I first heard of metacognition through O’Reiley’s Head First computer manuals.

Circular self-evident definitions of metacognition as “thinking about thinking” dampened my enthusiasm but sources such as the videos included here (replace the videos – Ed) came to the rescue.

The vids demonstrate much in common with the aspirations mores and didacts of contemporary medical education including the requirements for appraisal.

However

- the arguments for using the strategies techniques and templates seemed somehow more convincing and less didactic coercive proscriptive patronising or introspective than that those imposed from above – maybe because the reasons for using them are in fact very well argued eg “why reflection might be helpful to you ” versus ” “You must reflect and do it this way”

Medical Education is Education but
(i) the stakes are particularly high (for doctor and patient) – not uniquely so but importantly so
(ii) the training and content has some specific peculiarities
(iii) doctors are particularly arsey – not just because of the God Complex or inherent arrogance – but also partly due to the brutality of life as a junior doctor (see the cardiac arrest clips) and the thwarting of intelligence and creativity through ongoing political managerial and beurocratic constraints including sometimes a seemingly contemptuous disregard for that same intelligence, creativity and talent. Doctors think they can be great doctors and do a better job of management than the managers. Some but by no means all of them may have a point.

A degree of autonomy helps of course whether GP Principal or Consultant and the erosion of such autonomy might have much to do with the often reported disgruntlement of many physicians on both sides of the Atlantic.

With autonomy comes responsibility – any caring comitted and competent clinician would agree – not personal autonomy but the ability to do ones best for the patient er but see also NASGP.

The other thing that appeals watching the metacognition clips is the understanding that so called “adult learning” is less different from non-adult learning than is than is often suggested – motivation, needs, prior learning, and competing priorities may be different -  but the metacognitive approach takes all this into account.o