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Perception of the usability and implementation of a metacognitive mnemonic to check cognitive errors in clinical setting

BACKGROUND: Establishing a diagnosis is a complex, iterative process involving patient data gathering, integration and interpretation. Premature closure is a fallacious cognitive tendency of closing the diagnostic process before sufficient data have been gathered. A proposed strategy to minimize pre...

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Autores principales: Chew, Keng Sheng, van Merrienboer, Jeroen J. G., Durning, Steven J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6327396/
https://www.ncbi.nlm.nih.gov/pubmed/30630472
http://dx.doi.org/10.1186/s12909-018-1451-4
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author Chew, Keng Sheng
van Merrienboer, Jeroen J. G.
Durning, Steven J.
author_facet Chew, Keng Sheng
van Merrienboer, Jeroen J. G.
Durning, Steven J.
author_sort Chew, Keng Sheng
collection PubMed
description BACKGROUND: Establishing a diagnosis is a complex, iterative process involving patient data gathering, integration and interpretation. Premature closure is a fallacious cognitive tendency of closing the diagnostic process before sufficient data have been gathered. A proposed strategy to minimize premature closure is the use of a checklist to trigger metacognition (the process of monitoring one’s own thinking). A number of studies have suggested the effectiveness of this strategy in classroom settings. This qualitative study examined the perception of usability of a metacognitive mnemonic checklist called TWED checklist (where the letter “T = Threat”, “W = What if I am wrong? What else?”, “E = Evidence” and “D = Dispositional influence”) in a real clinical setting. METHOD: Two categories of participants, i.e., medical doctors (n = 11) and final year medical students (Group 1, n = 5; Group 2, n = 10) participated in four separate focus group discussions. Nielsen’s 5 dimensions of usability (i.e. learnability, effectiveness, memorability, errors, and satisfaction) and Pentland’s narrative network were adapted as the framework to study the usability and the implementation of the checklist in a real clinical setting respectively. RESULTS: Both categories (medical doctors and medical students) of participants found that the TWED checklist was easy to learn and effective in promoting metacognition. For medical student participants, items “T” and “W” were believed to be the two most useful aspects of the checklist, whereas for the doctor participants, it was item “D”. Regarding its implementation, item “T” was applied iteratively, items “W” and “E” were applied when the outcomes did not turn out as expected, and item “D” was applied infrequently. The one checkpoint where all four items were applied was after the initial history taking and physical examination had been performed to generate the initial clinical impression. CONCLUSION: A metacognitive checklist aimed to check cognitive errors may be a useful tool that can be implemented in the real clinical setting. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12909-018-1451-4) contains supplementary material, which is available to authorized users.
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spelling pubmed-63273962019-01-15 Perception of the usability and implementation of a metacognitive mnemonic to check cognitive errors in clinical setting Chew, Keng Sheng van Merrienboer, Jeroen J. G. Durning, Steven J. BMC Med Educ Research Article BACKGROUND: Establishing a diagnosis is a complex, iterative process involving patient data gathering, integration and interpretation. Premature closure is a fallacious cognitive tendency of closing the diagnostic process before sufficient data have been gathered. A proposed strategy to minimize premature closure is the use of a checklist to trigger metacognition (the process of monitoring one’s own thinking). A number of studies have suggested the effectiveness of this strategy in classroom settings. This qualitative study examined the perception of usability of a metacognitive mnemonic checklist called TWED checklist (where the letter “T = Threat”, “W = What if I am wrong? What else?”, “E = Evidence” and “D = Dispositional influence”) in a real clinical setting. METHOD: Two categories of participants, i.e., medical doctors (n = 11) and final year medical students (Group 1, n = 5; Group 2, n = 10) participated in four separate focus group discussions. Nielsen’s 5 dimensions of usability (i.e. learnability, effectiveness, memorability, errors, and satisfaction) and Pentland’s narrative network were adapted as the framework to study the usability and the implementation of the checklist in a real clinical setting respectively. RESULTS: Both categories (medical doctors and medical students) of participants found that the TWED checklist was easy to learn and effective in promoting metacognition. For medical student participants, items “T” and “W” were believed to be the two most useful aspects of the checklist, whereas for the doctor participants, it was item “D”. Regarding its implementation, item “T” was applied iteratively, items “W” and “E” were applied when the outcomes did not turn out as expected, and item “D” was applied infrequently. The one checkpoint where all four items were applied was after the initial history taking and physical examination had been performed to generate the initial clinical impression. CONCLUSION: A metacognitive checklist aimed to check cognitive errors may be a useful tool that can be implemented in the real clinical setting. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12909-018-1451-4) contains supplementary material, which is available to authorized users. BioMed Central 2019-01-10 /pmc/articles/PMC6327396/ /pubmed/30630472 http://dx.doi.org/10.1186/s12909-018-1451-4 Text en © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Chew, Keng Sheng
van Merrienboer, Jeroen J. G.
Durning, Steven J.
Perception of the usability and implementation of a metacognitive mnemonic to check cognitive errors in clinical setting
title Perception of the usability and implementation of a metacognitive mnemonic to check cognitive errors in clinical setting
title_full Perception of the usability and implementation of a metacognitive mnemonic to check cognitive errors in clinical setting
title_fullStr Perception of the usability and implementation of a metacognitive mnemonic to check cognitive errors in clinical setting
title_full_unstemmed Perception of the usability and implementation of a metacognitive mnemonic to check cognitive errors in clinical setting
title_short Perception of the usability and implementation of a metacognitive mnemonic to check cognitive errors in clinical setting
title_sort perception of the usability and implementation of a metacognitive mnemonic to check cognitive errors in clinical setting
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6327396/
https://www.ncbi.nlm.nih.gov/pubmed/30630472
http://dx.doi.org/10.1186/s12909-018-1451-4
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