On the Curse of Knowledge

I was feeling ambitious and hungry.

So I decided to make myself buttery rosemary fingerling potatoes. Like the ones mom makes on Thanksgiving.

I looked up a recipe on my phone and assembled the ingredients.

Forty minutes later, I had a cast iron skillet full of burnt rosemary and brownish butter, and potatoes too raw to eat.

How did this happen?

The recipe writer thought that some things were too obvious to mention.

With my (non-existent) culinary skills, there is nothing too obvious to mention.

I didn’t get the potatoes I wanted, but I did get a perfect illustration of two cognitive biases to watch out for.

The Curse of Knowledge

AKA The Curse of Expertise, Expert’s Curse

A cognitive bias where individuals, once they know something, find it difficult to imagine not knowing it, making it challenging to communicate or teach that knowledge effectively to others who lack the same understanding.

The Dunning-Kruger Effect

The Dunning-Kruger Effect suggests that people with the least knowledge or skills are the most likely to overestimate their abilities. It was initially described in 1999 based on studies with college students.

It’s possible that this math isn’t mathing, according to smart people who understand heteroscedasticity (I don’t). Or possibly that the math is mathing too much, in that there’s not much room for an underperformer to go with their predictions other than up.

Despite these arguments, the Dunning-Kruger Effect has stuck in the collective consciousness, probably because it feels true to our everyday experiences.

In fact, some studies suggest that the Dunning-Kruger Effect is a concern in medical training:

1. Residency In-Training Exam score predictions (2024): Residents misjudged their exam scores, with lower performers overestimating and higher performers underestimating.

2. Surgical trainees (2020): Inexperienced trainees overestimated their ability to perform open cholecystectomy.

Whether the original Dunning-Kruger Effect holds up to scrutiny or not, it might be just a matter of degree. Consider these similar cognitive biases:

Knowledge Illusion: A cognitive bias where we overestimate our understanding of complex topics, often because we confuse access to external knowledge with our own internal comprehension.

Illusory Superiority: A cognitive bias where people overestimate their own abilities, qualities, or performance compared to others. This is why 65% of Americans think they are of above average intelligence 🤦‍♂️

Recipe for Disaster

The Curse of Knowledge and cognitive biases like the Dunning-Kruger Effect, the Knowledge Illusion, or Illusory Superiority are challenges on their own. Together, they’re a recipe for disaster.

Imagine you’re explaining something you know inside and out, like the principles of treating DKA, to a trainee:

• The Curse of Knowledge makes it easy for you to skim over key details because you can’t imagine they don’t already know them.

• The Knowledge Illusion leads the trainee to think they understand it because they attended a lecture once, even if their grasp is only surface-level.

Two ships pass in the night, and patient safety hangs in the balance. No good.

• Be Basic: When teaching about a topic you know really well, force yourself to start at a more basic level than feels natural.

• Be Skeptical: Don’t take a trainee’s word for it if they say they already understand a crucial concept. I’m not saying you should accuse them of lying, but ask a couple of follow-up questions to make sure they aren’t overestimating their level of mastery due to common biases.

• Be Vigilant: Continuously check your own level of mastery to make sure your brain isn’t playing tricks on you.

P.S - I was on a Podcast! Listen wherever you get your podcasts (I’ve always wanted to say that). I’d love to get your feedback 🤩