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      What Do Physicians Believe About the Way Decisions Are Made? A Pilot Study on Metacognitive Knowledge in the Medical Context

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          Abstract

          Metacognition relative to medical decision making has been poorly investigated to date. However, beliefs about methods of decision making (metacognition) play a fundamental role in determining the efficiency of the decision itself. In the present study, we investigated a set of beliefs that physicians develop in relation to the modes of making decisions in a professional environment. The Solomon Questionnaire, designed to assess metacognitive knowledge about behaviors and mental processes involved in decision making, was administered to a sample of 18 emergency physicians, 18 surgeons, and 18 internists. Significant differences in metacognitive knowledge emerged among these three medical areas. Physicians’ self-reports about the decision process mirrored the peculiarities of the context in which they operate. Their metacognitive knowledge demonstrated a reflective attitude that is an effective tool during the decision making process.

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          Most cited references14

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          Anticipated regret, expected feedback and behavioral decision making

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            Heuristic decision making in medicine

            Can less information be more helpful when it comes to making medical decisions? Contrary to the common intuition that more information is always better, the use of heuristics can help both physicians and patients to make sound decisions. Heuristics are simple decision strategies that ignore part of the available information, basing decisions on only a few relevant predictors. We discuss: (i) how doctors and patients use heuristics; and (ii) when heuristics outperform information-greedy methods, such as regressions in medical diagnosis. Furthermore, we outline those features of heuristics that make them useful in health care settings. These features include their surprising accuracy, transparency, and wide accessibility, as well as the low costs and little time required to employ them. We close by explaining one of the statistical reasons why heuristics are accurate, and by pointing to psychiatry as one area for future research on heuristics in health care.
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              The cognitive imperative: thinking about how we think.

              There are three domains of expertise required for consistently effective performance in emergency medicine (EM): procedural, affective, and cognitive. Most of the activity is performed in the cognitive domain. Studies in the cognitive sciences have focused on a number of common and predictable biases in the thinking process, many of which are relevant to the practice of EM. It is important to understand these biases and how they might influence clinical decision-making behavior. Among the specialities, EM provides a unique clinical milieu of inconstancy, uncertainty, variety, and complexity. Injury and illness are seen within narrow time windows, often under pressured ambient conditions. These operating characteristics force practitioners to adopt a distinctive blend of thinking strategies. Principal among them is the use of heuristics, a form of abbreviated thinking that often leads to successful outcomes but that occasionally may result in error. A number of opportunities exist to overcome interdisciplinary, linguistic, and other historical obstacles to develop a sound approach to understanding how we think in EM. This will lead to a better awareness of our cognitive processes, an improved capacity to teach effectively about cognitive strategies, and, ultimately, the minimization or avoidance of clinical error.
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                Author and article information

                Journal
                EJOP
                Eur J Psychol
                Europe's Journal of Psychology
                Eur. J. Psychol.
                PsychOpen
                1841-0413
                27 November 2015
                : 11
                : 4
                : 691-706
                Affiliations
                [a ]Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
                [b ]Department of Health Sciences, University of Milan, Milan, Italy
                [c ]Interdisciplinary Centre for Research and Intervention on Decision (IRIDe Centre), Milan, Italy
                [d ]Institute of Oncology (IEO), Milan, Italy
                [5]University of South Wales, Newport, United Kingdom
                Author notes
                [* ]Department of Psychology, Catholic University of the Sacred Heart, largo Gemelli, 1, 20123 Milan, Italy. Phone: +39 0272342557. paola.iannello@ 123456unicatt.it
                Article
                ejop.v11i4.979
                10.5964/ejop.v11i4.979
                4873084
                27247686
                e4cf1fba-42d3-46d1-ac20-61001c21861b
                Copyright @ 2015

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 30 March 2015
                : 10 October 2015
                Categories
                Research Reports

                Psychology
                metacognition,surgery,medical decision making,self-awareness,emergency care,internal medicine

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