Date of Award

January 2023

Document Type


Degree Name

Doctor of Philosophy (PhD)


Teaching & Learning

First Advisor

Julie R. Robinson


Medical laboratories across the United States have been experiencing a workforce shortage for the past several decades. While the causes of this shortage are numerous, one of the contributing factors is high turnover and attrition rates due to low workplace satisfaction. Research has shown that higher levels of self-efficacy lead to increased job satisfaction and performance outcomes. Therefore, increasing the self-efficacy of medical laboratory science (MLS) students as they prepare to transition into the workforce may help address the labor shortage.To explore a potential exercise to increase self-efficacy among MLS students, a metacognitive learning strategy—reflective journaling—was implemented during the final semester of an MLS professional program. Students (n = 46) engaged in reflective journaling every two weeks while completing a hospital-based clinical rotation. At the end of the semester, they completed a survey assessing their feelings of self-efficacy regarding laboratory testing skills. The survey results were compared to those for the previous student cohort, which did not participate in reflective journaling. Additionally, a subset of students was interviewed to further understand how the metacognitive learning strategy shaped feelings of self-efficacy, and to obtain feedback on refining the activity for future MLS students. The results of the survey indicated that students who engaged in reflective journaling felt more self-efficacious in their laboratory testing skills than students who did not journal. Further, reflective journaling responses and interviews illuminated ways in which self-reflection enhanced feelings of self-efficacy. Refining the assignment for future MLS students was explored. This study provides evidence that metacognition, fostered by reflective journaling, has a positive effect on MLS students’ perceived feelings of self-efficacy. The research offers MLS instructors guidance for implementing a metacognitive learning strategy to enhance these feelings among students.