Surgical Metacognition

Dr Uttam Shiralkar, FRCS, MRCPsych, is a surgical performance coach based in the UK. Uttam worked as a surgeon for 15 years in the UK, India, and the US before moving to psychiatry. This transition was the result of the medical problems he faced after a serious car accident. While working in psychiatry, it became clear to him the profound impact that a surgeon's psychology has on performance and surgical outcomes. This revelation inspired him to bring psychological research into surgical practice and training.His first book, 'Smart Surgeons, Sharp Decisions' was an initial step in bringing psychology and surgery together. In his second book, 'Cognitive Simulation', Uttam wrote about the importance of cognitive factors and how surgeons can use them to improve operative skills. His third book, 'Surgeon, Heal Thyself' focused on stress management. Uttam's newest book, 'Surgical Metacognition: Smarter Decision-making for Surgeons', focuses on the key tool that underlies surgical expertise - metacognition, i.e., 'thinking about thinking.' Understanding metacognition and how to develop and teach it is an important step in improving a surgeon's self-awareness, astute thinking, and clinical decision-making. By taking heed of psychological studies discussed in the book - which have already been successfully taken on board by professions such as business, military, and aviation - surgery as a profession and surgeons as individuals can progress to higher levels of expertise.For more than a decade Uttam has helped many surgeons at various levels of their careers on a range of issues, providing mentorship, conducting research, speaking at meetings, and running workshops.

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.
As Professor Derek Alderson, Past-President of the Royal College of Surgeons of England, states in the foreword, "better decisions make better surgeons and improve outcomes for patients. This book explains how this thinking occurs and how it can be improved."

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.

The book is a groundbreaking introduction to a new field - surgical psychology, that has the potential to transform surgical culture. The first steps of understanding surgical metacognition may feel like learning a new language, but you will start improving as soon as you put this knowledge into practice.