The role of metacognition in teaching clinical reasoning: Theory to practice

Abstract

The ability to think critically in an uncertain and complex health-care environment is a paramount skill needed for health profession students to transition to clinical practice. Experts and educators in health profession education have unintentionally created confusion regarding operationalizing critical thinking, clinical reasoning, and clinical decision-making. In the purest form, health profession educators are referencing the cognitive abilities of a clinician to transfer thinking skills from an academic to a clinical setting. The problem with teaching clinical reasoning in health professions is that the ability to transfer knowledge and skill to patient care is often inefficient. Metacognitive awareness provides a theoretical and practical construct to make previously unconscious cognitive processes overt. The benefit of integrating and scaffolding pedagogical practices to emphasize explicit student knowledge and regulation of cognition may benefit health profession educators in teaching future clinicians how to handle cognitively complex problems. Making clinical reasoning overt through metacognitive awareness provides health profession educators a framework which helps to teach and assess cognitive strategies associated with clinical reasoning. Metacognitive awareness operationalizes a complex construct to allow a definitive way for health profession educators to instruct the cognitive system, resulting in enhanced clinical reasoning. Learning the components of metacognitive awareness is essential to a solid foundation for students and faculty. As students receive further instruction and feedback on cognitive strategies, the potential exists to improve metacognitive judgments. Case-based learning, simulated and standardized patient interactions, and experiential learning all provide pedagogical tools to promote metacognitive awareness in health profession students. Through serial assessment of metacognitive awareness, health profession educators may also gain valuable insight into how students develop cognitive strategies for future clinical reasoning. The increased ability to plan and evaluate cognitive processes may aid health profession students and educators in attaining more meaningful thinking for complex problem-solving in clinical practice.