Teaching metacognition in clinical decision-making using a novel mnemonic checklist: an exploratory study.

• Main Authors: Chew, Keng Sheng, Durning, Steven J, van Merriënboer, Jeroen Jg
• Format: E-Article
• Language: English
• Published: Singapore Medical Association 2016
• Subjects: LB Theory and practice of education; LB2300 Higher Education; LG Individual institutions (Asia. Africa); R Medicine (General); RZ Other systems of medicine
• Online Access: http://ir.unimas.my/id/eprint/11810/1/OA-2015-016-epub.pdf; http://ir.unimas.my/id/eprint/11810/; https://sma.org.sg/UploadedImg/files/SMJ/epub/OA-2015-016-epub.pdf

INTRODUCTION Metacognition is a cognitive debiasing strategy that clinicians can use to deliberately detach themselves from the immediate context of a clinical decision, in order to reflect upon the thinking process engaged. However, the use of cognitive debiasing strategies is often most needed in occasions where the clinician cannot afford the time to do so. A mnemonic checklist known as the TWED checklist (where T = Threat, W = What else, E = Evidence and D = Disposition influence) was recently created to facilitate metacognition. This study explores the hypothesis that the TWED checklist improves the ability of medical students to make better quality clinical decisions. METHODS Two groups of final year medical students from Universiti Sains Malaysia, Malaysia, were recruited for participation in this quasi-experimental study. The intervention group (n = 21) received educational intervention introducing the TWED checklist, while the control group (n = 19) received a tutorial on basic electrocardiography. Post-intervention, both groups received a similar assessment on clinical decision making based on five case scenarios. RESULTS The mean score of the students in the intervention group was significantly higher than that of students in the control group (18.50 ± 4.45 marks vs. 12.50 ± 2.84 marks, p < 0.001). Specifically, in three of the five case scenarios, the students in the intervention group obtained higher scores than the students in the control group. CONCLUSION This results of this study supports the use of the TWED checklist to facilitate metacognition in clinical decision-making.