Objective. To examine the impact of pre-class concept mapping on students' ability to self-assess their degree of foundational disease state knowledge (metacognition), as well as pre-class quiz performance. Methods. Second-year pharmacy students in a problem-based learning course were responsible for self-directed learning of foundational knowledge for 14 disease states. After completing independent pre-class reading, students either (1) created group concept maps for which feedback was provided; (2) created group concept maps with no formal feedback; or (3) had no formal group activity. The next day, prior to the formal in class discussion, students completed a quiz covering foundational knowledge and predicted the number of questions they would answer correctly before completing the quiz. Quiz performance was compared between the three conditions, and bias and absolute bias were calculated to evaluate metacognitive skills. Results. There was no difference in metacognition among the conditions, as reflected by inaccuracy between predicted and actual quiz scores. However, when students engaged in concept mapping, their quiz performance was significantly higher than the business-as-usual control. Conclusion. Concept mapping did not improve metacognitive skills but did have small effects on quiz performance. More research is needed to tease apart the roles of concept mapping, group activity, and feedback in altering quiz performance and metacognitive skills.