Self-monitoring in clinical practice: A challenge for medical educators
Self-monitoring in clinical practice: A challenge for medical educators
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DOI：
10.1002/chp.149
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发表时间：
2008-12-01
影响因子：
1.8
通讯作者：
Silberman, Jordan
中科院分区：
文献类型：
--
作者：
Epstein, Ronald M.;Siegel, Daniel J.;Silberman, Jordan
最近的文献描述了同时自我评估的能力-持续的时刻到时刻的自我监控-是医生专业能力的重要组成部分。自我监控指的是注意我们自己的行为的能力，对检查这些行为的影响的好奇心，以及愿意利用这些观察来改善未来的行为和思维。自我监控可以及早识别认知偏差、技术错误和情绪反应，并可能促进自我纠正和治疗关系的发展。认知神经科学已经开始探索与自我监控相关的大脑功能，以及在心理训练期间发生的结构和功能变化，以提高注意力、好奇心和临场感。这种训练包括培养思维习惯，如将信息作为新奇的体验，将“事实”视为有条件的，从多个角度看待情况，暂停分类和判断，以及进行自我质疑。由此产生的意识被称为正念和相关的时刻自我监控，称为正念练习--与在一个人的行为中处于“自动驾驶”或“无意识”状态形成对比。本文对教育评估、认知神经科学和专心实践的交叉进行了初步探索，以期促进临床医生在临床实践中提高自我监控能力的方法，进而提高他们提供的护理质量。
Recent literature has described how the capacity for concurrent self-assessment-ongoing moment-to-moment self-monitoring-is an important component of the professional competence of physicians. Self-monitoring refers to the ability to notice our own actions, curiosity to examine the effects of those actions, and willingness to use those observations to improve behavior and thinking in the future. Self-monitoring allows for the early recognition of cognitive biases, technical errors, and emotional reactions and may facilitate self-correction and development of therapeutic relationships. Cognitive neuroscience has begun to explore the brain functions associated with self-monitoring, and the structural and functional changes that occur during mental training to improve attentiveness, curiosity, and presence. This training involves cultivating habits of mind such as experiencing information as novel, thinking of "facts" as conditional, seeing situations from multiple perspectives, suspending categorization and judgment, and engaging in self-questioning. The resulting awareness is referred to as mindfulness and the associated moment-to-moment self-monitoring as mindful practice-in contrast to being on "automatic pilot" or "mindless" in one's behavior. This article is a preliminary exploration into the intersection of educational assessment, cognitive neuroscience, and mindful practice, with the hope of promoting ways of improving clinicians' capacity to self-monitor during clinical practice, and, by extension, improve the quality of care that they deliver.