Would You Know If You Were Incompetent?


By:  The Generation Y Surgeon (@GenYSurgeon)


There’s more to business than dollar signs and sales–a lot more.  Within the broad discipline of business, there is a focus on people: how they think, how they interact, why they do the things they do and how to get the most out of each and every member of the team.  Teamwork, interpersonal relations and communication can make or break even the strongest of businesses and as a result, our friends in business have invested a lot of time and energy into learning how and why individuals and teams fail or succeed.  

As providers we are required to function within teams. The environment is stressful, the stakes are high, the time crunch is unrelenting and our partners/coworkers can be challenging to work with.  There are tools available to help alleviate these problem interactions and inefficiencies yet very few of us use them.  Worse yet, we don’t even know where to look for help.

For my next few blog entries I would like to share some of the concepts and skills that I have found to be most useful in the hospital and clinic.  Thinking about our workplace in a different light, and learning just a few new tools to deal with people and stressful environments, can lead to positive changes…if you choose to experiment with some of these tools.  I challenge you to take these concepts and ideas into your own workplace and use them to create a happier and more efficient workplace for yourself and your healthcare team.


The Dunning-Kruger Effect


The Dunning-Kruger effect is one of my favorite proposals, especially when you think about what it means to providers, to medical education and to our own personal development.  If you’re not worried about your own personal performance after learning about this then, well, you have a problem.

The Dunning-Kruger effect is a cognitive bias whereby unskilled individuals suffer from illusory superiority, mistakenly rating their ability much higher than accurate.  (More about it here in that classic tome of knowledge, Wikipedia.)  Highly skilled people, however, tend to underestimate their competence and wrongly assume that tasks they find easy themselves are also found easy by others.  In other words, the unskilled don’t realize they are inept and the skilled undervalue their skill.  Again, this is a cognitive bias and it’s related to confirmation bias, meaning that people see what they want to see and ignore what they don’t want to see.  Most people believe that they couldn’t possibly be wrong or less intelligent than others so they develop an artificially inflated sense of self-esteem.  Unfortunately, this shields them from recognizing their own lack of skill, the extremity of their inadequacy, and the presence of genuine skill in others.  For these reasons, the incompetent tend to stay incompetent.

Think for a moment about what this means.  Try to remember the last time you felt truly competent and confident in your abilities…were you actually competent or blinded by your own ignorance?  Now think of the last time you felt inferior to your peers…was that your shining moment?  So…are you second-guessing yourself yet?  The good news is that you’re probably not as inept as you sometimes think you are…Yet, on the flip side, you may be lacking severely some skills without even knowing it!

Understanding the Dunning-Kruger Effect is the first step, now let’s apply it to a couple of scenarios:


-M&M conferences:  Providers know a lot and pay special attention to learn from mistakes.  According to Dunning and Kruger however, the inept are unable to recognize their own lack or skill, the extremity of their lack of skill and the presence of genuine skill in others…did you ever wonder why so many M&M’s repeat themselves?  It’s because some of the people in the audience are unable to see their ineptitudes and therefore fail to learn.  Wise physicians will tell you “know what you know, and more importantly, know what you don’t yet know.”  Incompetent physicians cannot fathom that there are things they do not yet know.

-Public opinions on vaccines and gluten-free diets:  As a provider you understand the science behind viral disease, vaccinations and how they impact the public’s health as a whole.  As a provider you’ve also seen the public refuse such vaccines.  Have you ever tried to explain the risk/benefits to someone who refuses vaccination?  Regardless of the data supporting influenza as a leading cause of death across all age groups, some people just cannot grasp the concept of vaccination.  We have been educated in virology, genetics, epidemiology and statistics and we’ve seen patients die from preventable causes.  Most patients have not.  This is why arguing with non-scientists about topics such as vaccination is so frustrating!  Because they have not been exposed to the skills/knowledge it requires to fully understand the topic they are unable to understand…and they don’t even realize how little they know!  They are so blinded by their lack of skill/knowledge in the topic that they cannot even see that they lack skill/knowledge.  (As an aside, I respect all educated decisions about vaccination…unfortunately most people who refuse vaccination are not equipped to do so.)

Now you know what the Dunning-Kruger Effect is and how it affects our daily lives.  You should find this concept unsettling because it uncouples perception and performance, leaving you wondering where you stand among your peers.  How can you correct your ineptitudes if you don’t even know you’re inept?!  Well the good news is that Dunning and Kruger also proposed that incompetent people will recognize and acknowledge their own previous lack or skill IF they are exposed to training for that skill.  So keep your eyes open and embrace those feelings of inadequacy…if you don’t feel incompetent sometimes you just might be, well, incompetent!

I hope you enjoyed this blog and learned a little something.  Take this new knowledge with you into the hospital or clinic and use it to better understand yourself and others.  And take it easy on yourself the next time you underestimate your own skill.