“The trouble with the world is that the stupid are cocksure and the intelligent are full of doubt.”
“Ignorance more frequently begets confidence than does knowledge.”
“It is one of the essential features of such incompetence that the person so afflicted is incapable of knowing that he is incompetent.”
William Ian Miller
I recently stumbled across an article on the Dunning-Kruger Effect, a theory of psychology that claims, “…the skills that engender competence in a particular domain are often the very same skills necessary to evaluate competence in that domain-one’s own or anyone else’s…” What this means in ordinary terms, is that while we all overestimate our own knowledge and skills, the less competent we are at something the more will will overestimate our abilities.
The original article is Unskilled and unaware of it: How difficulties in Recognizing one’s own incompetence lead to inflated self-assessment, and it is well worth a read. The authors conducted a number of experiments on that paradigm of Guinea pigs, the undergraduate psychology student. They gave them tests of social skills (recognizing how funny jokes were compared to a standard of professional comedians’ assessment) and cognitive skills (English grammar and logical reasoning), and they evaluated the accuracy of the subjects’ self-assessment compared with their actual performance. Those in the bottom quartile were most likely to overestimate their skills by the largest amount.
Subsequent tests and analyses indicated that this inaccurate self-assessment was tied to the lack of the same skills needed to perform well on the tests. Those subjects in the top quartile consistently underestimated their performance, but when exposed to representative samples of other subjects’ tests, these top performers were able to adjust their self-assessment appropriately, whereas the bottom quartile subjects did not correct their inaccurate self-assessment based on being able to see directly how their peers performed.
How is this relevant to medicine? Well, in the obvious way that the very people who most need to improve their knowledge and skills and those who are least likely to be able to see that they need this improvement. We all rationalize our failures under the pressure of cognitive dissonance, and we all assess ourselves more charitably than we assess others. But the Dunning-Kruger Effect suggests that those of us with the weakest skills, whether it be in medicine specifically or in the kinds of critical thinking necessary to separate truth from nonsense, we are also the least likely to be able to recognize our own deficiencies.
There is some good news, however. The study also looked at whether or not the least competent subjects could improve the accuracy of their self-assessment. As it turns out, if you make them more competent, by training them on the skills they are being tested on, they also become better able to accurately gauge their own performance. That’s a strong argument for widespread teaching of critical thinking skills and the skeptical outlook, since it suggests we can do better in both our assessments of the world around us and our judgments of our own capabilities.