title: Incorporating metacognition into morbidity and mortality rounds: The next frontier in quality improvement.
abstract: This Perspective proposes the introduction of metacognition (thinking about thinking) into the existing format of hospital-based morbidity and mortality rounds. It is placed in the context of historical movements to advance quality improvement by expanding the spectrum of the causes of medical error from systems-based issues to flawed human decision-making capabilities. We suggest that the current approach that focuses on systems-based issues can be improved by exploiting the opportunities to educate physicians about predictable errors committed by reliance on cognitive heuristics. In addition, because the field of educating clinicians about cognitive heuristics has shown mixed results, this proposal represents fertile ground for further research. Educating clinicians about cognitive heuristics may improve metacognition and perhaps be the next frontier in quality improvement.
authors.affiliation: Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Katz
authors.affiliation: Institute of Health Policy, Management and Evaluation, and Department of Medicine, University of Toronto, Toronto, Ontario, Canada.|Department of Medicine, Mount Sinai Hospital and University Health Network, Toronto, Ontario, Canada.
authors.forename: Allan S
authors.initials: AS
authors.lastname: Detsky
mesh_terms: D000368:Aged; D002305:Cardiac Tamponade / Q000175:diagnosis; D003657:Decision Making; D004452:Echocardiography / Q000379:methods; D006801:Humans; D008297:Male; D019300:Medical Errors / Q000517:prevention & control*; D008505:Medical Staff, Hospital; D000067489:Metacognition; D058996:Quality Improvement; D056164:Teaching Rounds / Q000379:methods*