Metacognition, the knowledge you have of your own cognitive process. Your awareness and self reflection about your own thinking.
Self awareness about knowledge involves three aspects:
Metacognitive knowledge: Learning process and beliefs about learning.
Metacognitive experience: The task of learning and how information is processed.
Metacognitive strategies: Strategies for leaning and when they will be used.
While metacognition is mostly thought of in the aspect of education and students learning setting. The concept of metacognition regulation is critical to be used by any critical care or emergency medicine practitioner to keep learning and getting better. Working in a high load, demanding situations make it a must for the practitioner to stop and self reflect both for his own sense of wellbeing, and for the sake of patients.
Emergency Practitioner self cognition is critical to improve clinical reasoning and decision making. The self awareness about cognitive overload, decision fatigue, mental baggages and cognitive bias can help ones clinical decision making skills over time and avoid critical mistakes. The most common theorized cognitive processing models involve the two system thinking, or the Dual Process Theory. In this theory it is postulated that we have 2 main thinking systems we alternate in between. Where system I is the more quick, intuitive and depend on quick pattern recognition and System II is more of a slower, deliberate analytical pattern.
It is an important critical skill for the junior learner or the seasoned emergency practitioner to frequently reflect on their own thinking processes, decision making and their own biases to be able to avoid biases and mistakes specially when performing under pressure in critical situations where clinical reasoning and decision making is greatly impacted.
There was a 2015 amazing talk by Mike Mallin where he described his own experience with impacted performance under pressure. He also shares great tips for how to battle cognitive stress and how to train to be prepared to excel in your performance under extremely stressful situations where usually the life of your patient depends on this skill.
In his book on combat, Dave grossman described this stress response where under stressful situations, it is normal that heart rates will increase. but what we need to anticipate and train for is how to manage this deterioration of cognitive skills that further declines with the increased HR >150.
How to train ourselves in anticipation for stressful situation?
The first important step is self awareness and reflection.
I'll probably leave how to for a different future post. But meanwhile these are 2 great resources that covers many practical tips on this.
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