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BackgroundClinical reasoning is a key competence in medicine. There is a lack of knowledge, how non-experts like medical students solve clinical problems. It is known that they have difficulties applying conceptual knowledge to clinical cases, that they lack metacognitive awareness and that higher level cognitive actions correlate with diagnostic accuracy. However, the role of conceptual, strategic, conditional, and metacognitive knowledge for clinical reasoning is unknown.MethodsMedical students (n = 21) were exposed to three different clinical cases and instructed to use the think-aloud method. The recorded sessions were transcribed and coded with regards to the four different categories of diagnostic knowledge (see above). The transcripts were coded using the frequencies and time-coding of the categories of knowledge. The relationship between the coded data and accuracy of diagnosis was investigated with inferential statistical methods.ResultsThe use of metacognitive knowledge is correlated with application of conceptual, but not with conditional and strategic knowledge. Furthermore, conceptual and strategic knowledge application is associated with longer time on task. However, in contrast to cognitive action levels the use of different categories of diagnostic knowledge was not associated with better diagnostic accuracy.ConclusionsThe longer case work and the more intense application of conceptual knowledge in individuals with high metacognitive activity may hint towards reduced premature closure as one of the major cognitive causes of errors in medicine. Additionally, for correct case solution the cognitive actions seem to be more important than the diagnostic knowledge categories.

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Metacognitive control is an important factor for successful learning and has been shown to increase across childhood and adolescence. Only few studies have attempted to investigate the cognitive processes and psychological mechanisms that subserve metacognitively-based control and the development thereof. Accordingly, the aim of the current study was to gain an insight into the cognitive and psychological correlates that relate to metacognitively-based control processes. Specifically, we were interested in two measures of metacognitive control: learners' ability to self-regulate their study time in a study time allocation paradigm, as well as the efficiency with which they allocated their study time. It was of particular interest to explore the relation between declarative metamemory and procedural metacognitive skills. In addition, we assessed learners' general cognitive and executive abilities. We tested a group of 10-year olds and a group of adults. Surprisingly, and in contrast to previous studies, the current study does not support a relation between declarative metamemory and procedural skills, or executive functions and intelligence and procedural skills. We interpret our results in line with a dual systems view of metacognitive abilities and further speculate whether procedural skills might become increasingly independent and automated with age.