Confidence, Competence, and Self-Awareness in Surgical Training: Re-Examining the Dunning-Kruger Effect in the Era of Competency-Based Education and Robotic Surgery

Background: Accurate self-assessment is fundamental to safe surgical practice. Surgical trainees must continuously evaluate their abilities, recognize limitations, and seek assistance when necessary. The Dunning–Kruger effect, first described in cognitive psychology, refers to the tendency of individuals with limited competence to overestimate their abilities, while highly competent individuals may underestimate their relative expertise. [1, 2, 3] Although originally described outside healthcare, the phenomenon has important implications for surgical education, competency development, and patient safety.

Objective: To examine the relevance of the Dunning–Kruger effect in surgical training, explore its relationship with competency development and patient safety, and discuss educational strategies that may improve calibration between confidence and competence.

Methods: Narrative review of literature from cognitive psychology, medical education, surgical training, competency-based medical education, simulation science, patient safety, robotic surgery, and paediatric surgical education.

Results: Evidence suggests that discrepancies between perceived and actual competence are common during surgical training, particularly during early skill acquisition. Objective assessment, simulation-based training, structured feedback, mentorship, and reflective practice improve self-awareness and promote more accurate self-assessment. Competency-based educational frameworks provide mechanisms for aligning confidence with demonstrated competence.

Conclusion: The Dunning–Kruger effect offers a useful conceptual framework for understanding confidence–competence miscalibration in surgical education. Modern surgical training should cultivate technical proficiency alongside metacognitive awareness, reflective practice, and professional humility. The ultimate goal is the development of surgeons whose confidence is grounded in competence and whose judgment is informed by continuous self-reflection.