Self-monitoring in clinical practice: A challenge for medical educators

Abstract

Recent literature has described how the capacity for concurrent self-assessment-ongoing moment-to-moment self-monitoring-is an important component of the professional competence of physicians. Self-monitoring refers to the ability to notice our own actions, curiosity to examine the effects of those actions, and willingness to use those observations to improve behavior and thinking in the future. Self-monitoring allows for the early recognition of cognitive biases, technical errors, and emotional reactions and may facilitate self-correction and development of therapeutic relationships. Cognitive neuroscience has begun to explore the brain functions associated with self-monitoring, and the structural and functional changes that occur during mental training to improve attentiveness, curiosity, and presence. This training involves cultivating habits of mind such as experiencing information as novel, thinking of "facts" as conditional, seeing situations from multiple perspectives, suspending categorization and judgment, and engaging in self-questioning. The resulting awareness is referred to as mindfulness and the associated moment-to-moment self-monitoring as mindful practice-in contrast to being on "automatic pilot" or "mindless" in one's behavior. This article is a preliminary exploration into the intersection of educational assessment, cognitive neuroscience, and mindful practice, with the hope of promoting ways of improving clinicians' capacity to self-monitor during clinical practice, and, by extension, improve the quality of care that they deliver.

Affective Forecasting: An Unrecognized Challenge in Making Serious Health Decisions

“…65,71 Therefore, physicians are likely to better address patients' emotional needs if they incorporate tools for reflective self-awareness into their practices. [72][73][74] Finally, stigma forms a powerful barrier to envisioning adapting to disability. Stigmatizing images of illness and disability depict broken and unfulfilling lives.…”

Towards Technology-Supported Surgical Training

“…Simulator practice should, however, especially while realized in early residency, boost efficacy in skills learning and guarantee the maintenance of training motivation (Kozlowski et al 2001). It would also be important to get the senior surgeons involved in training, although simulator practise should always contain tutoring, assessment and corrective feedback for enhancing learners' evaluative reflection processes (Kneebone 2003, Carter et al 2005) (Epstein, Siegel & Silberman 2008). There are a lot of demands placed on a surgeon; however, there seem to be a lot of demands placed on simulation technology and methods for using it as well.…”

“…The current research on continuing education of health professionals tends to promote research-based pedagogical self-assessment in professional development, to help physicians become better informed about self-assessment and more skilled monitors of their own practice (Sargeant 2008). Selfmonitoring is one aspect of self-assessment, a metacognitive process that is necessary to manage in order to sustain adequate situational awareness, one important key to expert performance (Epstein, Siegel & Silberman 2008, Eva & Regehr 2007, Eva & Regehr 2011, Moulton & Epstein 2011. According to Billet (2000), not all workplace experiences are appropriate; wrong or even dangerous working methods might be learned.…”

“…Achieving high expertise in surgery, similarly as in other critical safety professions, is, however, particularly important when there are human lives at stake. Therefore, the physician's capacity for concurrent moment-to-moment self-monitoring is an important aspect of professionalism that seems to form the basis of the early recognition of cognitive biases, technical errors and facilitating self-correction and selfquestioning (Epstein, Siegel & Silberman 2008). The one difference between an expert and novice is that an expert makes fewer mistakes.…”

La escucha activa en Atención Primaria

“…Se ha puesto en ocasiones en tela de juicio la capacidad del propio profesional para juzgar el tipo de práctica profesional que está realizando 19 Estamos de acuerdo en definitiva con la opinión de Borrell, cuando concluye que el profesional debe escuchar al paciente, tomar su perspectiva, sus expectativas y creencias, y en un segundo momento de la relación, madurar su propia opinión y criterio. Uno de las mayores prerrogativas del clínico es su independencia de criterio, discurrir lo que otros compañeros no han pensado y, por supuesto, pensar lo que el paciente no es capaz de pensar.…”