Metacognitive awareness and confidence as predictors of academic performance in pharmacy students: insights from grade predictions and structural equation modeling

Background Pharmacy students often struggle with accurate self-assessment of learning outcomes. Many students overestimate exam performance, reflecting poor metacognitive awareness and overconfidence. This study examined the relationships between metacognitive awareness, self-confidence in grade predictions, and academic performance in pharmacy education, thus addressing how these factors interact without inferring causation. Methods Pharmacy students ( n = 151) at King Saud University participated in this study while enrolled in a Pathophysiology, Drug Action, and Therapeutics course. Surveys were pre-tested and post-tested twice at two midterm examinations to determine their self-reported metacognitive awareness and confidence. Students made predictions for future course grades. These self-tests were then contrasted to actual exam scores. Statistical analysis was performed using R software version 4.3.1, and students were categorized by metacognitive and confidence ability. Results Despite underperforming on the first exam, students’ confidence in their grade predictions remained high. Students with better metacognitive awareness and well-calibrated confidence scored significantly higher on exams ( p < 0.01). Metacognitive cognition and confidence were positively associated with academic performance ( r = 0.467 and 0.361, p < 0.01), and with each other ( r = 0.251, p < 0.01). Gender differences showed higher overall confidence and metacognitive cognition scores in males. Discussion The results indicate that metacognition and confidence are critical for academic performance. These findings suggest that educational programs targeting self-evaluation warrant further investigation.