Metacognition and the Diagnostic Process in Pathology

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Project Summary Metacognition, or one's ability to monitor their cognitive processes, guides problem-solving and improves the efficiency of such behavior (Davidson et al., 1994). The diagnostic process in medicine is a form of problem-solving (Foucar, 2001) implemented by physicians to successfully recognize and place certain conditions into specific categories. If done unsuccessfully, incorrect judgements or diagnostic errors can have dire consequences, resulting in overdiagnosis, misdiagnosis and even death. Approximately 10% of patient deaths are attributed to diagnostic errors nationwide (National Academies of Sciences, 2015). Assessment of metacognitive processes may offer important insights into physicians' diagnostic strategies to deter errors associated with lack of cognitive awareness during information processing. This study evaluates the relationship between physicians' self-reported confidence-level and their diagnostic accuracy. By doing so, we will identify physicians' ability to effectively gauge their own incorrect and correct diagnostic judgments, or metacognitive sensitivity. Our study goal is to determine metacognitive sensitivity of pathologists' viewing skin biopsy slides. Specifically, we will be assessing the relationship between pathologist characteristics (e.g., level of training and gender) and metacognitive sensitivity as well as metacognitive sensitivity's association with secondary diagnostic actions (e.g., requesting a second opinion). Past research demonstrates significant implications of metacognition for education (Colbert et al., 2015; Chew et al., 2016; Kosior et al., 2019). Therefore, findings from our study may improve pedagogical practices in medicine and subsequently impact patient care by contributing to the development of quality cognitive strategies for complex problem-solving, such as interpreting difficult cases in pathology. If funded, this application will provide the opportunity for Dayna Clayton, a black female research associate applying for graduate school, to lead the analytic plans for this scientific project, reinforcing the skills necessary to become an independent researcher in the domain of cognitive sciences. Ms. Clayton is a highly qualified candidate with the potential to offer promising scientific contributions to medical and cognitive science research.