title: Epistemic cognition in medical education: a literature review.
abstract: OBJECTIVE
  To review the research literature on epistemic cognition in medical education.
  
  
  METHODS
  We conducted database searches using keywords related to epistemic cognition and medical education or practice. In duplicate, authors selected and reviewed empirical studies with a central focus on epistemic cognition and participant samples including medical students or physicians. Independent thematic analysis and consensus procedures were used to identify major findings about epistemic cognition and implications for research and medical education.
  
  
  RESULTS
  Twenty-seven articles were selected. Themes from the findings of selected studies included developmental frameworks of epistemic cognition revealing simple epistemological positions of medical learners, increasing epistemological sophistication with experience, relationships between epistemic cognition and context, patterns in epistemic orientations to clinical practice, and reactions to ambiguity and uncertainty. Many studies identified the need for new instruments and methodologies to study epistemic cognition in medical education settings and its relationship to clinical outcomes. Relationships between epistemological beliefs and humanistic patient care and influences of medical education practices were commonly cited implications for medical education.
  
  
  CONCLUSIONS
  Epistemic cognition is conceptualized and operationalized in a variety of ways in the medical research literature. Advancing theoretical frameworks and developing new methodological approaches to examine epistemic cognition are important areas for future research. Also, examination of the relationship between the contexts of medical learning and practice and epistemic cognition has potential for improving medical education. This work also establishes a need for further investigation into the implications of epistemic cognition for humanistic orientations and ultimately for patient care.
authors.affiliation: Department of Anatomy and Cell Biology, Burrell College of Osteopathic Medicine, Las Cruces, New Mexico, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Eastwood
authors.affiliation: Department of Philosophy, Oakland University, Rochester, Michigan, USA.
authors.forename: Elysa
authors.initials: E
authors.lastname: Koppelman-White
authors.affiliation: Department of Biomedical Sciences, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA.
authors.forename: Misa
authors.initials: M
authors.lastname: Mi
authors.affiliation: Department of Biomedical Sciences, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA.
authors.forename: Jason Adam
authors.initials: JA
authors.lastname: Wasserman
authors.affiliation: Department of Biomedical Sciences, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA.
authors.forename: Ernest F
authors.initials: EF
authors.lastname: Krug Iii
authors.affiliation: Department of Biomedical Sciences, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Joyce
mesh_terms: D003071:Cognition; D004501:Education, Medical / Q000379:methods*; D006808:Humanism; D006801:Humans; D019359:Knowledge; D007858:Learning; D005791:Patient Care / Q000379:methods; D010820:Physicians / Q000523:psychology; D013337:Students, Medical / Q000523:psychology*
keywords: epistemic cognition; epistemology; humanism; medical education; uncertainty