Journal of Continuing Education in the Health Professions



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CURRENT ISSUE BACK ISSUES SUBSCRIBE ADVERTISE ABOUT JCEHP FOR AUTHORS JCEHP AWARD SEARCH		Volume 28 (1) Volume 28, Issue 1, Winter 2008 J Contin Educ Health Prof 2008; 28(1) FOUNDATIONS OF CONTINUING EDUCATION Self-Monitoring in Clinical Practice: A Challenge for Medical Educators Epstein RM, Siegel DJ, Silberman J A b s t r a c t Recent literature has described how the capacity for concurrent self-assessment—ongoing moment-to-moment self-monitoring—is an important component of the professional competence of physicians. Self-monitoring refers to the ability to notice our own actions, curiosity to examine the effects of those actions, and willingness to use those observations to improve behavior and thinking in the future. Self-monitoring allows for the early recognition of cognitive biases, technical errors, and emotional reactions and may facilitate self-correction and development of therapeutic relationships. Cognitive neuroscience has begun to explore the brain functions associated with self-monitoring, and the structural and functional changes that occur during mental training to improve attentiveness, curiosity, and presence. This training involves cultivating habits of mind such as experiencing information as novel, thinking of “facts” as conditional, seeing situations from multiple perspectives, suspending categorization and judgment, and engaging in self-questioning. The resulting awareness is referred to as mindfulness and the associated moment-to-moment self-monitoring as mindful practice—in contrast to being on “automatic pilot” or “mindless” in one’s behavior. This article is a preliminary exploration into the intersection of educational assessment, cognitive neuroscience, and mindful practice, with the hope of promoting ways of improving clinicians’ capacity to self-monitor during clinical practice, and, by extension, improve the quality of care that they deliver. Lessons for Practice Self-monitoring is an aspect of selfassessment that may contribute to quality of care and reduction in errors. Self-monitoring depends on the ability to regulate attention, maintain curiosity, and be flexible during daily work, especially when under stress and multitasking. Self-deception, denial, and delusion are common barriers to self-assessment and self-monitoring. Self-monitoring can be improved by cultivating the “observing self”: adopting a “beginner’s mind,” seeing “facts” as conditional, considering multiple perspectives, suspending categorization and judgment, and developing habits of self-questioning.
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