Katz David, Detsky Allan S
Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Institute of Health Policy, Management and Evaluation, and Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
J Hosp Med. 2016 Feb;11(2):120-2. doi: 10.1002/jhm.2505. Epub 2015 Nov 3.
This Perspective proposes the introduction of metacognition (thinking about thinking) into the existing format of hospital-based morbidity and mortality rounds. It is placed in the context of historical movements to advance quality improvement by expanding the spectrum of the causes of medical error from systems-based issues to flawed human decision-making capabilities. We suggest that the current approach that focuses on systems-based issues can be improved by exploiting the opportunities to educate physicians about predictable errors committed by reliance on cognitive heuristics. In addition, because the field of educating clinicians about cognitive heuristics has shown mixed results, this proposal represents fertile ground for further research. Educating clinicians about cognitive heuristics may improve metacognition and perhaps be the next frontier in quality improvement.
这一观点建议将元认知（对思维的思考）引入现有的医院发病率和死亡率病例讨论形式中。它是在通过将医疗差错原因的范围从基于系统的问题扩展到有缺陷的人类决策能力来推进质量改进的历史进程背景下提出的。我们认为，当前侧重于基于系统问题的方法可以通过利用机会来教育医生认识到因依赖认知启发法而产生的可预测差错而得到改进。此外，由于在教育临床医生认识认知启发法这一领域的结果喜忧参半，这一提议为进一步研究提供了丰富的素材。教育临床医生认识认知启发法可能会提高元认知，也许还会成为质量改进的下一个前沿领域。
