Surgical Metacognition

The conventional image of a surgeon is of an actor rather than thinker. This perception is inaccurate as surgeons don’t think any less. They may appear to think less because their thoughts are visual or tactile instead of verbal; but it is still ‘thinking.’ Although it is not true that surgeons think less, it may be the case that they tend to use less metacognition.

Although the word ‘metacognition ‘may appear unfamiliar, we all use metacognition routinely. Metacognition is ‘thinking about thinking.’ It is to understand how you think and how to control thinking. In short, metacognition is your ability to manage your thinking.

It is not a chance observation that experts exhibit better metacognitive skills than nonexperts. What we don’t know so far is if having metacognitive skills makes someone expert or if one gains such skills after becoming an expert; a ‘chicken or egg’ conundrum!

You would expect, since good decision-making is central to surgery, there is plenty of information on how to take it. Unfortunately, there isn’t much information, and whatever little information there is, it is about what decision to make rather than how to make a good decision!

Surgical decisions have increased in complexity over the years due to technological advances, changes in service delivery and patient expectations. This increased complexity also increases our need to have a clearer understanding of surgical decision-making to successfully manage increasing complexity.

Over the years, as surgery has become increasingly dependent on ‘data’ and computers, intuitive thinking has become less and less a part of the surgical profession. Despite this, intuition is as essential as ever, and this balance needs to be redressed so that we can improve surgical decision-making.