Elsevier

Journal of Surgical Education

Volume 71, Issue 3, May–June 2014, Pages 405-412
Journal of Surgical Education

Original reports
The Relationship Between Confidence and Competence in the Development of Surgical Skills

https://doi.org/10.1016/j.jsurg.2013.08.009Get rights and content

Background

Confidence is a crucial trait of any physician, but its development and relationship to proficiency are still unknown. This study aimed to evaluate the relationship between confidence and competency of medical students undergoing basic surgical skills training.

Methods

Medical students completed confidence surveys before and after participating in an introductory workshop across 2 samples. Performance was assessed via video recordings and compared with pretraining and posttraining confidence levels.

Results

Overall, 150 students completed the workshop over 2 years and were evaluated for competency. Most students (88%) reported improved confidence after training. Younger medical students exhibited lower pretraining confidence scores but were just as likely to achieve competence after training. There was no association between pretraining confidence and competence, but confidence was associated with demonstrated competence after training (p < 0.001).

Conclusions

Most students reported improved confidence after a surgical skills workshop. Confidence was associated with competency only after training. Future training should investigate this relationship on nonnovice samples and identify training methods that can capitalize on these findings.

Introduction

As the first 2 years of medical school consist primarily of didactic teaching, students often experience anxiety about beginning hands-on clinical rotations.1 Institutions often implement “boot camps” or “minicourses” to enhance specific skills and improve confidence. Research has demonstrated that such concentrated courses increase confidence among medical students.1, 2, 3, 4, 5 Indeed, social cognitive theory posits that higher levels of confidence improve some motivational element (i.e., direction, effort, or persistence) during learning.6 Accordingly, confidence should have a positive effect on task performance.

Confidence is a crucial trait for physicians. The relationship between confidence and medical knowledge is complex, as evidenced by a wide array of studies that have exhibited a weak relationship at best between students’ confidence and proficiency.7, 8, 9, 10, 11, 12, 13 However, the focus of these articles generally revolves around medical knowledge or clinical skills examinations. Basic surgical skills are necessary for a wide range of medical specialties but insufficient competency is achieved during medical school.14 Additionally, insufficient surgical education literature addresses the relationship between confidence and competence relating to procedural skills. Several articles have demonstrated an accurate ability for surgeons to self-rate their own operative skills.15, 16, 17 Self-ratings are further improved with increasing experience and training.16, 17 However, it is unclear how confidence plays a role in the self-evaluation process. Empirical work from nonmedical domains suggests a negative relationship between confidence beliefs and performance on tasks requiring analytical and critical-thinking skills.18, 19 This inverse relationship may also exist among medical students developing technical surgical skills. Inexperienced students who enter the learning environment feeling sufficiently prepared may allocate fewer resources to learn the new skill and spend less time on the task, negatively affecting skill acquisition and performance. Thus, some self-doubt may provide medical students with an incentive to obtain the knowledge and skills needed to master the task.

With the increasing amount of constraints being placed on medical education, educators must identify relevant factors that can increase skill acquisition and knowledge retention. Being aware of such factors and designing training programs accordingly is essential to the development of physician expertise and ultimately affects patient outcomes. This study examined confidence and competence of medical students taking part in a basic surgical skills training workshop. We sought to evaluate for an association between students’ confidence and ability as they learn to develop basic surgical skills in a structured environment.

Section snippets

Participants and Setting

Each year, upcoming third-year medical students at an accredited allopathic medical school in the Midwest region undergo a “clinical prologue” before beginning their clinical rotations. This workshop includes, but is not limited to, knot-tying and suturing instruction. All third-year medical students entering clinical rotations were eligible for this study.

On the day of the workshop, subjects received 60 minutes of instruction on a 2-handed knot tie, an instrument tie, and basic suturing skills

Results

All students entering their third-year clinical rotations (n = 248) were eligible for this study. In year 1 (the knot-tying cohort), 128 third-year medical students were eligible, both surveys were completed by 83 (65%) students, and 76 (59%) videos were recorded and evaluated. In year 2 (the suturing cohort), 120 third-year medical students were eligible, both surveys were completed by 74 (62%) students, and 109 (91%) videos were recorded and evaluated. The cohorts combined together had 185

Discussion

There is a unique relationship between posttraining confidence and competence, as it relates to medical skills and knowledge. A novel finding of this study was the strong association between confidence and competence that emerged after training. The inability to demonstrate such a relationship before training suggests that self-reported competency from a novice may be inaccurate or unreliable or both. However, the proposed relationship emerged when investigating the relationship with

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  • Cited by (0)

    Previous presentations: A portion of this information was presented as a poster at the annual Surgical Education Week in San Diego, CA, March 19 to 24, 2012.

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