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

Marianne G Chirica, Tamzin J Batteson

Abstract


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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References


(WHO), W. H. O. (2010). Framework for action on interprofessional education & collaborative practice. http://www.who.int.ezproxy.rosalindfranklin.edu/hrh/resources/framework_action/en/

Adamson, K., Loomis, C., Cadell, S., & Verweel, L. C. (2018). Interprofessional empathy: A four-stage model for a new understanding of teamwork. J Interprof Care, 32(6), 752-761. https://doi.org/10.1080/13561820.2018.1511523

Anderson, E., & Bennett, S. (2020). Taking a closer look at undergraduate acute care interprofessional simulations: lessons learnt. J Interprof Care, 34(6), 772-783. https://doi.org/10.1080/13561820.2019.1676705

Batteson, T., & Garber, S. S. (2019). Assessing constructs underlying interprofessional competencies through the design of a new measure of interprofessional education. Journal of Interprofessional Education & Practice, 16, 100195. https://doi.org/https://doi.org/10.1016/j.xjep.2018.08.004

Bebeau, M. J. (2002). The Defining Issues Test and the Four Component Model: Contributions to professional education. Journal of Moral Education, 31(3), 271-295. https://doi.org/10.1080/0305724022000008115

Bransford, J., Franks, J., Morris, C., & Stein, B. (2014). Some general constraints on learning and memory research. Levels of Processing in Human Memory (PLE: Memory), 331.

Cattell, R. B. (1966). The Scree Test For The Number Of Factors. Multivariate Behavioral Research, 1(2), 245-276. https://doi.org/10.1207/s15327906mbr0102_10

Chen, A., Treviño, L. K., & Humphrey, S. E. (2020). Ethical champions, emotions, framing, and team ethical decision making. J Appl Psychol, 105(3), 245-273. https://doi.org/10.1037/apl0000437

Chibnall, J. T., Tait, R. C., & Jovel, A. (2014). Accountability and empathy effects on medical students' clinical judgments in a disability determination context for low back pain. J Pain, 15(9), 915-924. https://doi.org/10.1016/j.jpain.2014.06.001

Darling-Hammond, L., Flook, L., Cook-Harvey, C., Barron, B., & Osher, D. (2020). Implications for educational practice of the science of learning and development. Applied Developmental Science, 24(2), 97-140. https://doi.org/10.1080/10888691.2018.1537791

Edmondson, A. C., & Lei, Z. (2014). Psychological Safety: The History, Renaissance, and Future of an Interpersonal Construct. Annual Review of Organizational Psychology and Organizational Behavior, 1(1), 23-43. https://doi.org/10.1146/annurev-orgpsych-031413-091305

Ekman, E., & Krasner, M. (2017). Empathy in medicine: Neuroscience, education and challenges. Med Teach, 39(2), 164-173. https://doi.org/10.1080/0142159x.2016.1248925

Ellertson, C. F., Ingerson, M.-C., & Williams, R. N. (2016). Behavioral Ethics: A Critique and a Proposal. Journal of Business Ethics, 138(1), 145-159.

Flavell, J. H. (1979). Metacognition and Cognitive Monitoring: A New Area of Cognitive-Developmental Inquiry. American Psychologist, 34, 906-911.

Hattie, J. (2009). Visible Learning: A Synthesis of Over 800 Meta-Analyses Relating to Achievement. https://doi.org/10.4324/9780203887332

Hegazi, I., & Wilson, I. (2013). Medical education and moral segmentation in medical students. Med Educ, 47(10), 1022-1028. https://doi.org/10.1111/medu.12252

Holden, M., Buck, E., Clark, M., Szauter, K., & Trumble, J. (2012). Professional identity formation in medical education: the convergence of multiple domains. HEC Forum, 24(4), 245-255. https://doi.org/10.1007/s10730-012-9197-6

Hren, D., Marušić, M., & Marušić, A. (2011). Regression of moral reasoning during medical education: combined design study to evaluate the effect of clinical study years. PLOS ONE, 6(3), e17406. https://doi.org/10.1371/journal.pone.0017406

Islam, R., Mayer, J., & Clutter, J. (2016). Supporting novice clinicians cognitive strategies: System design perspective. ... IEEE-EMBS International Conference on Biomedical and Health Informatics. IEEE-EMBS International Conference on Biomedical and Health Informatics, 2016, 509-512. https://doi.org/10.1109/BHI.2016.7455946

Kiesewetter, J., Ebersbach, R., Tsalas, N., Holzer, M., Schmidmaier, R., & Fischer, M. R. (2016). Knowledge is not enough to solve the problems – The role of diagnostic knowledge in clinical reasoning activities. BMC Medical Education, 16(1), 303. https://doi.org/10.1186/s12909-016-0821-z

Lin, Y. L., Tomasi, J., Guerguerian, A. M., & Trbovich, P. (2019). Technology-mediated macrocognition: Investigating how physicians, nurses, and respiratory therapists make critical decisions. J Crit Care, 53, 132-141. https://doi.org/10.1016/j.jcrc.2019.06.002

Madani, M., Larijani, B., Madani, E., & Ghasemzadeh, N. (2017). Establishment of medical education upon internalization of virtue ethics: bridging the gap between theory and practice. J Med Ethics Hist Med, 10, 3.

Martin, R. M., Shafto, M., & Vandeinse, W. (1977). The reliability, validity, and design of the Defining Issues Test. Developmental Psychology, 13(5), 460-468. https://doi.org/10.1037/0012-1649.13.5.460

Min Simpkins, A. A., Koch, B., Spear-Ellinwood, K., & St John, P. (2019). A developmental assessment of clinical reasoning in preclinical medical education. Med Educ Online, 24(1), 1591257. https://doi.org/10.1080/10872981.2019.1591257

O'Hara, S., Klar, R. T., Patterson, E. S., Morris, N. S., Ascenzi, J., Fackler, J. C., & Perry, D. J. (2018). Macrocognition in the Healthcare Built Environment (mHCBE): A Focused Ethnographic Study of "Neighborhoods" in a Pediatric Intensive Care Unit. Herd, 11(2), 104-123. https://doi.org/10.1177/1937586717728484

Parker, M., Willmott, L., White, B., Williams, G., & Cartwright, C. (2018). Law as Clinical Evidence: A New ConstitutiveModel of Medical Education and Decision-Making. J Bioeth Inq, 15(1), 101-109. https://doi.org/10.1007/s11673-017-9836-3

Patterson, E. S., Su, G., & Sarkar, U. (2020). Reducing delays to diagnosis in ambulatory care settings: A macrocognition perspective. Appl Ergon, 82, 102965. https://doi.org/10.1016/j.apergo.2019.102965

Physician-assisted suicide: toward a comprehensive understanding. Report of the Task Force on Physician-assisted Suicide of the Society for Health and Human Values. (1995). Acad Med, 70(7), 583-590.

Reale, M. C., Riche, D. M., Witt, B. A., Baker, W. L., & Peeters, M. J. (2018). Development of critical thinking in health professions education: A meta-analysis of longitudinal studies. Curr Pharm Teach Learn, 10(7), 826-833. https://doi.org/10.1016/j.cptl.2018.04.019

Rest, J., Cooper, D., Coder, R., Masanz, J., & Anderson, D. (1974). Judging the important issues in moral dilemmas: An objective measure of development. Developmental Psychology, 10(4), 491-501. https://doi.org/10.1037/h0036598

Rest, J. R., Narvaez, D., Thoma, S. J., & Bebeau, M. J. (1999). DIT2: Devising and testing a revised instrument of moral judgment. Journal of Educational Psychology, 91(4), 644-659. https://doi.org/10.1037/0022-0663.91.4.644

Rickey, D., & Stacy, A. (2000). The Role of Metacognition in Learning Chemistry. Journal of Chemical Education - J CHEM EDUC, 77. https://doi.org/10.1021/ed077p915

Schut, S., & Driessen, E. (2019). Setting decision-making criteria: is medical education ready for shared decision making? Med Educ, 53(4), 324-326. https://doi.org/10.1111/medu.13826

Shukor, N., Tasir, Z., Meijden, H., & Harun, J. (2014). Exploring Students’ Knowledge Construction Strategies in Computer Supported Collaborative Learning Discussions Using Sequential Analysis. Educational Technology & Society, 17, 216-228.

Thoma, S. J., & Dong, Y. (2014). The Defining Issues Test of moral judgment development. Behavioral Development Bulletin, 19(3), 55-61. https://doi.org/10.1037/h0100590

Veenman, M., Van Hout-Wolters, B., & Afflerbach, P. (2006). Metacognition and learning: Conceptual and methodological considerations. Metacognition and Learning, 1, 3-14. https://doi.org/10.1007/s11409-006-6893-0

Wagner, K., Austin, J., Toon, L., Barber, T., & Green, L. (2019). Differences in Team Mental Models Associated With Medical Home Transformation Success. The Annals of Family Medicine, 17, S50-S56. https://doi.org/10.1370/afm.2380

Waltz, L. A. (2020). Determining the effectiveness of an interprofessional educational intervention for teamwork competencies among nursing, physical therapy, and pharmacy students. J Interprof Care, 34(6), 826-828. https://doi.org/10.1080/13561820.2019.1682531

Wang, M., Geneva, H., & Walberg, H. (2015). What Influences Learning? A Content Analysis of Review Literature. The Journal of Educational Research, 84, 30-43. https://doi.org/10.1080/00220671.1990.10885988

Ward, P., Hoffman, R., Conway, G., Schraagen, J. M., Peebles, D., Hutton, R., & Petushek, E. (2017). Editorial: Macrocognition: The Science and Engineering of Sociotechnical Work Systems. Frontiers in Psychology, 8. https://doi.org/10.3389/fpsyg.2017.00515

Wiles, K., Bahal, N., Engward, H., & Papanikitas, A. (2016). Ethics in the interface between multidisciplinary teams: a narrative in stages for inter-professional education. London journal of primary care, 8(6), 100-104. https://doi.org/10.1080/17571472.2016.1244892

Wilhelmsson, M., Pelling, S., Uhlin, L., Owe Dahlgren, L., Faresjö, T., & Forslund, K. (2012). How to think about interprofessional competence: a metacognitive model. J Interprof Care, 26(2), 85-91. https://doi.org/10.3109/13561820.2011.644644




DOI: https://doi.org/10.51383/jesma.2022.26