Using Cognitive Science to Make Clinical Reasoning Overt
Purpose: The current definition of clinical reasoning provided by the Clinical Reasoning Curricula and Assessment Research Consortium (CRCARC) defines clinical reasoning as “a nonlinear, recursive cognitive process in which the clinician synthesizes information collaboratively… The clinician reflectively integrates information with previous knowledge and best available evidence in order to take deliberate action” (Christensen et al., 2017). This definition highlights the importance of metacognitive reflection, which has been recommended as a key component in the development of clinical reasoning in physical therapy students (Prokop, 2018). As with other clinical competences, including psychomotor and professional behaviors, cognitive skills need to be instructed, practiced, and assessed. Standardized patient’s (SPs) provide an educational experience that closely resembles the clinical environment with the deconstructed elements of patient variables essential to care. The specificity of patient presentation, including emotional and personality, are precisely the aspects of patient-centered care that require a high level of intuition and metacognitive awareness. The purpose of this research is to examine the effects of SP events on metacognitive awareness at various points throughout the physical therapy curriculum. Specifically, will participation in events with SPs improve metacognitive awareness in both the knowledge of cognition and regulation of cognition subdomains?
Methods and/or Description of Project: This study is a 2x2 mixed, quasi-experimental design involving 59 students enrolled in physical therapy education. Prior to completing a SP encounter, students completed the Metacognitive Awareness Inventory (MAI) (G. Schraw & Dennison, 1994)as a means of quantifying baseline metacognitive awareness. Following the SP encounter, all students completed a post-test MAI.
Results/Outcomes: A statistically significant difference was found between pre and post-test MAI scores (p=.038). Of the eight subdomains of the MAI, only planning and evaluation revealed a statistically significant difference, p=.008 and <.001 respectively.
Conclusions/Relevance to the conference theme: Simulated patient experiences improve the planning and evaluation subcomponents of metacognition, which may positively impact the development of clinical reasoning in physical therapy students. Planning and evaluation are both regulatory skills described in the literature (Schraw & Moshman, 1995). Planning involves the selection of appropriate strategies and the allocation of resources that affect performance. Evaluation refers to appraising the products and regulatory processes of one's learning. As Shaw noted, regulatory competence improves thinking and learning through better use of cognitive resources such as attention, use of strategies, and a greater awareness of comprehension breakdowns (1994). Given the relationship between metacognition and effective clinical reasoning, it is imperative that educators incorporate ways of teaching and assessing metacognition. Additional research is needed to further demonstrate the relationship between improvements and awareness of metacognition and enhanced clinical reasoning.