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Metacognition in the practice of medicine

E Bulzacka, S Lavault, A Pelissolo, C Bagnis Isnard
OBJECTIVES: Mindfulness based interventions (MBI) have recently gained much interest in western medicine. MBSR paradigm is based on teaching participants to pay complete attention to the present experience and act nonjudgmentally towards stressful events. During this mental practice the meditator focuses his or her attention on the sensations of the body. While the distractions (mental images, thoughts, emotional or somatic states) arise the participant is taught to acknowledge discursive thoughts and cultivate the state of awareness without immediate reaction...
February 2018: L'Enc├ęphale
Kadriye O Lewis, Susan Farber, Haiqin Chen, Don N Peska
CONTEXT: The value of reflective practices has gained momentum in osteopathic medical education. However, the use of reflective pedagogies has not been explored in the larger context of medical course delivery and design, to the authors' knowledge. OBJECTIVE: To determine the types of reflection demonstrated by osteopathic medical students on an online discussion board and to explore differences in discussion engagement caused by the use of a reflective learning self-assessment tool...
November 2015: Journal of the American Osteopathic Association
Maggie Bartlett, Simon P Gay, Penelope Ad List, Robert K McKinley
BACKGROUND: Clinical reasoning is an important skill for all clinicians and historically has rarely been formally taught either at undergraduate or postgraduate level. Clinical reasoning is taught as a formal course in the fourth year of the undergraduate programme at Keele School of Medicine by tutors who are all practicing general practitioners. AIM: We aimed to explore the tutors' perceptions about how teaching on the course has impacted on their own consultation skills...
July 2015: Education for Primary Care
Lucie Walters, Caroline O Laurence, Joanne Dollard, Taryn Elliott, Diann S Eley
BACKGROUND: Resilience can be defined as the ability to rebound from adversity and overcome difficult circumstances. General Practice (GP) registrars face many challenges in transitioning into general practice, and additional stressors and pressures apply for those choosing a career in rural practice. At this time of international rural generalist medical workforce shortages, it is important to focus on the needs of rural GP registrars and how to support them to become resilient health care providers...
July 2, 2015: BMC Medical Education
Silke Kruse-Weber, Richard Parncutt
Musicians tend to strive for flawless performance and perfection, avoiding errors at all costs. Dealing with errors while practicing or performing is often frustrating and can lead to anger and despair, which can explain musicians' generally negative attitude toward errors and the tendency to aim for flawless learning in instrumental music education. But even the best performances are rarely error-free, and research in general pedagogy and psychology has shown that errors provide useful information for the learning process...
2014: Frontiers in Psychology
Anthony R Artino, Timothy J Cleary, Ting Dong, Paul A Hemmer, Steven J Durning
OBJECTIVES: The primary objectives of this study were to examine the regulatory processes of medical students as they completed a diagnostic reasoning task and to examine whether the strategic quality of these regulatory processes were related to short-term and longer-term medical education outcomes. METHODS: A self-regulated learning (SRL) microanalytic assessment was administered to 71 second-year medical students while they read a clinical case and worked to formulate the most probable diagnosis...
March 2014: Medical Education
Andrew Petrosoniak, Christopher M Hicks
PURPOSE OF REVIEW: Error is ubiquitous in medicine, particularly during critical events and resuscitation. A significant proportion of adverse events can be attributed to inadequate team-based skills such as communication, leadership, situation awareness and resource utilization. Aviation-based crisis resource management (CRM) training using high-fidelity simulation has been proposed as a strategy to improve team behaviours. This review will address key considerations in CRM training and outline recommendations for the future of human factors education in healthcare...
December 2013: Current Opinion in Anaesthesiology
Simon Gay, Maggie Bartlett, Robert McKinley
BACKGROUND: Keele Medical School's new curriculum includes a 5-week course to extend medical students' consultation skills beyond those historically required for competent inductive diagnosis. CONTEXT: Clinical reasoning is a core skill for the practice of medicine, and is known to have implications for patient safety, yet historically it has not been explicitly taught. Rather, it has been assumed that these skills will be learned by accumulating a body of knowledge and by observing expert clinicians...
October 2013: Clinical Teacher
Cynthia A Riccio, Hilary Gomes
For children with neurodevelopmental or acquired disorders, deficits in executive function (EF) processes (i.e., attention, working memory, cognitive flexibility, and problem solving), are often evident. Moreover, EF deficits are associated with academic difficulties, behavioral and social difficulties, and long-term psychological maladjustment rendering prevention and intervention of EF deficits an important consideration. Many methods exist to address EF processes; this review will focus on pharmacological, cognitive/metacognitive, computerized, and neurofeedback approaches...
2013: Applied Neuropsychology. Child
Victoria R Tallentire, Samantha E Smith, Janet Skinner, Helen S Cameron
CONTEXT: A particularly onerous aspect of the transition from medical student to practising doctor concerns the necessity to be able to rapidly identify acutely unwell patients and initiate appropriate resuscitation. These are skills in which many graduates feel poorly prepared and are considered by some to be best learned on the job. This constructivist study investigated the factors that influence the behaviour of junior doctors in this context and initiated the development of a framework that promotes understanding of this important area...
October 2011: Medical Education
Kaye Atkinson, Rola Ajjawi, Nick Cooling
BACKGROUND: Clinical reasoning requires knowledge, cognition and metacognition, and is contextually bound. Clinical teachers can and should play a key role in explicitly promoting clinical reasoning. CONTEXT: The aim of this article is to relate the clinical reasoning literature to the general practice or family medicine context, and to provide clinical teachers with strategies to promote clinical reasoning. INNOVATION: It is important that the clinical teacher teaches trainees the specific skills sets of the expert general practitioner (e...
September 2011: Clinical Teacher
RuthAnne Kuiper, Nancy Murdock, Nancy Grant
The standard in nursing education today is to prepare nurses for future practice through generic programs with a culminating practicum experience. The clinical faculty in this program was interested in evaluating differences in student thinking strategies that occurred as a result of an increase from 60 to 120 clinical hours, coupled with reflective journaling. The Self-Regulated Learning model was used as a conceptual support for the journaling prompts, as well as a structure for narrative analysis. the 120-hour practicum group revealed a greater use of metacognitive self-evaluation strategies versus greater use of behavioral self-monitoring strategies by the 60-hour practicum group...
August 2010: Journal of Nursing Education
Sara E McEwen, Maria P J Huijbregts, Jennifer D Ryan, Helene J Polatajko
OBJECTIVE: The objective of this critical review was to examine the literature regarding the use of cognitive strategies to acquire motor skills in people who have had a stroke, to determine which strategies are in use and to compile evidence of their effectiveness. SEARCH TERMS: A computerized search of a range of databases was conducted using the following search terms: stroke, cerebrovascular accident; combined with strategy training, learning strateg*, cognitive strateg*, metacognitive strateg*, goal setting, goal planning, goal attainment, goal direct*, goal orient*, self talk, imagery, mental practice, self evaluat*, ready*, attentional focus*, problem solv*, goal management; combined with motor, mobility, activit*, skill, task, function, ADL...
April 2009: Brain Injury: [BI]
Eric Garland, Susan Gaylord, Jongbae Park
Mindfulness meditation is increasingly well known for therapeutic efficacy in a variety of illnesses and conditions, but its mechanism of action is still under debate in scientific circles. In this paper, we propose a hypothetical causal model that argues for the role of mindfulness in positive reappraisal coping. Positive reappraisal is a critical component of meaning-based coping that enables individuals to adapt successfully to stressful life events. Mindfulness, as a metacognitive form of awareness, involves the process of decentering, a shifting of cognitive sets that enables alternate appraisals of life events...
January 2009: Explore: the Journal of Science and Healing
Judith A Kitzes, Summers Kalishman, Darra D Kingsley, Jan Mines, Elizabeth Lawrence
BACKGROUND: The medical student's experience with patients' dying and death has profound impact on personal and professional development. Death Rounds at the University of New Mexico School of Medicine is a small group educational model that promotes student self-reflection, metacognition, professional growth, and collegial support. OBJECTIVE: To describe the implementation and evaluation activities of a third year clerkship Death Rounds which are a structured, institutionally supported resource for helping students to understand the clinical, ethical, legal, professional, cultural, and spiritual aspects of death...
December 2008: American Journal of Hospice & Palliative Care
Veronica Swallow, Maggie Coates
Using reflection within a metacognitive model this paper aims to explore and discuss two recently developed approaches to flexible education. The increasing number of new nursing roles coupled with a dramatically changing health care environment determines the need for educational approaches that recognise and value learning in daily practice. By presenting a lecturer's and a student's reflections of two such approaches (accredited work-based learning at level 2/3 and the MA Advanced Practice) within one paper we have sought to capture the essence of learning that occurs at the interface between patient care and nurse education at three different academic levels and from two different perspectives...
March 2004: Nurse Education in Practice
Malathi Srinivasan, Daniel D Pratt, John Collins, Constance M Bowe, Frazier T Stevenson, Stephen J Pinney, Michael S Wilkes
OBJECTIVE: At the University of California, Davis (UCD), the authors sought to develop an institutional network of reflective educational leaders. The authors wanted to enhance faculty understanding of medical education's complexity, and improve educators' effectiveness as regional/national leaders. METHODS: The UCD Teaching Scholars Program is a half-year course, comprised of 24 weekly half-day small group sessions, for faculty in the School of Medicine and Veterinary Medicine...
November 2007: Academic Psychiatry
D A Freshwater-Turner, R J Boots, R N Bowman, H G Healy, A C Klestov
Difficult clinical decision-making is a common experience in intensive care units. There is often considerable pressure on time and decisions may have to be made in a stressful environment. Patients in the intensive care unit not infrequently present with extreme or rare manifestations of a disease process. Clinical evidence to guide management of such patients may be incomplete, non-existent, or its relevance to the problem at hand may be questionable. In this context, formal decision-making analytical tools are often impractical...
October 2007: Anaesthesia and Intensive Care
Kent J Sheets, Mark E Quirk, Ardis K Davis
Faculty development implications related to implementing the Family Medicine Curriculum Resource (FMCR) Project provide an opportunity to look at the recommendations of the Society of Teachers of Family Medicine's federally funded Faculty Futures Initiative (FFI) and the recent Future of Family Medicine (FFM) project. Implications for faculty development include the importance of the clerkship setting, originally defined in 1991, with new features added in today's practice environment as outlined by the FFM and the changing assumptions in approaching faculty development...
January 2007: Family Medicine
Tessa Hart, Jonathan Evans
Goal planning is a central concept in the clinical practice of rehabilitation. Several disciplines within psychology and medicine have elaborated theories related to goal attainment and self-regulation, the process of managing one's own goal-directed behavior. These theories may be highly relevant to brain injury rehabilitation both to help address characteristic deficits in executive function and to teach clients how to manage life tasks outside of formal rehabilitation. In this article, we describe testable, theoretically motivated interventions at 2 levels: the goal level focused on attaining or enhancing performance on individual tasks and the self-regulation level of metacognitive processes involved in planning and managing one's own goal-directed behavior...
March 2006: Journal of Head Trauma Rehabilitation
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