Current models of maintenance of competence and self-regulation within medicine are largely formalizations of the instruction "Physician, know thyself." For the individual, appreciating the limits of one's abilities is considered a core aspect of professionalism. Failure in this regard threatens quality of care. For the medical profession, serf-direction has been established as a foundation on which maintenance of competence (and maintenance of certification programs) are built. Failure in this regard threatens the privilege of serf-regulation granted to the profession. In this commentary, we use a cognitive perspective to outline the insufficiency of reliance on serf-assessment and the inadequacy of simple efforts to redress its limitations. Our goals are to raise awareness of the complexity of the issue and offer some practical solutions.
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