[BLANK_AUDIO] Welcome back. Caren Stalburg here.

onto our second segment here for the first week.

We're going to be talking about metacognition.

So, what, I want to make sure that we get at the end of this session is that you

understand how metacognition can inform lifelong learning skills and then, really

most importantly, how you can utilize metacognitive theory to support learning.

Another optional reference is a wonderful book by Dr.

Mark Quirk that talks about sort of intuition and metacognition in medical

education and the ways in which it can be incorporated and utilized to develop

expertise. So let's talk about this notion of

lifelong learning, which has become the new, new thing.

Again, another great article by Dr. Sanders that's listed below.

But, basically, what we're talking about is sort of this paradigm shift from the

notion that you can learn everything you need to learn in medical school or

nursing school or pharmacy school. And, you know, once you've learned it,

you've learned it. Because the challenge for us as health

care providers is that knowledge is no longer static.

And, you know, as a gynecologist, I can tell you that the rules for sort of, the

guidelines for pap smear testing have changed at least three times in the last

12 months. and so, you know, how we approach that as

we move through our careers is very important.

The other thing that has changed is the complexity of care.

And so, while you may have been able to sort of have as much information as you

could've in your head or in your peripheral brain in your pocket patients

and, and our situations, and our, our constructs have just become so complex

that not every single person can know everything.

And that's why teamwork is so important and it's also why being able to sort of

have reflection about what you know what you need to know, and where you can get

it is really important. and also then getting feedback on your

learning process. So what do I need as a novice learner to

gain education and to develop expertise. Or as an expert learner, while

information changes or I interact with new teams, what do I need to further my

education and further my ability to take care of patients.

So, it's really this iterative process to understand yourself.

and your situation and you use both to sort of inform further learning.

So I'd like to point out that metacognition really is about thinking

about thinking and this is a wonderful image of The Thinker.

So the thing about metacognition is that it's deliberate thought so, it's

conscience thought, it's self regulated. No one else is working on it, your

thinking about thinking. and its a critical review of what you do

or don't know or what you need to know and, then, planning ahead for how you

might get that information or ways in which that information can, can be given

to you for instance. So, one sort of way to bring it into a

real life context that we may all understand is we all have this

metacognitive sense around clinical decision making.

So if we break that up and say okay, if we define the problem.

Defining the problem is really what's the history, what's the physical examination?

And we always ask our learners, well, gosh, what do you think is going on?

So after our learner relays the history and physical exam findings to us, they

may, hopefully are coming up with a mental representation of what the disease

process is or what their surgical plan is or what medication they want to give.

and offer a plan for how to proceed. And then, hopefully once we've made a

clinical decision and we help our learner do that, then we have a sort of debrief

about what worked well, what could have been better, you know, what do we need

next time? and, and a lot of this sort of

metacognitive theory is, is sort of appearing in a lot of our team training,

a lot of our debriefs that we do after procedures.

So, you know, this whole notion about thinking about thinking, is actually more

prevalent than you would think. Yeah.

Sorry. So let me have you take a moment, and

take your own meta-moment, actually. So, I want you to pause for for a few

minutes, or a half a second, if that's what works best for you, and think of a

situation where you are aware of your own thought processes.

And how does your awareness influence your actions or your behavior in that

situation. So like I said, just take a minute, some

of you may want to sort of pause and, and write your thoughts down.

Some of you may need to sort of come back to this later.

But I really, really do want you to take a moment and think about your own thought

processes. So let's hold here for a second and then

we'll come right back. Alright.

So thanks for coming back. hopefully you've taken a minute or two to

think about where you are thinking about your own thinking, and how that awareness

influences your actions or behavior. So, one of the things we want to try to

do for our learners is. Help them be in their own meta moments.

And Dr. Quirk has come up with a wonderful

gnomonic that's, that means gnome that actually I employ when I teach as well.

And so what we do is we help our learner by asking them what their goals are, what

other needs for this learning interaction What are their objectives or their

purposeful outcomes, what methods are they going to use.

And, then ,we talk about an evaluation. So you could think about a number of

scenarios. we could think about a novice learner who

comes to clinic for the first time and needs to learn how to do, again, I'm a

Gynecologist so I'm going to go with a pelvic exam.

So I always ask them, you know, what do you want to get from this six week

rotation? You know, what are the things you need to

learn? How do you want to gain that information?

This is how I prefer to teach, and so we're going to talk about the methods.

But these are other options in terms of reading and studying that, that might be

helpful to you. And then, obviously, as we move forward,

we're going to do an evaluation which is what's working, what's not working, what

can we do better? I, I will share a story about a, an

advanced learner when we were in the operating room.

She was almost done with her residency. And, and we were doing a laparoscopic

oophorectomy and so I said okay, what's your learning objective.

And she said, well, you know, since I'm going to be graduating I feel like I,

there's too many movements with laproscopic instruments.

And so, what I'd really like to do is, is come up with a way, to use fewer

movements and to place my ports better and, and to just be more efficient in the

way I'm operating. And so, we came up with a way, to do

that, a method. And what we decided together, was that we

would get three movements with the instruments.

And if we couldn't get to whatever structure we were trying to get to or

couldn't you know perform the task that we had to sort of switch and the other

person got to be the primary surgeon. And, you know, that worked great.

And it's something that I wouldn't personally have thought of.

But because I asked my learner, gosh, you know, what you need and, and then, she

was able to take a moment and [INAUDIBLE] and self-reflect and assess and, and

really have some metacognitive thoughts about this is what I need to do.

Then we were able to go forward and we're going to, of course, then afterwards, we

talked about what worked well, what didn't work well and, you know, did we do

reports differently et cetera. And, so hopefully you'll see, you know,

as we go through these segments, how these different theories can apply to,

adult learning and people's learning styles or preferences in different

situations. So I've taken a minute to share what I

think is a useful way to employ the GNOME idea into teaching.

So I'd like you to also consider the following, you know, how can you

incorporate GNOME into your teaching. And I was hoping that we could share best

practices and ideas with one another in the forum.

So when you have time please head over to the forum and, and share with your

colleagues, how you want to use GNOME or how you've used GNOME in the past or the

success that you've had.

01.02 - Metacognition

Instructional Methods in Health Professions Education

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