Metacognitive competence as a goal for medical training

Professionals who are faced with emergency situations daily during their work can rely on three different ways of thinking. They can base their judgments and decisions on intuition. Alternatively they can apply heuristic strategies, which offer simple procedures to simplify situations and find satisfactory solutions. Finally, they can reflect analytically. The optimal approach would be a flexible use of these three systems, since it enables doctors to activate the system that is more relevant to the given situation and eventually to pass to another system when they realize that the previous one is inadequate. Metacognitive competence is required in order to identify the mental system that is more relevant to a specific case. This competence consists in the ability to self-regulate cognitive processes in order to match the specific needs of the moment. To do so, individuals have to pay attention to their cognitive processes and understand how they can be trusted and what is the best way to handle them. Operatively, metacognitive competence should be developed by leading professionals to identify the mode of thinking – intuitive, heuristic or analytical – that is best suited to make the choices required by the clinical cases that they are facing. Suggestions concerning the way physicians working in emergency department can be trained to enhance their metacognitive skills are reported