{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T01:54:53Z","timestamp":1791338093975,"version":"4.3.1"},"reference-count":77,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T00:00:00Z","timestamp":1757462400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T00:00:00Z","timestamp":1757462400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Adv in Health Sci Educ"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Metacognitive reflection is widely recognized as essential for navigating the complexities of clinical practice and medical education. Despite extensive literature emphasizing its importance, a robust framework elucidating its practical application and theory remains a significant gap. The present paper argues that the\n                    <jats:italic>praxis<\/jats:italic>\n                    of metacognitive reflection\u2014how it is enacted and acquired\u2014is best understood and exemplified through the interconnected principles of inquiry, adaptive action, and pattern logic. These three processes offer a novel framework for both explaining the dynamics of metacognitive reflection and cultivating its development in learners and practitioners. By engaging in iterative cycles of inquiry, adapting to evolving contexts, and discerning the logic of underlying complex patterns, individuals can refine their metacognitive capacities, ultimately leading to enhanced clinical practice and learning outcomes, and a more sophisticated understanding of the complex adaptive systems within which healthcare operates. This model has the potential to significantly advance both our theoretical understanding of metacognitive reflection and its practical application in the training and professional development of health professionals.\n                  <\/jats:p>","DOI":"10.1007\/s10459-025-10469-w","type":"journal-article","created":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T12:17:33Z","timestamp":1757506653000},"page":"989-1002","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Towards a praxis of metacognitive reflection in medical education: a framework of inquiry, adaptive action, and pattern logic"],"prefix":"10.1007","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3707-8920","authenticated-orcid":false,"given":"Jerusalem","family":"Merkebu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0350-3386","authenticated-orcid":false,"given":"Stewart","family":"Mennin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,9,10]]},"reference":[{"key":"10469_CR1","doi-asserted-by":"publisher","first-page":"861","DOI":"10.1111\/j.1365-2753.2010.01500.x","volume":"16","author":"H. Arrow","year":"2010","unstructured":"Arrow, H., Henry, K. B. (2010). Using complexity to promote group learning in healthcare. J Eval Clin Practice, 16, 861\u201366.","journal-title":"J Eval Clin Practice"},{"key":"10469_CR2","doi-asserted-by":"publisher","DOI":"10.4135\/9781452204666","volume-title":"Small groups as complex adaptive systems: Formation, coordination, development and adaptation","author":"H. Arrow","year":"2000","unstructured":"Arrow, H., McGrath, J. E., Berdahl, J. L. (2000). Small groups as complex adaptive systems: Formation, coordination, development and adaptation. Sage."},{"key":"10469_CR3","doi-asserted-by":"publisher","DOI":"10.1007\/978-1-4757-5426-1","volume-title":"How nature works: The science of self-organized criticality","author":"P. Bak","year":"1996","unstructured":"Bak, P. (1996). How nature works: The science of self-organized criticality. Springer-Verlag."},{"issue":"4","key":"10469_CR4","doi-asserted-by":"publisher","first-page":"486","DOI":"10.1002\/1098-237X(200007)84:4<486::AID-SCE4>3.0.CO;2-U","volume":"84","author":"L. M. Blank","year":"2000","unstructured":"Blank, L. M. (2000). A metacognitive learning cycle: A better warranty for studentunderstanding? Science Education, 84(4), 486\u2013506.","journal-title":"Science Education"},{"key":"10469_CR5","doi-asserted-by":"publisher","first-page":"534","DOI":"10.1111\/j.1365-2929.2005.02126.x","volume":"39","author":"A. Bleakley","year":"2005","unstructured":"Bleakley, A. (2005). Stories as data, data as stories: Making sense of narrative inquiry in clinical education. Medical Education, 39, 534\u201340.","journal-title":"Medical Education"},{"issue":"11","key":"10469_CR6","doi-asserted-by":"publisher","first-page":"1516","DOI":"10.1097\/ACM.0000000000001228","volume":"91","author":"T. J. Cleary","year":"2016","unstructured":"Cleary, T. J., Durning, S. J., Artino, A. R.Jr (2016). Microanalytic assessment of self-regulated learning during clinical reasoning tasks: Recent developments and next steps. Academic Medicine, 91(11), 1516\u201321.","journal-title":"Academic Medicine"},{"key":"10469_CR7","first-page":"73","volume":"2","author":"I. J. Cohen","year":"1996","unstructured":"Cohen, I. J. (1996). Theories of action and praxis. The Blackwell Companion to Social Theory, 2, 73\u2013111.","journal-title":"The Blackwell Companion to Social Theory"},{"issue":"2","key":"10469_CR8","doi-asserted-by":"publisher","first-page":"265","DOI":"10.1515\/dx-2021-0112","volume":"9","author":"D. M. Connor","year":"2022","unstructured":"Connor, D. M., Narayana, S., Dhaliwal, G. (2022). A clinical reasoning curriculum for medical students: An interim analysis. Diagnosis, 9(2), 265\u201373.","journal-title":"Diagnosis"},{"issue":"1","key":"10469_CR9","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.bjpt.2019.01.010","volume":"24","author":"D. A. Cook","year":"2019","unstructured":"Cook, D. A., Decary, S. (2019). Higher order thinking about differential diagnosis. Braz J Phys Ther, 24(1), 1\u20137.","journal-title":"Braz. J. Phys. Ther"},{"key":"10469_CR10","first-page":"139","volume-title":"Metacognition and cognitive neuropsychology","author":"C. Cornoldi","year":"2014","unstructured":"Cornoldi, C. (2014). The impact of metacognitive reflection on cognitive control. In Metacognition and cognitive neuropsychology (pp. 139\u201360). Psychology Press."},{"issue":"4","key":"10469_CR11","doi-asserted-by":"publisher","first-page":"1075","DOI":"10.1007\/s10212-020-00511-3","volume":"36","author":"L. De Backer","year":"2021","unstructured":"De Backer, L., Van Keer, H., Valcke, M. (2021). Collaborative learning groups\u2019 adoption of shared metacognitive regulation: Examining the impact of structuring versus reflection-provoking support and its relation with group performance. European Journal of Psychology of Education, 36(4), 1075\u201394.","journal-title":"European Journal of Psychology of Education"},{"key":"10469_CR77","doi-asserted-by":"crossref","unstructured":"De la Croix, A., & Veen, M. (2018). The reflective zombie: Problematizing the conceptual framework of reflection in medical education. Perspectives on Medical Education, 7(6), 394\u2013400.","DOI":"10.1007\/S40037-018-0479-9"},{"key":"10469_CR69","unstructured":"Dewey, J. (1933). How we think: A restatement of the relation of reflective thinking to the educative process (1910), revisededition. Boston: Heath."},{"key":"10469_CR12","volume-title":"Experience and education","author":"J. Dewey","year":"1938","unstructured":"Dewey, J. (1938). Experience and education. Free Press."},{"issue":"1","key":"10469_CR13","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1023\/A:1022375910940","volume":"1","author":"K. J. Dooley","year":"1997","unstructured":"Dooley, K. J. (1997). A complex adaptive systems model of organization change. Nonlinear Dynamics, Psychology, and Life Sciences, 1(1), 69\u201397.","journal-title":"Nonlinear Dynamics, Psychology, and Life Sciences"},{"issue":"4","key":"10469_CR14","doi-asserted-by":"publisher","first-page":"64","DOI":"10.7812\/TPP\/14-027","volume":"18","author":"Q. G. Eichbaum","year":"2014","unstructured":"Eichbaum, Q. G. (2014). Thinking about thinking and emotion: The metacognitive approach to the medical humanities that integrates the humanities with the basic and clinical sciences. The Permanente Journal, 18(4), 64\u201375.","journal-title":"The Permanente Journal"},{"key":"10469_CR15","volume-title":"The enlightened eye: Qualitative inquiry and the enhancement of educational practice","author":"E. Eisner","year":"2017","unstructured":"Eisner, E. (2017). The enlightened eye: Qualitative inquiry and the enhancement of educational practice. Teachers College Press."},{"key":"10469_CR16","first-page":"200","volume-title":"Metacognition, metahumanities, and medical education","author":"R. Ellaway","year":"2025","unstructured":"Ellaway, R. (2025). Metacognition and pattern thinking. In A. Bleakley, R. Ellaway, Q. Eichbaum (Eds.), Metacognition, metahumanities, and medical education (pp. 200\u201314). London: Routledge."},{"issue":"2","key":"10469_CR17","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1080\/13603120050083918","volume":"3","author":"C. Emihovich","year":"2000","unstructured":"Emihovich, C., Battaglia, C. (2000). Creating cultures for collaborative inquiry: New challenges for school leaders. J Leadership in Education, 3(2), 225\u201338.","journal-title":"J Leadership in Education"},{"key":"10469_CR18","volume-title":"Conditions for self-organizing in human systems","author":"G. H. Eoyang","year":"2001","unstructured":"Eoyang, G. H. (2001). Conditions for self-organizing in human systems. The Union Institute and University]. The Union Institute and University."},{"key":"10469_CR19","unstructured":"Eoyang, G. H. (2003). Voices from the field: An introduction to human systems dynamics. Human Systems Dynamics Institute Press."},{"key":"10469_CR20","first-page":"10","volume-title":"Conditions for self-organizing in human systems. Futurics","author":"G. H. Eoyang","year":"2004","unstructured":"Eoyang, G. H. (2004). Conditions for self-organizing in human systems. Futurics (Vol. 28 (3-4), pp. 10\u201377). St. Paul."},{"key":"10469_CR21","volume-title":"Adaptive action: Leveraging uncertainty in your organization","author":"G. H. Eoyang","year":"2013","unstructured":"Eoyang, G. H., Holladay, R. (2013). Adaptive action: Leveraging uncertainty in your organization. Stanford University press."},{"key":"10469_CR22","doi-asserted-by":"crossref","unstructured":"Ericsson, A.K. (2004). Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. Academic Medicine, 79(10 Supplement Pages), s70\u201381.","DOI":"10.1097\/00001888-200410001-00022"},{"issue":"3","key":"10469_CR23","doi-asserted-by":"publisher","first-page":"297","DOI":"10.4471\/ijep.2013.29","volume":"2","author":"M. Flores","year":"2013","unstructured":"Flores, M., Duran, D. (2013). Effects of peer tutoring on reading self-concept. International Journal of Educational Psychology, 2(3), 297\u2013324.","journal-title":"International Journal of Educational Psychology"},{"key":"10469_CR24","first-page":"60067","volume-title":"The mindful school: How to teach for metacognitive reflection","author":"R. Fogarty","year":"1994","unstructured":"Fogarty, R. (1994). The mindful school: How to teach for metacognitive reflection (p. 60067). Palatine, IL: IRI\/Skylight Publishing, Inc., 200 East Wood Street, Suite 274."},{"key":"10469_CR25","doi-asserted-by":"crossref","unstructured":"Ford, C. L., Yore, L. D. (2012). Toward convergence of critical thinking, metacognition, and reflection: Illustrations from natural and social sciences, teacher education, and classroom practice. Metacognition in Science Education: Trends in Current Research, 251\u201371.","DOI":"10.1007\/978-94-007-2132-6_11"},{"issue":"3","key":"10469_CR26","doi-asserted-by":"publisher","first-page":"365","DOI":"10.1080\/0950069032000119401","volume":"26","author":"P. Georghiades","year":"2004","unstructured":"Georghiades, P. (2004). From the general to the situated: Three decades of metacognition. International Journal of Science Education, 26(3), 365\u201383.","journal-title":"International Journal of Science Education"},{"key":"10469_CR27","doi-asserted-by":"publisher","first-page":"e9","DOI":"10.1017\/jrr.2017.8","volume":"8","author":"A. Gerace","year":"2017","unstructured":"Gerace, A., Day, A., Casey, S., Mohr, P. (2017). \u2018I think, you think\u2019: Understanding the importance of self-reflection to the taking of another person\u2019s perspective. Journal of Relationships Research, 8, e9.","journal-title":"Journal of Relationships Research"},{"issue":"4","key":"10469_CR28","doi-asserted-by":"publisher","first-page":"3","DOI":"10.3102\/0013189X030004003","volume":"30","author":"M. Glassman","year":"2001","unstructured":"Glassman, M. (2001). Dewey and Vygotsky: Society, experience, and inquiry in educational practice. Educational Researcher, 30(4), 3\u201314.","journal-title":"Educational Researcher"},{"issue":"7","key":"10469_CR29","doi-asserted-by":"publisher","first-page":"535","DOI":"10.1136\/bmjqs-2011-000149","volume":"21","author":"M. L. Graber","year":"2012","unstructured":"Graber, M. L., Kissam, S., Payne, V. L., Meyer, A. N., Sorensen, A., Lenfestey, N., & Singh, H. (2012). Cognitive interventions to reduce diagnostic error: A narrative review. BMJ Quality & Safety, 21(7), 535\u201357.","journal-title":"BMJ Quality & Safety"},{"issue":"1","key":"10469_CR30","doi-asserted-by":"publisher","first-page":"15","DOI":"10.3200\/CTCH.57.1.15-22","volume":"57","author":"R. Grossman","year":"2009","unstructured":"Grossman, R. (2009). Structures for facilitating student reflection. College Teaching, 57(1), 15\u201322.","journal-title":"College Teaching"},{"key":"10469_CR31","doi-asserted-by":"crossref","unstructured":"Hargreaves, K. (2016). Reflection in medical education. Journal of University Teaching & Learning Practice, 13(2).","DOI":"10.53761\/1.13.2.6"},{"key":"10469_CR32","doi-asserted-by":"crossref","unstructured":"Hartman, H. J. (2001). Developing students\u2019 metacognitive knowledge and skills. Metacognition in Learning and Instruction: Theory, Research and Practice, 33\u201368.","DOI":"10.1007\/978-94-017-2243-8_3"},{"key":"10469_CR33","doi-asserted-by":"publisher","DOI":"10.4159\/9780674038479","volume-title":"Leadership without easy answers","author":"R. A. Heifetz","year":"1994","unstructured":"Heifetz, R. A. (1994). Leadership without easy answers. Belknap Press."},{"issue":"3","key":"10469_CR34","doi-asserted-by":"publisher","first-page":"261","DOI":"10.3109\/0142159X.2014.993601","volume":"37","author":"B. D. Hodges","year":"2015","unstructured":"Hodges, B. D. (2015). Sea monsters & whirlpools: Navigating between examination and reflection in medical education. Medical Teacher, 37(3), 261\u201366.","journal-title":"Medical Teacher"},{"issue":"3","key":"10469_CR35","doi-asserted-by":"publisher","first-page":"e200146","DOI":"10.1212\/NE9.0000000000200146","volume":"3","author":"S. Hodges","year":"2024","unstructured":"Hodges, S., Konopasky, A., Merkebu, J. (2024). Education research: Debriefing of assessments with certainty-based marking promotes metacognitive reflection: Results of a qualitative study. Neurology\u00ae Education, 3(3), e200146.","journal-title":"Neurology\u00ae Education"},{"key":"10469_CR73","doi-asserted-by":"crossref","unstructured":"Holmer, L. L. (2014). Understanding and reducing the impact of defensiveness on management learning: some lessons from neuroscience. Journal of management education, 38(5), 618\u2013641.","DOI":"10.1177\/1052562913505568"},{"key":"10469_CR36","volume-title":"The promise of faculty inquiry for teaching and learning skills","author":"M. T. Huber","year":"2008","unstructured":"Huber, M. T. (2008). The promise of faculty inquiry for teaching and learning skills. The Carnegie Foundation for the Advancement of Teaching."},{"key":"10469_CR37","doi-asserted-by":"crossref","unstructured":"Irby, D. M., Cooke, M., O\u2019Brien, B. C. (2010). Calls for reform of medical education by the carnegie foundation for the advancement of teaching: 1910 and","DOI":"10.1097\/ACM.0b013e3181c88449"},{"issue":"2","key":"10469_CR38","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1080\/18117295.2016.1192239","volume":"20","author":"D. Jagals","year":"2016","unstructured":"Jagals, D., Van der Walt, M. (2016). Enabling metacognitive skills for mathematics problem solving: A collective case study of metacognitive reflection and awareness. African Journal of Research in Mathematics, Science & Technology Education, 20(2), 154\u201364.","journal-title":"African Journal of Research in Mathematics, Science & Technology Education"},{"key":"10469_CR70","doi-asserted-by":"crossref","unstructured":"Johnson, M., & Webb, C. (1995). Rediscovering unpopular patients: The concept of social judgement. Journal of advanced nursing, 21(3), 466\u2013475.","DOI":"10.1111\/j.1365-2648.1995.tb02729.x"},{"key":"10469_CR39","doi-asserted-by":"publisher","DOI":"10.1891\/9780826146618","volume-title":"Implementing problem-based medical education: Lessons from successful innovations","author":"A. Kaufman","year":"1985","unstructured":"Kaufman, A. (1985). Implementing problem-based medical education: Lessons from successful innovations. Springer."},{"key":"10469_CR40","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1016\/j.profnurs.2004.02.006","volume":"20","author":"M. R. Keefe","year":"2004","unstructured":"Keefe, M. R., Pesut, D. (2004). Appreciative inquiry and leadership transitions. Journal of Prof Nurs, 20, 103\u201309.","journal-title":"Journal of Prof Nurs"},{"key":"10469_CR72","doi-asserted-by":"crossref","unstructured":"Kim, K., & Lee, Y. M. (2018). Understanding uncertainty in medicine: Concepts and implications in medical education. Korean journal of medical education, 30(3), 181.","DOI":"10.3946\/kjme.2018.92"},{"key":"10469_CR41","doi-asserted-by":"publisher","first-page":"1019","DOI":"10.1111\/medu.14222","volume":"54","author":"C. Koufidis","year":"2020","unstructured":"Koufidis, C., Manninen, K., Nieminen, J. (2020). Grounding judgement in context: A conceptual learning model of clinical reasoning. Med Ed, 54, 1019\u201328. https:\/\/doi.org\/10.1111\/medu.14222.","journal-title":"Med Ed"},{"issue":"4","key":"10469_CR42","doi-asserted-by":"publisher","first-page":"381","DOI":"10.1046\/j.1365-2648.2003.02921.x","volume":"45","author":"R. A. Kuiper","year":"2004","unstructured":"Kuiper, R. A., Pesut, D. J. (2004). Promoting cognitive and metacognitive reflective reasoning skills in nursing practice: Self-regulated learning theory. Journal of Advanced Nursing, 45(4), 381\u201391.","journal-title":"Journal of Advanced Nursing"},{"issue":"2","key":"10469_CR43","first-page":"1","volume":"11","author":"S. Mahmud","year":"2009","unstructured":"Mahmud, S. (2009). Framework for the role of self-organization in the handling of adaptive challenges. E: CO, 11(2), 1\u201314.","journal-title":"E: CO"},{"issue":"1","key":"10469_CR44","doi-asserted-by":"publisher","first-page":"57","DOI":"10.5465\/19416520.2014.873177","volume":"8","author":"S. Maitlis","year":"2014","unstructured":"Maitlis, S., Christianson, M. (2014). Sensemaking in organizations: Taking stock and moving forward. Academy of Management Annals, 8(1), 57\u2013125.","journal-title":"Academy of Management Annals"},{"key":"10469_CR45","doi-asserted-by":"crossref","unstructured":"Majumder, M. M., Sa, B., Alateeq, F. A., Rahman, S. (2019). Teaching and assessing critical thinking and clinical reasoning skills in medical education. In Handbook of Research on Critical Thinking an Teacher Education Pedagogy. IGI-Global.","DOI":"10.4018\/978-1-5225-7829-1.ch012"},{"key":"10469_CR46","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1111\/j.1365-2923.2010.03757.x","volume":"45","author":"K. Mann","year":"2011","unstructured":"Mann, K. (2011). Theoretical perspectives in medical education: Past experience and future possibilities. Med Educ, 45, 60\u201368.","journal-title":"Med. Educ"},{"key":"10469_CR47","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1023\/A:1003548425626","volume":"37","author":"L. McAlpine","year":"1999","unstructured":"McAlpine, L., Weston, C., Beauchamp, C., Wiseman, C., Beauchamp, J. (1999). Building a metacognitive model of reflection. Higher Education, 37, 105\u201331.","journal-title":"Higher Education"},{"key":"10469_CR75","doi-asserted-by":"crossref","unstructured":"Medina, M. S., Castleberry, A. N., & Persky, A. M. (2017). Strategies for improving learner metacognition in health professional education. American journal of pharmaceutical education, 81(4), 78.","DOI":"10.5688\/ajpe81478"},{"key":"10469_CR48","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1016\/j.tate.2006.12.016","volume":"23","author":"S. Mennin","year":"2007","unstructured":"Mennin, S. (2007). Small-group problem-based learning as a complex adaptive system. Teaching & Teacher Education, 23, 303\u201313.","journal-title":"Teaching & Teacher Education"},{"key":"10469_CR49","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1111\/j.1365-2923.2009.03548.x","volume":"44","author":"S. Mennin","year":"2010","unstructured":"Mennin, S. (2010). Self-organization, integration and curriculum in the complex world of medical education. Medical Education, 44, 20\u201330.","journal-title":"Medical Education"},{"key":"10469_CR50","doi-asserted-by":"crossref","unstructured":"Mennin, S. (2013 2013). Health professions education: Complexity, teaching and learning. In J. P. Sturmberg and C. Martin (Eds.), Handbook of systems and complexity in health. Springer.","DOI":"10.1007\/978-1-4614-4998-0_43"},{"key":"10469_CR51","doi-asserted-by":"publisher","DOI":"10.1111\/jep.13704","author":"S. Mennin","year":"2022","unstructured":"Mennin, S. (2022). Question storming: Power of questions - a methods to increase options for action in uncertainty. J Eval Clin Pract. https:\/\/doi.org\/10.1111\/jep.13704.","journal-title":"J Eval Clin Pract"},{"key":"10469_CR52","doi-asserted-by":"crossref","unstructured":"Mennin, S., Eoyang, G. H., Nations, M. (2020). Health, healthcare, and health education: Problems, paradigms, and patterns. In A. Bleakley.Routledge (Ed.), Routledge Handbook of the medical humanities.","DOI":"10.4324\/9781351241779-5"},{"key":"10469_CR53","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1111\/j.1743-498X.2006.00093.x","volume":"3","author":"S. Mennin","year":"2006","unstructured":"Mennin, S., Petroni-Mennin, R. (2006). Community-based medical education. The Clinical Teacher, 3, 90\u201396.","journal-title":"The Clinical Teacher"},{"key":"10469_CR54","first-page":"1166195","volume-title":"Frontiers in education","author":"J. Merkebu","year":"2023","unstructured":"Merkebu, J., Kitsantas, A., Durning, S. J., Ma, T. (2023, April). What is metacognitive reflection? The moderating role of metacognition on emotional regulation and reflection. In Frontiers in education (Vol. 8, p. 1166195). Frontiers Media SA."},{"issue":"2","key":"10469_CR55","doi-asserted-by":"publisher","first-page":"e70043","DOI":"10.1111\/tct.70043","volume":"22","author":"J. Merkebu","year":"2025","unstructured":"Merkebu, J., Mennin, S., Durning, S. J., Samuel, A. (2025). Cultivating the art of Metacognitive reflection in medical education. The Clinical Teacher, 22(2), e70043.","journal-title":"The Clinical Teacher"},{"key":"10469_CR56","doi-asserted-by":"crossref","unstructured":"Merkebu, J., Veen, M., Hosseini, S., Varpio, L. (2024). The case for metacognitive reflection: A theory integrative review with implications for medical education. Advances in Health Sciences Education, 1\u201320.","DOI":"10.1007\/s10459-023-10310-2"},{"key":"10469_CR57","doi-asserted-by":"crossref","unstructured":"Norcini, J., Burch, V. (2007). AMEE Guide in medical education No, 31: Workplace-based assessment as an educational tool. Med Teacher, 29(9), 855\u201371.","DOI":"10.1080\/01421590701775453"},{"issue":"11","key":"10469_CR58","doi-asserted-by":"publisher","first-page":"1203","DOI":"10.1097\/00001888-199911000-00012","volume":"74","author":"L. N. Pangaro","year":"1999","unstructured":"Pangaro, L. N. (1999). A new vocabulary and other innovations for improving descriptive in-training evaluations. Acad Med, 74(11), 1203\u201307.","journal-title":"Acad Med"},{"key":"10469_CR59","volume-title":"Radical rules for schools: Adaptive action for complex change. Human Systems dynamics institute","author":"L. Patterson","year":"2013","unstructured":"Patterson, L., Holladay, R., Eoyang, G. H. (2013). Radical rules for schools: Adaptive action for complex change. Human Systems dynamics institute. Circle Pines, Mn."},{"key":"10469_CR60","volume-title":"The end of certainty: Time, chaos. And the new laws of nature","author":"I. Prigogine","year":"1996","unstructured":"Prigogine, I. (1996). The end of certainty: Time, chaos. And the new laws of nature. The Free Press."},{"issue":"8","key":"10469_CR61","doi-asserted-by":"publisher","first-page":"685","DOI":"10.1080\/01421590903050374","volume":"31","author":"J. Sandars","year":"2009","unstructured":"Sandars, J. (2009). The use of reflection in medical education: AMEE Guide No. 44. Med Teach, 31(8), 685\u201395. https:\/\/doi.org\/10.1080\/01421590903050374.","journal-title":"Med Teach"},{"key":"10469_CR62","doi-asserted-by":"publisher","first-page":"805","DOI":"10.1111\/j.1365-2929.2004.01851.x","volume":"38","author":"L. W. T. Schuwirth","year":"2004","unstructured":"Schuwirth, L. W. T., van der Vleuten, C. P. M. (2004). Changing education, changing assessment, changing research? Medical Education, 38, 805\u201312.","journal-title":"Medical Education"},{"key":"10469_CR71","doi-asserted-by":"crossref","unstructured":"Schwartzman, L. (2007). Student defensiveness as a threshold to reflective learning in software design. Informatics in Education-An International Journal, 6(1), 197\u2013214.","DOI":"10.15388\/infedu.2007.14"},{"key":"10469_CR63","doi-asserted-by":"crossref","unstructured":"Silver, N., Kaplan, M., LaVaque-Manty, D., & Meizlish, D. (Ed.). (2023). Using reflection and metacognition to improve student learning: Across the disciplines, across the academy. Taylor & Francis.","DOI":"10.4324\/9781003448570"},{"issue":"4","key":"10469_CR64","doi-asserted-by":"publisher","first-page":"314","DOI":"10.1080\/08878730.2016.1195468","volume":"51","author":"M. D. Smith","year":"2016","unstructured":"Smith, M. D., Glenn, T. L. (2016). \u201cReflecting on the reflection \u2026\u201d: Exploring Teacher Candidates\u2019 assumptions of self and others through facilitated reflection. The Teacher Educator, 51(4), 314\u201334.","journal-title":"The Teacher Educator"},{"issue":"7","key":"10469_CR65","doi-asserted-by":"publisher","first-page":"1183","DOI":"10.1080\/09500693.2013.778438","volume":"35","author":"G. P. Thomas","year":"2013","unstructured":"Thomas, G. P. (2013). Changing the metacognitive orientation of a classroom environment to stimulate metacognitive reflection regarding the nature of physics learning. International Journal of Science Education, 35(7), 1183\u2013207.","journal-title":"International Journal of Science Education"},{"issue":"3","key":"10469_CR66","doi-asserted-by":"publisher","first-page":"526","DOI":"10.1037\/0022-3514.92.3.526","volume":"92","author":"B. Verplanken","year":"2007","unstructured":"Verplanken, B., Friborg, O., Wang, C. E., Trafimow, D., Woolf, K. (2007). Mental habits: Metacognitive reflection on negative self-thinking. Journal of Personality & Social Psychology, 92(3), 526.","journal-title":"Journal of Personality & Social Psychology"},{"key":"10469_CR74","unstructured":"Weick, K. E. (1995). Sensemaking in organizations (Vol. 3, No. 10.1002). Thousand Oaks, Sage publications."},{"key":"10469_CR67","unstructured":"White, B., Frederiksen, J. (2004). Improving students\u2019 learning and achievement through the development of generalizable skills for inquiry and self-reflection. Final report to OERI. US Department of Education. UC Berkeley."},{"issue":"1","key":"10469_CR68","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1207\/s1532690xci1601_2","volume":"16","author":"B. Y. White","year":"1998","unstructured":"White, B. Y., Frederiksen, J. R. (1998). Inquiry, modeling, and metacognition: making science accessible to all students. Cognition & Instruction, 16(1), 3\u2013118.","journal-title":"Cognition &amp; Instruction"},{"key":"10469_CR76","doi-asserted-by":"crossref","unstructured":"Woodruff, J. N. (2019). Accounting for complexity in medical education: A model of adaptive behaviour in medicine. Medical Education, 53(9), 861\u2013873.","DOI":"10.1111\/medu.13905"}],"container-title":["Advances in Health Sciences Education"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10459-025-10469-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10459-025-10469-w","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10459-025-10469-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T12:39:23Z","timestamp":1781613563000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10459-025-10469-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,10]]},"references-count":77,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10469"],"URL":"https:\/\/doi.org\/10.1007\/s10459-025-10469-w","relation":{},"ISSN":["1382-4996","1573-1677"],"issn-type":[{"value":"1382-4996","type":"print"},{"value":"1573-1677","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,10]]},"assertion":[{"value":"6 February 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 August 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 September 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics and consent to publish"}},{"value":"The views expressed herein are those of the authors and do not necessarily reflect the official position or policy of the United States Government, Department of Defense, and Uniformed Services University of the Health Sciences.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclaimer"}},{"value":"The authors declare that they have no conflict of interest.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of interest"}}]}}