Cognitive Skill in Medicine: An Introduction

Abstract

Cognition encompasses all processes from perception to action including attention and memory, reasoning, and decision making. Therefore, all skills (perceptual skills, motor skills, diagnosing skill, medical skills) are cognitive skills. Cognitive skills are supported by two types of knowledge: declarative (knowing what) and procedural knowledge (knowing how). Some skills rely more on declarative knowledge such as clinical reasoning, while others are mainly procedural, for example, technical skills. Technical medical skills rely heavily on biomedical and clinical knowledge, which in experts is highly organized and easily accessible and applicable. Surgery or interventional skills involve highly developed motor performance, but success in surgery is more related to cognitive factors such as perceptual skill and decision making. Experts do not have better general decision-making skills, but their superior performance is based on extensive, domain-specific knowledge. Basic motor skills can and should be practiced outside operating theaters and catheterization laboratories, while further instruction in surgical and interventional skills should also focus on developing adequate domain-specific decision-making and procedural skills. Instruction that explains the decisions within a procedure should result in flexible and stress-resistant skills. Cognitive task analysis is very useful here, while cognitive models appear to have great potential to enrich medical education and improve professional medical performance, including cardiovascular medicine.