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Singapore Med J. 2016 Dec;57(12):694-700. doi: 10.11622/smedj.2016015. Epub 2016 Jan 15.

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

Author information

1
Formerly from the School of Medical Sciences, Universiti Sains Malaysia, Malaysia.
2
Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
3
School of Health Education, Maastricht University, Maastricht, the Netherlands.

Abstract

INTRODUCTION:

Metacognition is a cognitive debiasing strategy that clinicians can use to deliberately detach themselves from the immediate context of a clinical decision, which allows them to reflect upon the thinking process. However, cognitive debiasing strategies are often most needed when the clinician cannot afford the time to use them. A mnemonic checklist known as TWED (T = threat, W = what else, E = evidence and D = dispositional factors) was recently created to facilitate metacognition. This study explores the hypothesis that the TWED checklist improves the ability of medical students to make better clinical decisions.

METHODS:

Two groups of final-year medical students from Universiti Sains Malaysia, Malaysia, were recruited to participate in this quasi-experimental study. The intervention group (n = 21) received educational intervention that introduced 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 intervention group was significantly higher than that of the control group (18.50 ± 4.45 marks vs. 12.50 ± 2.84 marks, p < 0.001). In three of the five case scenarios, students in the intervention group obtained higher scores than those in the control group.

CONCLUSION:

The results of this study support the use of the TWED checklist to facilitate metacognition in clinical decision-making.

KEYWORDS:

checklist; cognitive bias; cognitive debiasing strategy; medical education; metacognition

PMID:
26778635
PMCID:
PMC5165179
DOI:
10.11622/smedj.2016015
[Indexed for MEDLINE]
Free PMC Article
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