{"id":"https://openalex.org/W7225233383","doi":"https://doi.org/10.1111/jep.70710","title":"Clinical Reasoning During Acute Decompensation: A Metacognitive Act","display_name":"Clinical Reasoning During Acute Decompensation: A Metacognitive Act","publication_year":2026,"publication_date":"2026-11-04","ids":{"openalex":"https://openalex.org/W7225233383","doi":"https://doi.org/10.1111/jep.70710"},"language":"en","primary_location":{"id":"doi:10.1111/jep.70710","doi":"https://doi.org/10.1111/jep.70710","is_oa":false,"landing_page_url":"https://doi.org/10.1111/jep.70710","pdf_url":null,"source":{"id":"https://openalex.org/S2713501","display_name":"Journal of Evaluation in Clinical Practice","issn_l":"1356-1294","issn":["1356-1294","1365-2753"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["anvur-class-a","anvur-scientific","cwts-core","dongbi-d","doyens","jufo-1","ki-jl-1","medline","norway-1","poland-70","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320595","host_organization_name":"Wiley","host_organization_lineage":["https://openalex.org/P4310320595"],"host_organization_lineage_names":["Wiley"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of Evaluation in Clinical Practice","raw_type":"journal-article"},"volume":null,"type":"article","indexed_in":["crossref"],"open_access":{"is_oa":false,"oa_status":"closed","oa_url":null,"any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5160622356","display_name":"Alison J. Bache","orcid":"https://orcid.org/0009-0000-5947-0961","observed_orcids":["https://orcid.org/0009-0000-5947-0961"]},"institutions":[{"id":"https://openalex.org/I148314036","display_name":"Uniformed Services University of the Health Sciences","ror":"https://ror.org/04r3kq386","country_code":"US","type":"education","lineage":["https://openalex.org/I148314036"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Alison J. Bache","raw_affiliation_strings":["Department of Health Professions Education School of Medicine Uniformed Services University Bethesda Maryland USA"],"raw_orcid":"https://orcid.org/0009-0000-5947-0961","affiliations":[{"raw_affiliation_string":"Department of Health Professions Education School of Medicine Uniformed Services University Bethesda Maryland USA","institution_ids":["https://openalex.org/I148314036"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5047273943","display_name":"Steven J. Durning","orcid":"https://orcid.org/0000-0001-5223-1597","observed_orcids":["https://orcid.org/0000-0001-5223-1597"]},"institutions":[{"id":"https://openalex.org/I148314036","display_name":"Uniformed Services University of the Health Sciences","ror":"https://ror.org/04r3kq386","country_code":"US","type":"education","lineage":["https://openalex.org/I148314036"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Steven J. Durning","raw_affiliation_strings":["Department of Health Professions Education Uniformed Services University Bethesda Maryland USA"],"raw_orcid":"https://orcid.org/0000-0001-5223-1597","affiliations":[{"raw_affiliation_string":"Department of Health Professions Education Uniformed Services University Bethesda Maryland USA","institution_ids":["https://openalex.org/I148314036"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5047843125","display_name":"Jerusalem Merkebu","orcid":"https://orcid.org/0000-0003-3707-8920","observed_orcids":["https://orcid.org/0000-0003-3707-8920"]},"institutions":[{"id":"https://openalex.org/I148314036","display_name":"Uniformed Services University of the Health Sciences","ror":"https://ror.org/04r3kq386","country_code":"US","type":"education","lineage":["https://openalex.org/I148314036"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Jerusalem Merkebu","raw_affiliation_strings":["Department of Health Professions Education Uniformed Services University Bethesda Maryland USA"],"raw_orcid":"https://orcid.org/0000-0003-3707-8920","affiliations":[{"raw_affiliation_string":"Department of Health Professions Education Uniformed Services University Bethesda Maryland USA","institution_ids":["https://openalex.org/I148314036"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":1,"corresponding_author_ids":[],"corresponding_institution_ids":["https://openalex.org/I148314036"],"apc_list":{"value":4430,"currency":"USD","value_usd":4430},"apc_paid":null,"fwci":0.0,"has_fulltext":false,"cited_by_count":0,"citation_normalized_percentile":{"value":0.89591942,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":"32","issue":"8","first_page":null,"last_page":null},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T12574","display_name":"Clinical Reasoning and Diagnostic Skills","score":1.0,"subfield":{"id":"https://openalex.org/subfields/2714","display_name":"Family Practice"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T12574","display_name":"Clinical Reasoning and Diagnostic Skills","score":1.0,"subfield":{"id":"https://openalex.org/subfields/2714","display_name":"Family Practice"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11238","display_name":"Simulation-Based Education in Healthcare","score":0.0,"subfield":{"id":"https://openalex.org/subfields/2737","display_name":"Physiology (medical)"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10254","display_name":"Innovations in Medical Education","score":0.0,"subfield":{"id":"https://openalex.org/subfields/2739","display_name":"Public Health, Environmental and Occupational Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[],"concepts":[{"id":"https://openalex.org/C118147538","wikidata":"https://www.wikidata.org/wiki/Q1126970","display_name":"Metacognition","level":3,"score":0.8033000230789185},{"id":"https://openalex.org/C169900460","wikidata":"https://www.wikidata.org/wiki/Q2200417","display_name":"Cognition","level":2,"score":0.6108999848365784},{"id":"https://openalex.org/C100660578","wikidata":"https://www.wikidata.org/wiki/Q18733","display_name":"Recall","level":2,"score":0.5605999827384949},{"id":"https://openalex.org/C13200473","wikidata":"https://www.wikidata.org/wiki/Q2747831","display_name":"Reflexivity","level":2,"score":0.5582000017166138},{"id":"https://openalex.org/C15744967","wikidata":"https://www.wikidata.org/wiki/Q9418","display_name":"Psychology","level":0,"score":0.5473999977111816},{"id":"https://openalex.org/C3020452639","wikidata":"https://www.wikidata.org/wiki/Q454812","display_name":"Clinical judgment","level":2,"score":0.5012999773025513},{"id":"https://openalex.org/C74196892","wikidata":"https://www.wikidata.org/wiki/Q7781188","display_name":"Thematic analysis","level":3,"score":0.4244000017642975},{"id":"https://openalex.org/C139265228","wikidata":"https://www.wikidata.org/wiki/Q5283089","display_name":"Distress","level":2,"score":0.4154999852180481},{"id":"https://openalex.org/C2780665704","wikidata":"https://www.wikidata.org/wiki/Q959298","display_name":"Intervention (counseling)","level":2,"score":0.38040000200271606},{"id":"https://openalex.org/C132413290","wikidata":"https://www.wikidata.org/wiki/Q7307322","display_name":"Reflective practice","level":2,"score":0.3716999888420105},{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.3553999960422516},{"id":"https://openalex.org/C2779458634","wikidata":"https://www.wikidata.org/wiki/Q24963715","display_name":"Debiasing","level":2,"score":0.3531000018119812},{"id":"https://openalex.org/C2779473830","wikidata":"https://www.wikidata.org/wiki/Q1540899","display_name":"MEDLINE","level":2,"score":0.34850001335144043},{"id":"https://openalex.org/C66102695","wikidata":"https://www.wikidata.org/wiki/Q5141208","display_name":"Cognitive flexibility","level":3,"score":0.3327000141143799},{"id":"https://openalex.org/C2780598303","wikidata":"https://www.wikidata.org/wiki/Q65921492","display_name":"Flexibility (engineering)","level":2,"score":0.3294999897480011},{"id":"https://openalex.org/C2779356329","wikidata":"https://www.wikidata.org/wiki/Q922625","display_name":"Checklist","level":2,"score":0.3174999952316284},{"id":"https://openalex.org/C68122502","wikidata":"https://www.wikidata.org/wiki/Q764527","display_name":"Informed consent","level":3,"score":0.31310001015663147},{"id":"https://openalex.org/C180747234","wikidata":"https://www.wikidata.org/wiki/Q23373","display_name":"Cognitive psychology","level":1,"score":0.3075000047683716},{"id":"https://openalex.org/C2780791683","wikidata":"https://www.wikidata.org/wiki/Q846785","display_name":"Action (physics)","level":2,"score":0.298799991607666},{"id":"https://openalex.org/C70410870","wikidata":"https://www.wikidata.org/wiki/Q199906","display_name":"Clinical psychology","level":1,"score":0.2985999882221222},{"id":"https://openalex.org/C133112747","wikidata":"https://www.wikidata.org/wiki/Q7251931","display_name":"Protocol analysis","level":2,"score":0.2892000079154968},{"id":"https://openalex.org/C65682993","wikidata":"https://www.wikidata.org/wiki/Q1056451","display_name":"Reflection (computer programming)","level":2,"score":0.28519999980926514},{"id":"https://openalex.org/C533356498","wikidata":"https://www.wikidata.org/wiki/Q843894","display_name":"Critical thinking","level":2,"score":0.2822999954223633},{"id":"https://openalex.org/C78821406","wikidata":"https://www.wikidata.org/wiki/Q391810","display_name":"Think aloud protocol","level":3,"score":0.28220000863075256},{"id":"https://openalex.org/C132829578","wikidata":"https://www.wikidata.org/wiki/Q581151","display_name":"Situated","level":2,"score":0.2700999975204468},{"id":"https://openalex.org/C2779328685","wikidata":"https://www.wikidata.org/wiki/Q1475557","display_name":"Patient safety","level":3,"score":0.26759999990463257},{"id":"https://openalex.org/C159110408","wikidata":"https://www.wikidata.org/wiki/Q121176","display_name":"Nursing","level":1,"score":0.25099998712539673}],"mesh":[],"locations_count":1,"locations":[{"id":"doi:10.1111/jep.70710","doi":"https://doi.org/10.1111/jep.70710","is_oa":false,"landing_page_url":"https://doi.org/10.1111/jep.70710","pdf_url":null,"source":{"id":"https://openalex.org/S2713501","display_name":"Journal of Evaluation in Clinical Practice","issn_l":"1356-1294","issn":["1356-1294","1365-2753"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["anvur-class-a","anvur-scientific","cwts-core","dongbi-d","doyens","jufo-1","ki-jl-1","medline","norway-1","poland-70","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320595","host_organization_name":"Wiley","host_organization_lineage":["https://openalex.org/P4310320595"],"host_organization_lineage_names":["Wiley"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of Evaluation in Clinical Practice","raw_type":"journal-article"}],"best_oa_location":null,"sustainable_development_goals":[],"study_designs":[],"awards":[],"funders":[],"has_content":{"pdf":false,"grobid_xml":false},"content_urls":null,"referenced_works_count":21,"referenced_works":["https://openalex.org/W1854828342","https://openalex.org/W2003220763","https://openalex.org/W2055470549","https://openalex.org/W2108707473","https://openalex.org/W2136049664","https://openalex.org/W2160357909","https://openalex.org/W2902680660","https://openalex.org/W3009177960","https://openalex.org/W3017115171","https://openalex.org/W3145425712","https://openalex.org/W3197832903","https://openalex.org/W4223415285","https://openalex.org/W4232488826","https://openalex.org/W4243216998","https://openalex.org/W4247063502","https://openalex.org/W4298037799","https://openalex.org/W4402507331","https://openalex.org/W4405735768","https://openalex.org/W4408124132","https://openalex.org/W7125370917","https://openalex.org/W7220651590"],"related_works":[],"abstract_inverted_index":{"ABSTRACT":[0],"Introduction":[1],"Medical":[2],"errors":[3],"contribute":[4],"to":[5,18,46,72,162,220],"preventable":[6],"morbidity":[7],"and":[8,15,56,63,87,104,129,138,147,149,169,181,212,262],"mortality.":[9],"Categories":[10],"of":[11,21,92,144],"error":[12],"include":[13],"diagnostic":[14,43,167],"management":[16,48,170],"error,":[17],"which":[19],"lack":[20],"urgency,":[22],"understanding,":[23],"or":[24],"awareness":[25,246],"contribute.":[26],"While":[27],"physician":[28,53],"reasoning":[29,55,97,155],"is":[30,59],"influenced":[31],"by":[32,61,135],"medical":[33],"content,":[34],"acute":[35,77,93],"clinical":[36,54,102,154,227],"situations":[37],"require":[38],"rapid":[39],"metacognitive":[40,64,160,210],"shifts\u2010moving":[41],"from":[42,70,208,218],"hypothesis":[44],"generation":[45],"decisive":[47],"action.":[49,171],"This":[50],"study":[51],"investigated":[52],"how":[57],"it":[58,241],"impacted":[60],"emotion":[62],"reflection":[65,150],"during":[66,249,260],"this":[67],"critical":[68],"transition":[69],"diagnosis":[71,219],"procedural":[73,205,214],"intervention":[74],"in":[75],"an":[76],"inpatient":[78],"encounter.":[79],"Methods":[80],"Physicians":[81],"(":[82],"n":[83],"=":[84],"19)":[85],"diagnosed":[86],"managed":[88],"a":[89,106,234],"live":[90],"simulation":[91],"patient":[94],"decompensation.":[95],"Clinical":[96],"performance":[98],"was":[99,247],"assessed":[100],"with":[101,201,226],"benchmarks":[103],"utilizing":[105],"novel":[107],"video\u2010stimulated":[108],"think\u2010aloud":[109],"protocol":[110],"immediately":[111],"following":[112],"the":[113,164,250],"encounter;":[114],"participants":[115],"reflected":[116],"aloud":[117],"while":[118,204],"reviewing":[119],"their":[120],"recorded":[121],"performance.":[122],"Verbatim":[123],"transcripts":[124],"were":[125,151],"analyzed":[126],"using":[127],"Braun":[128],"Clarke's":[130],"reflexive":[131],"thematic":[132],"analysis,":[133],"informed":[134],"situated":[136],"cognition":[137],"Sch\u00d6n's":[139],"reflective":[140,238],"framework.":[141],"Results":[142],"Themes":[143],"deliberation,":[145],"prioritization":[146],"fixation,":[148],"identified.":[152],"Effective":[153],"depended":[156],"on":[157],"executing":[158],"timely":[159],"shifts":[161],"bridge":[163],"gap":[165],"between":[166,176],"recognition":[168],"Video":[172],"recall":[173],"revealed":[174],"distinctions":[175],"real\u2010time":[177,257],"cognitive":[178,194,224,258],"processing":[179],"(reflection\u2010in\u2010action)":[180],"post\u2010hoc":[182,232],"insights":[183],"(reflection\u2010on\u2010action).":[184],"Environmental":[185],"cues,":[186],"such":[187],"as":[188,192],"nurse":[189],"prompting,":[190],"functioned":[191],"distributed":[193],"support.":[195],"Notably,":[196],"emotional":[197],"distress":[198],"often":[199],"coexisted":[200],"effective":[202],"prioritization,":[203],"hesitation":[206],"stemmed":[207],"both":[209],"regulation":[211],"limited":[213],"familiarity.":[215],"Conclusion":[216],"Transitioning":[217],"action":[221],"requires":[222],"dynamic":[223],"flexibility":[225],"reasoning.":[228],"Recognizing":[229],"missed":[230],"opportunities":[231],"represents":[233],"substantive":[235],"finding":[236],"for":[237],"learning,":[239],"though":[240],"does":[242],"not":[243],"imply":[244],"identical":[245],"active":[248],"event.":[251],"Educational":[252],"strategies":[253],"must":[254],"separately":[255],"address":[256],"pivoting":[259],"crisis":[261],"post\u2010event":[263],"debriefing.":[264]},"counts_by_year":[],"updated_date":"2026-11-05T12:25:35.769452","created_date":"2026-11-05T00:00:00"}
