This post has evolved from a conversation with WONCA Junior Researcher of the Year nominee, Dr Ebrahim Mulla. One of the things that I love is hearing about frameworks and theories that encapsulate things that we observe on a day-to-day basis. This was particular to a discussion about something we call in the UK ‘reg-itis’ which is when someone fairly junior (i.e a senior house officer) acts like they are more senior than they are (i.e. a registrar). In real terms, they are annoying to deal with because you can’t trust what they’re saying but they have an ego that you need to manage. I’m sure we have all had experiences like this before. I’ve always thought it was to cover up any insecurities but Ebrahim introduced to me the concept of the Dunning-Kruger effect.

The Dunning-Kruger effect

This effect describes the cognitive bias that leads to people overestimating their ability or knowledge. In their paper, “Unskilled and Unaware of It: How Difficulties in Recognizing One’s Own Incompetence Lead to Inflated Self-Assessments” (1999), low performers were often found to have low self-awareness which Dunning and Kruger, two social scientists, called the “double burden” – not only are they incompetent but they lack the mental facility to recognise that they are. My concern with this is that you need this metacognition to step back and evaluate yourself in order to figure out how to improve which suggests that such people remain limited in their growth. There are cultural biases where another study showed that North Americans were likely to talk themselves up and exhibit the Dunning-Kruger effect than the Japanese (this may be due to the fact that being ostentatious is seen as a negative in Japanese culture, and failure is seen positively as it means room to grow). Just to be clear, these low performers don’t think they’re better than high-performers, they just think that they are more competent than they actually are.

Unfortunately, we are all susceptible to the Dunning-Kruger effect; think of the times that we have thought we might be experts in topics that we know nothing about. I will give the example of doctors dishing out advice on finances as if we were financial advisors. Thankfully, the more experience and more expertise we gain in life, the more we are able to recognise what we don’t know and are at less risk of this effect. However, this might only be the case in your given social or intellectual domain and just watch out it doesn’t leach out into another part of your life! You have been warned!

Four stages of competence

“What is this?” I hear you say! This theory (which can also be called the four stages of learning) suggests that we always start with not knowing how little we know or not realising how useful a skill is – unconscious incompetence. Once we learn the value of the skill, we can see how bad we are at it = conscious incompetence. Once we kind of get good at something, we enter conscious competence where it still takes us concentration and focus to perform the skill but we actually know what we are doing. Finally, we reach unconscious incompetence where the skill is so second nature to us that we can even do other things at the same time. Shall we equate this to family medicine training?

Unconscious incompetence = we sign up to family medicine training and we are super excited but we don’t realise how much learning there will be

Conscious incompetence = we start training and we realise how much there is to learn and we panic that we will never be a good doctor

Conscious competence = we have just finished our training or taken our professional exam and we’re thinking that we can do this safely but each day is still exhausting

Unconscious incompetence = the dream. When we’re so good at communication skills and clinical knowledge that we feel comfortable with our day-to-day. That’s when we feel like the grown-ups.

Conclusion

I think self-awareness is such an important thing and is often the first step to change. Whether we are subject to the Dunning-Kruger effect or on our journey through the four stages of competence, having the moment to reflect on where we are and are we really qualified to say what we say is essential. These are only theories to frame everyday problems but is an entertaining way to view the world.