Physician cognition, metacognition and affect may have an impact upon the quality of clinical rea... more Physician cognition, metacognition and affect may have an impact upon the quality of clinical reasoning. The purpose of this study was to examine the relationship between measures of physician metacognition and affect and patient outcomes in obstetric practice. Reflective coping (RC), proactive coping, need for cognition (NFC), tolerance for ambiguity, state-trait anxiety and metacognitive awareness were assessed for obstetricians (n = 12) who provided intra-partum care to 4,149 women. Outcome measures included delivery mode and intrapartum asphyxia. Analysis was carried out using logistic regression and tree-based classification. Obstetricians with high RC scores were more likely to perform a caesarean section (OR 1.59, p p p p = 0.08). Obstetricians with high NFC scores were more likely to perform a caesarean section (OR 1.53, p = 0.03), more likely to undertake a vacuum delivery (OR 5.8, p = 0.001), less likely undertake a mid-forceps delivery (OR 0.45, p = 0.02) and less likely to supervise a spontaneous vaginal delivery (OR 0.47, p p = 0.01) or a vacuum delivery (OR 5.08, p = 0.003), and less likely to supervise a spontaneous vaginal delivery (OR 0.38, p p p
Firstly, the many characteristics of expertiseare examined: they include aspects of patternrecogn... more Firstly, the many characteristics of expertiseare examined: they include aspects of patternrecognition, knowledge, skill, flexibility,metacognitive monitoring, available cognitivespace and teaching abilities. Secondly, threeeducational models from different domains(Nursing, Surgical Education, Education) areanalysed, compared and contrasted, in relationto both educational approach and thedevelopment of expertise. Thirdly, a new modelfor the development of expertise is proposed,incorporating aspects of each of the threepreviously discussed models. Within this newmodel, four phases of development are proposed,culminating in the achievement of expertise.Furthermore, it is noted that under certaincircumstances performance can deteriorate, andthat with appropriate support, there can berecursion back through earlier phases ofdevelopment. Significant implications for bothhealthcare education and practice arediscussed, in relation to concepts ofexpertise, potential educational approaches andthe proposed model for the development ofexpertise.
Physician cognition, metacognition and affect may have an impact upon the quality of clinical rea... more Physician cognition, metacognition and affect may have an impact upon the quality of clinical reasoning. The purpose of this study was to examine the relationship between measures of physician metacognition and affect and patient outcomes in obstetric practice. Reflective coping (RC), proactive coping, need for cognition (NFC), tolerance for ambiguity, state-trait anxiety and metacognitive awareness were assessed for obstetricians (n = 12) who provided intra-partum care to 4,149 women. Outcome measures included delivery mode and intrapartum asphyxia. Analysis was carried out using logistic regression and tree-based classification. Obstetricians with high RC scores were more likely to perform a caesarean section (OR 1.59, p p p p = 0.08). Obstetricians with high NFC scores were more likely to perform a caesarean section (OR 1.53, p = 0.03), more likely to undertake a vacuum delivery (OR 5.8, p = 0.001), less likely undertake a mid-forceps delivery (OR 0.45, p = 0.02) and less likely to supervise a spontaneous vaginal delivery (OR 0.47, p p = 0.01) or a vacuum delivery (OR 5.08, p = 0.003), and less likely to supervise a spontaneous vaginal delivery (OR 0.38, p p p
Firstly, the many characteristics of expertiseare examined: they include aspects of patternrecogn... more Firstly, the many characteristics of expertiseare examined: they include aspects of patternrecognition, knowledge, skill, flexibility,metacognitive monitoring, available cognitivespace and teaching abilities. Secondly, threeeducational models from different domains(Nursing, Surgical Education, Education) areanalysed, compared and contrasted, in relationto both educational approach and thedevelopment of expertise. Thirdly, a new modelfor the development of expertise is proposed,incorporating aspects of each of the threepreviously discussed models. Within this newmodel, four phases of development are proposed,culminating in the achievement of expertise.Furthermore, it is noted that under certaincircumstances performance can deteriorate, andthat with appropriate support, there can berecursion back through earlier phases ofdevelopment. Significant implications for bothhealthcare education and practice arediscussed, in relation to concepts ofexpertise, potential educational approaches andthe proposed model for the development ofexpertise.
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Papers by Stacey Dunphy