Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Kota Samarahan, Malaysia.
School of Health Education, Maastricht University, Maastricht, The Netherlands.
BMC Med Educ. 2019 Jan 10;19(1):18. doi: 10.1186/s12909-018-1451-4.
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.
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.
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.
A metacognitive checklist aimed to check cognitive errors may be a useful tool that can be implemented in the real clinical setting.
建立诊断是一个复杂的、迭代的过程，涉及到患者数据的收集、整合和解释。过早关闭是一种在收集到足够的数据之前就过早结束诊断过程的错误认知倾向。一种被提议的最小化过早关闭的策略是使用清单来触发元认知（监控自己思维的过程）。许多研究表明，在课堂环境中，这种策略是有效的。这项定性研究考察了一种名为 TWED 清单（其中字母“T = 威胁”、“W = 如果我错了怎么办？还有什么？”、“E = 证据”和“D = 性格影响”）的元认知记忆辅助工具在真实临床环境中的可用性感知。
两类参与者，即医生（n=11）和医学生（第 1 组，n=5；第 2 组，n=10），参加了四个单独的焦点小组讨论。Nielsen 的可用性 5 个维度（即易学性、有效性、可记性、错误和满意度）和 Pentland 的叙事网络分别被改编为研究框架，以研究清单在真实临床环境中的可用性和实施情况。
两类参与者（医生和医学生）都认为 TWED 清单易于学习，并且能有效地促进元认知。对于医学生参与者，他们认为清单中的“T”和“W”两个项目是最有用的方面，而对于医生参与者，则是“D”项目。关于其实施，“T”项目被迭代地应用，“W”和“E”项目在结果不如预期时应用，而“D”项目则很少应用。所有四个项目都应用的一个检查点是在初始病史采集和体检完成后，以生成初始临床印象。
一种旨在检查认知错误的元认知清单可能是一种有用的工具，可以在真实的临床环境中实施。
