The dark side of dialog

We agree that the self is constructed through a collaborative dialog. But hostile interlocutors could use various cognitive techniques to hijack the dialog, resulting in beliefs, values, and even selves that are out of line with reality. The implications of this problem are dire, but we suggest that increased metacognitive awareness could help guide this process to a truthful conclusion

Metacognition is Prior

We agree with Carruthers that evidence for metacognition in species lacking mindreading provides dramatic evidence in favor of the metacognition-is-prior account and against the mindreading-is-prior account. We discuss this existing evidence and explain why an evolutionary perspective favors the former account and poses serious problems for the latter account

Animal Metacognition: Problems and Prospects

Researchers have begun to evaluate whether nonhuman animals share humans’ capacity for metacognitive monitoring and self-regulation. Using perception, memory, numerical, and foraging paradigms, they have tested apes, capuchins, a dolphin, macaques, pigeons, and rats. However, recent theoretical and formal-modeling work has confirmed that some paradigms allow the criticism that low-level associative mechanisms could create the appearance of uncertainty monitoring in animals. This possibility has become a central issue as researchers reflect on existing phenomena and pause to evaluate the area’s current status. The present authors discuss the associative question and offer our evaluation of the field. Associative mechanisms explain poorly some of the area’s important results. The next phase of research in this area should consolidate the gains achieved by those results and work toward a theoretical understanding of the cognitive and decisional (not associative) capacities that animals show in some of the referent experiments

Unskilled and unaware: second-order judgments increase with miscalibration for low performers

Overestimation and miscalibration increase with a decrease in performance. This finding has been attributed to a common factor: participants’ knowledge and skills about the task performed. Researchers proposed that the same knowledge and skills needed for performing well in a test are also required for accurately evaluating one’s performance. Thus, when people lack knowledge about a topic they are tested on, they perform poorly and do not know they did so. This is a compelling explanation for why low performers overestimate themselves, but such increases in overconfidence can also be due to statistical artifacts. Therefore, whether overestimation indicates lack of awareness is debatable, and additional studies are needed to clarify this issue. The present study addressed this problem by investigating the extent to which students at different levels of performance know that their self-estimates are biased. We asked 653 college students to estimate their performance in an exam and subsequently rate how confident they were that their self-estimates were accurate. The latter judgment is known as second-order judgments (SOJs) because it is a judgment of a metacognitive judgment. We then looked at whether miscalibration predicts SOJs per quartile. The findings showed that the relationship between miscalibration and SOJs was negative for high performers and positive for low performers. Specifically, for low performers, the less calibrated their self-estimates were the more confident they were in their accuracy. This finding supports the claim that awareness of what one knows and does not know depends in part on how much one knows

Integration of primary care and palliative care services to improve equality and equity at the end-of-life:Findings from realist stakeholder workshops

Background: Inequalities in access to palliative and end of life care are longstanding. Integration of primary and palliative care has the potential to improve equity in the community. Evidence to inform integration is scarce as research that considers integration of primary care and palliative care services is rare. Aim: To address the questions: ‘how can inequalities in access to community palliative and end of life care be improved through the integration of primary and palliative care, and what are the benefits?’ Design: A theory-driven realist inquiry with two stakeholder workshops to explore how, when and why inequalities can be improved through integration. Realist analysis leading to explanatory context(c)-mechanism(m)-outcome(o) configurations(c) (CMOCs). Findings: A total of 27 participants attended online workshops (July and September 2022): patient and public members (n=6), commissioners (n=2), primary care (n=5) and specialist palliative care professionals (n=14). Most were White British (n=22), other ethnicities were Asian (n=3), Black African (n=1) and British mixed race (n=1). Power imbalances and racism hinder people from ethnic minority backgrounds accessing current services. Shared commitment to addressing these across palliative care and primary care is required in integrated partnerships. Partnership functioning depends on trusted relationships and effective communication, enabled by co-location and record sharing. Positive patient experiences provide affirmation for the multi-disciplinary team, grow confidence and drive improvements. Conclusions: Integration to address inequalities needs recognition of current barriers. Integration grounded in trust, faith and confidence can lead to a cycle of positive patient, carer and professional experience. Prioritising inequalities as whole system concern is required for future service delivery and research. <br/