Metacognition for Every Clinician


Clinical decision-making
critical thinking

How to Cite

Shiralkar, U. (2023). Metacognition for Every Clinician: Book Synopsis. The Physician, 8(2), 1-11.


A call to action, Surgical Metacognition: Smarter Decision-making for Surgeons challenges surgeons to understand the processes that underpin decision-making and performance, and how we can use this new knowledge to improve a surgeon's performance both in and outside the operating theatre.

Decision-making is a core professional activity for surgeons of all levels. It is a distinct high-level skill that is closely associated with the quality of surgical outcomes, patient satisfaction, teamwork, and a surgeon's well-being. Yet it has so far been woefully neglected in surgical training and professional development, with an assumption that these skills develop on their own and cannot be taught or improved. This is an unfortunate and costly oversight that it is time we redress.

But how are good decisions and expertise made? And how can we as a profession improve our thinking to optimize our decision-making and train expertise?

The answer lies not only in gaining more knowledge and experience, which although essential for good decision-making, do not address the fact that so few of us understand the process itself, let alone how to optimize and teach it. The first step, and focus of this book, is understating 'metacognition'; 'thinking about thinking, ' to improve self-awareness, critical thinking and how we make decisions.

The profound developments of psychology and decision-science are now well established and have been successfully incorporated into other high-stakes professions such as senior business management, the military and aviation, to significantly improve both professional and personal outcomes. That surgery has yet to implement this knowledge is like a race car driver using a car with technology that is decades old, ignoring developments that would significantly increase performance. It is time for surgery to embrace this knowledge; to advance and modernize the profession with sharper critical thinking and teaching.

With many real-world surgical examples, Surgical Metacognition: Smarter Decision-making for Surgeons reviews the psychological understanding of decisions and decision-making from recent decades of research, giving us the tools to improve how we think and teach this fundamental skill of expertise.


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