{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T01:51:41Z","timestamp":1791597101332,"version":"4.3.4"},"reference-count":89,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T00:00:00Z","timestamp":1791590400000},"content-version":"vor","delay-in-days":282,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Haute Autorit\u00e9 de Sant\u00e9"},{"name":"Paris Brain Institute\u2014ICM","id":[{"id":"https:\/\/ror.org\/050gn5214","id-type":"ROR","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100007492","name":"Bettencourt Schueller Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100007492","id-type":"DOI","asserted-by":"publisher"}]},{"name":"EURIP Graduate Program","award":["ANR-17-EURE-0012"],"award-info":[{"award-number":["ANR-17-EURE-0012"]}]},{"name":"La Fondation des Treilles","id":[{"id":"https:\/\/ror.org\/00714rg33","id-type":"ROR","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100001961","name":"AXA Research Fund","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001961","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,17]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>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\u2019s own correct and incorrect decisions. Here, we aim to overcome these limitations by drawing from state-of-the-art paradigms and tools from the cognitive science of metacognition. To examine overconfidence and to 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 physicians\u2019 confidence, reliably discriminated their correct from their incorrect decisions, demonstrating genuine metacognitive sensitivity. However, physicians were also overconfident, and this overconfidence was most pronounced among the least accurate participants. Moreover, the costliest errors (i.e. missed urgent cases) were held with higher confidence than unnecessary referrals. Finally, unlike previous reports, we found limited interindividual variability depending on specialty, gender, or seniority level, although our study was not powered for these comparisons.<\/jats:p>\n                  <jats:p>Highlights Physicians were overconfident, replicating previous reports, yet their confidence reliably discriminated correct from incorrect decisions\u2014genuine metacognitive sensitivity, quantified here for the first time with signal detection theory metrics. Metacognitive measures showed limited variation by specialty, gender, or seniority (the study was not powered for these comparisons), though specialties differed markedly in their urgency-referral criterion. The costliest errors\u2014missed urgent cases\u2014were held with higher confidence than unnecessary referrals. Refining medical training to assess and cultivate metacognitive sensitivity\u2014rather than merely mitigating overconfidence\u2014could help better align confidence judgments with diagnostic accuracy.<\/jats:p>","DOI":"10.1093\/nc\/niag064","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T11:38:38Z","timestamp":1790077118000},"source":"Crossref","is-referenced-by-count":0,"title":["Physicians\u2019 metacognition in medical decision-making"],"prefix":"10.1093","volume":"2026","author":[{"given":"Camille","family":"Lakhlifi","sequence":"first","affiliation":[{"name":"Sorbonne Universit\u00e9, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, APHP, H\u00f4pital de la Piti\u00e9 Salp\u00eatri\u00e8re , 75013 Paris ,","place":["France"]},{"name":"Universit\u00e9 Paris Cit\u00e9 , 75013 Paris 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,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Beuzon","sequence":"additional","affiliation":[{"name":"Sorbonne Universit\u00e9, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, APHP, H\u00f4pital de la Piti\u00e9 Salp\u00eatri\u00e8re , 75013 Paris ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00e9r\u00f4me","family":"Mawet","sequence":"additional","affiliation":[{"name":"AP-HP, H\u00f4pital Lariboisi\u00e8re, Emergency Headache Center (Centre d\u2019Urgences C\u00e9phal\u00e9es), Department of Neurology , 75013 Paris ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Roos","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Paris Cit\u00e9 , 75013 Paris ,","place":["France"]},{"name":"AP-HP, H\u00f4pital Lariboisi\u00e8re, Emergency Headache Center (Centre d\u2019Urgences C\u00e9phal\u00e9es), Department of Neurology , 75013 Paris ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2515-1046","authenticated-orcid":false,"given":"Mehdi","family":"Khamassi","sequence":"additional","affiliation":[{"name":"Institute of Intelligent Systems and Robotics, Sorbonne Universit\u00e9, CNRS , 75013 Paris ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6752-8756","authenticated-orcid":false,"given":"Benjamin","family":"Rohaut","sequence":"additional","affiliation":[{"name":"Sorbonne Universit\u00e9, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, APHP, H\u00f4pital de la Piti\u00e9 Salp\u00eatri\u00e8re , 75013 Paris ,","place":["France"]},{"name":"AP-HP, H\u00f4pital de la Piti\u00e9 Salp\u00eatri\u00e8re, DMU Neurosciences - Neuro ICU , 75013 Paris 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