Epstein Ronald M, Siegel Daniel J, Silberman Jordan
Rochester Center to Improve Communication in Health Care, University of Rochester School of Medicine and Dentistry, Rochester, NY 14610, USA.
J Contin Educ Health Prof. 2008 Winter;28(1):5-13. doi: 10.1002/chp.149.
Recent literature has described how the capacity for concurrent self-assessment-ongoing moment-to-moment self-monitoring-is an important component of the professional competence of physicians. Self-monitoring refers to the ability to notice our own actions, curiosity to examine the effects of those actions, and willingness to use those observations to improve behavior and thinking in the future. Self-monitoring allows for the early recognition of cognitive biases, technical errors, and emotional reactions and may facilitate self-correction and development of therapeutic relationships. Cognitive neuroscience has begun to explore the brain functions associated with self-monitoring, and the structural and functional changes that occur during mental training to improve attentiveness, curiosity, and presence. This training involves cultivating habits of mind such as experiencing information as novel, thinking of "facts" as conditional, seeing situations from multiple perspectives, suspending categorization and judgment, and engaging in self-questioning. The resulting awareness is referred to as mindfulness and the associated moment-to-moment self-monitoring as mindful practice-in contrast to being on "automatic pilot" or "mindless" in one's behavior. This article is a preliminary exploration into the intersection of educational assessment, cognitive neuroscience, and mindful practice, with the hope of promoting ways of improving clinicians' capacity to self-monitor during clinical practice, and, by extension, improve the quality of care that they deliver.
近期文献描述了同步自我评估（即持续的即时自我监测）能力是医生专业能力的一个重要组成部分。自我监测是指留意自身行为的能力、审视这些行为效果的好奇心，以及愿意利用这些观察结果来改善未来行为和思维的意愿。自我监测有助于早期识别认知偏差、技术错误和情绪反应，并可能促进自我纠正以及治疗关系的发展。认知神经科学已开始探索与自我监测相关的大脑功能，以及在进行心理训练以提高注意力、好奇心和专注度时发生的结构和功能变化。这种训练包括培养思维习惯，比如将信息视为新奇事物来体验、将“事实”视为有条件的、从多个角度看待情况、暂停分类和判断以及进行自我提问。由此产生的意识被称为正念，与之相关的即时自我监测被称为正念练习，这与行为处于“自动驾驶”或“无意识”状态形成对比。本文是对教育评估、认知神经科学和正念练习交叉领域的初步探索，希望能推广一些方法，以提高临床医生在临床实践中的自我监测能力，进而提高他们提供的护理质量。
