Download PDF
Thorac Cardiovasc Surg 2022; 70(05): 361
DOI: 10.1055/s-0042-1755185
Editorial

The Dunning-Kruger Effect

Markus K. Heinemann
1   Department of Cardiac and Vascular Surgery, Universitaetsmedizin Mainz, Mainz, Germany
› Author Affiliations
› Further Information
    Permissions and Reprints All articles of this category

Relatively early in my career in cardiac surgery I was unknowingly confronted with what is now known as the Dunning-Kruger effect.[1] [2] The staff surgeon, whom I had been assisting during a somewhat tricky operation which clearly bore a less-than-expected result, afterwards turned to me with a grim frown and asked: “Heinemann, have you ever thought of doing something completely different?”

Up to that moment I had been an aspiring resident in a renowned department, still believing in a fast ascent up the ladder. Now I was unexpectedly cast into doubt. Could it be that I overestimated myself? Could it be that my mother's son wasn't made for cardiac surgery? What was I doing in this place? Should I quit and have try at forensic medicine instead? Would I be able to feed my (then) two children in a year's time? Was I, in short, unskilled and unaware of it[1]? On my resulting sharp descent from Mount Stupid into the Valley of the Desparate, however, I came upon mounting evidence that it might have been the senior rather than the junior who had a self-perception problem - or at least both. This, in turn, made me persist in my original plan, resuming my probably still unjustified self-assurance. The result is history (and debatable).

It is one of the positive educative qualities of a training in surgery that it should teach you to become humble very early. If it doesn't, the respective trainee must be considered a real hazard. “Well Sir, I put the drain in alright in no time, and I have everything under control with my finger on the right ventricle, but I would appreciate a helping hand now, if you don't mind!” That is not exactly the call you like to get at 2 a.m. from the superstar second year resident. But you'll get it, because the Dunning-Kruger effect is a reality, also in cardiac surgery.

Reference [1] makes very pleasant reading and is not without self-irony. It deservedly earned the 2017 Nobel Prize – in the “Ig Nobel Prize” category, that is. During the Ig Nobel Prize ceremony a new mini-opera has premiered since 1996, and in that year it was The Incompetence Opera, featuring the Dunning-Kruger aria.[3] [4] It concludes: “They don't know that they don't know!”

The effect itself and the theories trying to prove the validity of it have been the cause of much debate. Statisticians tried to relativize it (as usual).[5] Others discussed the methodology and potential confounding psychological influences.[6] Be that as it may, it certainly cannot harm to include reference [1] and the Incompetence Opera in your continuing medical education program. They are both educating and entertaining.

Mentoring is an essential part of any training, especially in surgery. Besides the teaching of manual skills and their evaluation, refinement of the trainee's character is a top priority. In the apodictic style of the above statement from the Incompetence Opera, one should revert to Sokrates and his apology “I know that I don't know.” Every operation bears its surprises, some pleasant and some markedly less so. It is the latter that teach us best and which will stay in our minds forever. Furthermore, acknowledging our persistent ignorance should serve as a strong incentive for lifelong learning. Whilst on your way, do not forget reading decent journals.



Publication History

Article published online:
10 August 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany