Confidence‐competence alignment and the role of self‐confidence in medical education: A conceptual review

Abstract

Context:There have been significant advances in competency-based medical education (CBME) within health professions education. While most of the efforts have focused on competency, less attention has been paid to the role of confidence as a factor in preparing for practice. This paper seeks to address this deficit by exploring the role of confidence and the calibration of confidence with regard to competence.Methods: This paper presents a conceptual review of confidence and the calibration of confidence in different medical education contexts. Building from an initial literature review, the authors engaged in iterative discussions exploring divergent and convergent perspectives, which were then supplemented with targeted literature reviews. Finally, a stakeholder consultation was conducted to situate and validate the provisional findings. Results: A series of axioms were developed to guide perceptions and responses to different states of confidence in health professionals: (a) confidence can shape how we act and is optimised when it closely corresponds to reality; (b) self-confidence is task-specific, but also inextricably influenced by the individual self-conceptualisation, the surrounding system and society; (c) confidence is shaped by many external factors and the context of the situation; (d) confidence must be considered in conjunction with competence and (e) the confidence-competence ratio (CCR) changes over time. It is important to track learners' CCRs and work with them to maintain balance. Conclusion: Confidence is expressed in different ways and is shaped by a variety of modifiers. While CBME primarily focuses on competency, proportional confidence is an integral component in ensuring safe and professional practice. As such, it is important to consider both confidence and competence, as well as their relationship in CBME. The CCR can serve as a key construct in developing mindful and capable health professionals. Future research should evaluate strategies for assessing CCR, identify best practices for teaching confidence and guiding self-calibration of CCR and explore the role of CCR in continuing professional development for individuals and teams.

Beyond competence: Towards a more holistic perspective in medical education

“…During collaborative learning, SSRL requires the learner to monitor not only their own but also the other group members', learning progress. Moreover, relational facets of confidence such as confidence perceived in others, distributed and shared confidence add to the meta‐cognitive burden, as pointed out by Gottlieb and colleagues 3 …”

“…15 However, if and how to train that ability is unknown-as is whether and how one can actually train confidence-competence calibration. 3 While there is much to be discovered in all of these aspects, it is encouraging to see in the articles contained in this issue that medical education is moving from merely addressing medical competence to a more holistic perspective of education, including metacognition, autonomy, regulation of learning and well-being.…”

“…Third, the ability to inhibit or take a certain action based on a task‐specific confidence judgement is a crucial component that could potentially be trained in addition to competence and confidence–competence calibration 15 . However, if and how to train that ability is unknown—as is whether and how one can actually train confidence–competence calibration 3 …”

Nurturing the “self” in health professions education

“…In particular, Bransen et al 1 challenge the naïve and traditional conception of self‐direction as the optimal means of regulating learning, prioritising instead a socially shared regulation that captures the social embeddedness of the self. Gottlieb et al 2 underscore the need to align confidence and competence to ensure patient safety in professional practice in a manner that requires considering the particulars of context; Mendelsohn D 4 highlight the vulnerability of health care professionals and students and emphasise the importance of our environment in enabling psychological wellness, and finally, Sawatsky et al, 5 aim to reconceptualise autonomy in the context of clinical supervision.…”

“…For example, Sawatsky et al 5 suggest an important role of clinical supervisors to be facilitating conditions that support learner autonomy and physician development by enabling students' ability to enact choices that are in line with their values and interests and, thereby, are likely to be linked with adaptive outcomes. Gottlieb et al 2 similarly speak to the critical role of teachers in enabling students to calibrate their confidence relative to competence. Second , the “self” itself has needs that must be met to enable practitioners to grow and develop.…”