Physicians’ metacognition in medical decision-making

A large literature reports that physicians are overconfident when making medical decisions. However, the validity of these findings is questioned due to methodology pitfalls leading to poor ecological validity. Moreover, most previous studies do not distinguish between i) metacognitive bias, the general tendency to report high or low confidence irrespectively of actual accuracy, and ii) metacognitive sensitivity, the capacity to discriminate between one’s own correct and incorrect decisions. Here, we aim to overcome these limitations by drawing from state-of-the-art experimental paradigms and robust tools from the cognitive science of metacognition. To examine overconfidence and disentangle metacognitive bias from metacognitive sensitivity, we developed a carefully-controlled set of case-vignettes of patients with headaches that was completed by 52 physicians. We found that, although physicians are overconfident, they maintain relatively good insight into the accuracy of their decisions. In addition, and unlike previous reports, we found limited inter-individual variability depending on specialty, gender, or seniority level. These results shed new light on the (meta)cognitive properties of medical decision-making and carry practical implications for medical education.