Metacognition, Macrocognition and Moral Reasoning in Collaborative Team Decision-Making: Implications for Healthcare Education

Marianne G Chirica, Tamzin J Batteson


Introduction: Interprofessional education improves clinical practice by facilitating student practitioners’ understanding of other provider’ roles, collaborative attitudes, and team behaviors. However, there is a paucity of research examining cognitive processes and mechanisms involved in collaborative decision-making in the interprofessional field. The purpose of this study was to assess the role of metacognition and macrocognition in communication and decision-making across individual and collaborative teams.

Method: 392 first-year graduate healthcare students representing eight disciplines were required to read a vignette from the Defining Issues Test (DIT) of moral judgement and rate their moral decisions individually and as an interprofessional team. Mixed methods were utilized.

Results: Paired samples t-tests showed significant differences between individual and group scores for all six questions. Exploratory Factor Analysis identified three latent factors of the DIT: Accountability, Law, and Empathy. Mediation analyses found the relationship between Accountability and Empathy factors was accounted for by the Law factor. A Thematic Analysis supported these findings.

Discussion: Changes from perceived vulnerable accountability stem from metacognitive systems/psychological safety buffered by protection within the same system and grounded in medical law. This allows crucial communication and team cohesiveness in interprofessional teams, facilitating an ethical shared mental model that may benefit patient outcomes.

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