Cognitive and Metacognitive Processes Demonstrated by Pharmacy Students When Making Therapeutic Decisions

Abstract

To characterize the types of cognitive and metacognitive processes demonstrated by third-year pharmacy students during a therapeutic reasoning activity. Methods. A qualitative, descriptive study following a think-aloud protocol was used to analyze the cognitive (analytical) and metacognitive processes observed by third-year pharmacy students as they completed a 25-minute therapeutic reasoning activity. Using a deductive codebook developed from literature about reasoning, two independent coders characterized processes from audio-recorded, transcribed student think-aloud episodes while making therapeutic decisions about simulated clinical cases. Results. A total of 40 think-aloud episodes were transcribed amongst the cohort. Categorization of the think-aloud transcriptions revealed a series of cognitive analytical and metacognitive processes demonstrated by students during the therapeutic decision-making activity. A total of 1,792 codes were categorized as analytical processes, falling into six major themes: 69% gathering information (1,232/1,792), 13% processing information (227/1,792), 7% making assessments (133/1,792), 1% synthesizing information (19/1,792), 7% articulating evidence (117/1,792) and 4% making a recommendation (64/1,792). In comparison to gathering information, a much lower frequency of processing and assessment was observed by students, particularly for those that were unable to resolve the case. Students' movement between major analytical processes co-occurred commonly with metacognitive processes. Of the 918 codes categorized as metacognitive processes the two major themes were: 28% monitoring for knowledge or emotions (257/918) and 72% controlling the planning of next steps or verification of correct information (661/918). Sequencing the codes and co-occurrences of processes allowed us to propose an integrated cognitive/metacognitive model of therapeutic reasoning for students. Conclusion. This study categorizes the cognitive (analytical) and metacognitive processes engaged during pharmacy students' therapeutic reasoning process. The findings can inform current instructional practices and further research into educational activities that can strengthen pharmacy student therapeutic reasoning skills.

Clinical reasoning in pharmacy: What do eye movements and verbal protocols tell us about the processing of a case task?

“…Boshuizen & Schmidt, 1992 ; de Bruin et al, 2005 ; Feltovich & Barrows, 1984 ; Schmidt & Rikers, 2007 ). However, clinical reasoning also plays an essential role in several other professions, such as in nursing, dentistry and pharmacy (Arisudhana, 2022 ; Eberhard et al, 2009 ; Higgs et al, 2018 ; Walker et al, 2022 ). In their role of patient counsellor, today’s pharmacists continuously face situations that require clinical reasoning and immediate action.…”

“…Scripts help to find patterns of diseases, filter out irrelevant information, rule out several diseases and construct working diagnoses efficiently and accurately (Monajemi et al, 2012 ). Although the illness script theory has been developed and the vast majority of studies has been conducted in the medical context, there are studies showing that the theory is also relevant for and can be extended to other health professions as well, such as in nursing (Arisudhana, 2022 ) and pharmacy (Walker et al, 2022 ).…”