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ARTICLE |

The Double Edge of Knowledge

Donald M. Berwick, MD
JAMA. 1991;266(6):841-842. doi:10.1001/jama.1991.03470060103036.
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Sometimes learning requires courage. It can be difficult for experts, especially, to admit candidly that they could be better at what they do if only they knew more. To become a learner is to become vulnerable.

The vulnerability is greater—and so, therefore, must be the courage—when accusation and fear are widespread. Under the threat of punishment or ridicule, normal people are more likely to defend themselves than to stretch themselves. Why take the risk of voluntarily admitting a need to learn more when that very admission can be used to hurt me?

The dilemma is painful. On the one hand, improvement depends on learning from information about performance. Yet, on the other hand, that same information can easily be used to make and enforce judgments that provoke fear and prevent learning. In many arenas, American culture seems addicted to forms of surveillance, measurement, comparison,

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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