Hrev_master


Dear Editor, 
 
We are writing to highlight the importance for emergency 

physicians to have metacognitive awareness to improve their abil-
ity to make decisions under pressure and cope with stressors. 
Improving well-being and enhancing resilience among emergency 
physicians and nurses is a critical concern due to heightened attri-
tion rates and increasing psychological issues.1 

Emergency physicians frequently deal with severe stress and 
mental health issues. Because of the nature of their employment, 
they are more likely to experience depression, anxiety, burnout, 
compassion fatigue, and other mental health problems.2 
Metacognitive awareness has proven to be an effective stress-man-
agement strategy, particularly in decision-making. Research on 
decision-making in emergency departments emphasizes the impor-
tance of cognitive techniques such as metacognitive awareness and 
mindfulness in improving decision-making under stress.3 

Metacognitive awareness is the capacity to introspect and con-
trol one’s own thought processes. This self-awareness may greatly 
improve concentration, lessen cognitive overload, and help in deci-
sion-making, thereby reducing errors under stressful situations. Al-
Azri’s conceptual mental model demonstrates how combining ana-
lytical and non-analytic approaches in decision-making facilitated 
by metacognitive strategies may improve decision-making, which 
is paramount in emergency care.4 

Emergency physicians who maintain metacognitive awareness 
handle challenging situations better and make well-informed judg-
ments, which are essential for patient care. Improvement in emer-
gency physicians’ well-being and resilience can be achieved by 
creating an atmosphere that encourages metacognitive training. 
Research has shown that practicing mindfulness enhances deci-
sion-making and aids in coping with stress.5 

In conclusion, we encourage healthcare organizations and pol-
icymakers to integrate metacognition- and mindfulness-based 
training sessions, workshops, and peer support networks to 
enhance the overall well-being of personnel working in emergency 
and critical care settings. 

 
 

References 
1. Heymann EP, Lim R, Lang E. Improving resilience and well-

being in emergency medicine. Intern Emerg Med 2025;20:213-
4. 

2. Ma H, Huang SQ, We B, Zhong Y. Compassion fatigue, 
burnout, compassion satisfaction, and depression among emer-
gency department physicians and nurses: a cross-sectional 
study. BMJ Open 2022;12:1-6.  

3. Donati A, Iannello P, Perucca V, Antonietti A. Decision making 
in the emergency care unit: a study on meta-cognitive aware-
ness. Emerg Care J 2012;8:18-25.  

4. Al-Azri NH. How to think like an emergency care provider: A 
conceptual mental model for decision making in emergency 
care. Int J Emerg Med 2020;13:1-9.  

5. Argyriadis A, Ioannidou L, Dimitrakopoulos I, et al. 
Experimental Mindfulness Intervention in an Emergency 
Department for Stress Management and Development of 
Positive Working Environment. Healthcare (Basel) 2023;11. 

                                              Emergency Care Journal 2025; volume 21:13470

                                                                         [Emergency Care Journal 2025; 21:13470]                                                        [page 27]

Correspondence: Tony P. Jose, Associate Professor, Department of 
Social Sciences, School of Social Sciences and Languages, Vellore 
Institute of Technology, Vellore, 632014 Tamil Nadu, India.  
E-mail: tony.jose@vit.ac.in 
 
Key words: mental health; emergency care; emergency physicians; 
metacognition; decision-making. 
 
Conflict of interest: the authors declare no potential conflict of interest. 
 
Received: 10 December 2024. 
Accepted: 18 February 2025. 
Early view: 20 March 2025. 
 
This work is licensed under a Creative Commons Attribution 4.0 
License (by-nc 4.0). 
 
©Copyright: the Author(s), 2025 
Licensee PAGEPress, Italy 
Emergency Care Journal 2025; 21:13470 
doi:10.4081/ecj.2025.13470 
 
Publisher's note: all claims expressed in this article are solely those of 
the authors and do not necessarily represent those of their affiliated 
organizations, or those of the publisher, the editors and the reviewers. 
Any product that may be evaluated in this article or claim that may be 
made by its manufacturer is not guaranteed or endorsed by the publisher.

Metacognitive awareness in coping with mental health challenges  
and decision-making among emergency physicians 
Albin Joseph, Tony P. Jose 

Department of Social Sciences, School of Social Sciences and Languages, Vellore Institute of Technology, Tamil Nadu, India