Background: Real knowledge is to know one’s ignorance. The ability to identify the existence of lacunae in the learning process by a learner is due to metacognitive awareness. Metacognitive awareness (which is the knowledge of one’s own cognitive process) development is imperative to assist a learner perform optimally, particularly in assessments. A medical student, burdened with the pressures of never ending academics would be wise to cultivate metacognitive skills. In order to cultivate these skills, a baseline evaluation of the existing skills is necessary. Aims: To analyse the role of metacognitive awareness on the academic scores in medical students. The effect of gender on metacognitive awareness and academic scores were also analysed. In this cross-sectional study, all first year medical students studying in a medical college in South India were included using the complete sampling method. Methods: Metacognitive awareness inventory, a validated questionnaire, was administered to all the students. The average academic scores for the whole of first year of medicine in all the subjects were calculated. Results: The results were statistically analysed using ANOVA and independent t test and the software used was SPSS version 22. Depending on the metacognitive awareness scores, students were grouped into 3 categories; low (<50%), average (50-80%) and high (>80%). Awareness was compared to the academic scores and the difference in groups was found to be significant (p<0.01). A gender wise significance was also noted in the low (p<0.05) and average (p<0.01) categories. Conclusion: Metacognitive awareness has an important role to play in determining the academic outcome. Hence, incorporation of metacognitive awareness strategies in the medical curriculum is recommended.