a 10-point Likert scale. Results: The post-intervention cohort showed significantly higher NMLE scores (429 ± 41 vs. 388 ± 46, p < 0.01) and pass rates (90.9% vs. 62.5%, p < 0.01). They also reported greater improvement in professionalism, integrated clinical proficiency, lifelong learning, and overall satisfaction (all p < 0.05). Conclusion: The MET model significantly enhanced NMLE performance and key competencies among first-year emergency medicine residents, offering an effective framework for residency training.