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  1. Fulltext Teaching metacognition in clinical decision-making using a novel mnemonic checklist: an exploratory study
    Chew KS, Durning SJ, van Merriënboer JJ
    Singapore Med J, 2016 Dec;57(12):694-700.
    PMID: 26778635 DOI: 10.11622/smedj.2016015
    INTRODUCTION: Metacognition is a cognitive debiasing strategy that clinicians can use to deliberately detach themselves from the immediate context of a clinical decision, which allows them to reflect upon the thinking process. However, cognitive debiasing strategies are often most needed when the clinician cannot afford the time to use them. A mnemonic checklist known as TWED (T = threat, W = what else, E = evidence and D = dispositional factors) was recently created to facilitate metacognition. This study explores the hypothesis that the TWED checklist improves the ability of medical students to make better clinical decisions.

    METHODS: Two groups of final-year medical students from Universiti Sains Malaysia, Malaysia, were recruited to participate in this quasi-experimental study. The intervention group (n = 21) received educational intervention that introduced the TWED checklist, while the control group (n = 19) received a tutorial on basic electrocardiography. Post-intervention, both groups received a similar assessment on clinical decision-making based on five case scenarios.

    RESULTS: The mean score of the intervention group was significantly higher than that of the control group (18.50 ± 4.45 marks vs. 12.50 ± 2.84 marks, p < 0.001). In three of the five case scenarios, students in the intervention group obtained higher scores than those in the control group.

    CONCLUSION: The results of this study support the use of the TWED checklist to facilitate metacognition in clinical decision-making.

  2. Fulltext Authors' reply
    Chew KS, Durning SJ, van Merriënboer JJ
    Singapore Med J, 2017 06;58(6):343-344.
    PMID: 28642962 DOI: 10.11622/smedj.2017051
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