P025: The Dunning-Kruger effect in medical education: double trouble for the learner in difficulty

Abstract

Results: We received responses from 242 physicians (47% EPs, 40% GPs, 13% others). The majority (78%) reported little/no knowledge on determining driver fitness and 94% had little/no training around guidelines, reporting, and laws involving fitness to drive. Most (88%) agreed that physicians should be obligated to advise medically unfit patients not to drive, and 74% reported that they often warn patients not to drive. The majority of physicians also chart their opinion of patients' fitness to drive (67% do so more than twice per year). Most respondents (70%) indicated that it is "always appropriate" to report definitely unfit drivers whereas only 25% indicated that it is "always appropriate" to report potentially unfit drivers. However, in practice physicians see far more unfit drivers than they report to licensing authority: 67% of physicians encounter definitely unfit drivers more than twice per year but only 19% report definitely unfit drivers more than twice per year and 34% never report definitely unfit drivers. Compared to other physicians, EPs reported less knowledge and training about criteria for determining fitness to drive, were more likely to feel that reporting unfit drivers was not their responsibility, and were less likely to report unfit drivers to licensing authorities. Conclusion: Our findings indicate a need for more education and information resources to help physicians, particularly EPs, identify and manage medically unfit drivers. Although most physicians warn unfit drivers not to drive and document this in medical records, many medically unfit drivers are not reported to licensing authorities, a potential public health problem that should be further investigated.

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

“…Ideally, confidence should align with competence, such that the more competent a person is, the more confident they are and vice versa (Figure 3, Table 1). However, it is when the CCR is miscalibrated that problems can arise 6,26,34 …”

“…Moreover, the level of confidence should reflect the dynamics of the specific situation that an individual finds themselves in. Small variances in routine confidence are often warranted (eg, resolution in the face of an emergency or caution in the face of growing uncertainty), 11 whereas significant excesses or absences of confidence should be avoided (eg, timidity in the face of clarity, recklessness in the face of risk) 6,26,34 …”

“…However, it is when the CCR is miscalibrated that problems can arise. 6,26,34 The CCR is typically articulated such that confidence needs to follow competence, with the former being a behavioural disposition, while the latter is the more critical and essential construct. The argument is that they should be aligned and proportional.…”

“…Small variances in routine confidence are often warranted (eg, resolution in the face of an emergency or caution in the face of growing uncertainty), 11 whereas significant excesses or absences of confidence should be avoided (eg, timidity in the face of clarity, recklessness in the face of risk). 6,26,34 AXIOM: Confidence can shape how we act in our reality and is optimised when it closely corresponds to reality.…”

“…Confidence can change behaviours and perceptions 5 . Unfortunately, individual self‐assessment of skills is poor, 6 which reflects a common mismatch between confidence and competence. Although self‐regulation has been proposed as a way of improving performance, it is still contingent on a robust understanding of one's confidence and skills 7 .…”