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. 2005 Dec;81(962):785–788. doi: 10.1136/pgmj.2004.029942

Dynamic confidence during simulated clinical tasks

A Byrne 1, M Blagrove 1, S McDougall 1
PMCID: PMC1743413  PMID: 16344305

Abstract

Objective: Doctors' confidence in their actions is important for clinical performance. While static confidence has been widely studied, no study has examined how confidence changes dynamically during clinical tasks.

Method: The confidence of novice (n = 10) and experienced (n = 10) trainee anaesthetists was measured during two simulated anaesthetic crises, bradycardia (easy task) and failure to ventilate (difficult task).

Results: As expected, confidence was high in the novice and experienced groups in the easy task. What was surprising, however, was that confidence during the difficult task decreased for both groups, despite appropriate performance.

Conclusions: Given that confidence affects performance, it is alarming that doctors who may be acting unsupervised should lose dynamic confidence so quickly. Training is needed to ensure that confidence does not decrease inappropriately during a correctly performed procedure. Whether time on task interacts with incorrect performance to produce further deficits in confidence should now be investigated.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Byrne A. J., Hilton P. J., Lunn J. N. Basic simulations for anaesthetists. A pilot study of the ACCESS system. Anaesthesia. 1994 May;49(5):376–381. doi: 10.1111/j.1365-2044.1994.tb03466.x. [DOI] [PubMed] [Google Scholar]
  2. Byrne A. J., Jones J. G. Inaccurate reporting of simulated critical anaesthetic incidents. Br J Anaesth. 1997 Jun;78(6):637–641. doi: 10.1093/bja/78.6.637. [DOI] [PubMed] [Google Scholar]
  3. Byrne A. J., Jones J. G. Responses to simulated anaesthetic emergencies by anaesthetists with different durations of clinical experience. Br J Anaesth. 1997 May;78(5):553–556. doi: 10.1093/bja/78.5.553. [DOI] [PubMed] [Google Scholar]
  4. Evans A. W., Leeson R. M. A., Newton-John T. R. O. The influence of self-deception and impression management on surgeons' self-assessment scores. Med Educ. 2002 Nov;36(11):1095–1095. doi: 10.1046/j.1365-2923.2002.134612.x. [DOI] [PubMed] [Google Scholar]
  5. Fitzgerald James T., White Casey B., Gruppen Larry D. A longitudinal study of self-assessment accuracy. Med Educ. 2003 Jul;37(7):645–649. doi: 10.1046/j.1365-2923.2003.01567.x. [DOI] [PubMed] [Google Scholar]
  6. Hall Katherine H. Reviewing intuitive decision-making and uncertainty: the implications for medical education. Med Educ. 2002 Mar;36(3):216–224. doi: 10.1046/j.1365-2923.2002.01140.x. [DOI] [PubMed] [Google Scholar]
  7. Hays R. B., Jolly B. C., Caldon L. J. M., McCrorie P., McAvoy P. A., McManus I. C., Rethans J-J. Is insight important? measuring capacity to change performance. Med Educ. 2002 Oct;36(10):965–971. doi: 10.1046/j.1365-2923.2002.01317.x. [DOI] [PubMed] [Google Scholar]
  8. Hutchinson S., Robson W. P. Confidence levels of PRHOs in caring for acutely ill patients. Postgrad Med J. 2002 Nov;78(925):697–697. doi: 10.1136/pmj.78.925.697-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Lewis K. E., Blagrove M., Ebden P. Sleep deprivation and junior doctors' performance and confidence. Postgrad Med J. 2002 Feb;78(916):85–87. doi: 10.1136/pmj.78.916.85. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Marel G. M., Lyon P. M., Barnsley L., Hibbert E., Parise A. Clinical skills in early postgraduate medical trainees: patterns of acquisition of confidence and experience among junior doctors in a university teaching hospital. Med Educ. 2000 Dec;34(12):1013–1015. doi: 10.1046/j.1365-2923.2000.00730.x. [DOI] [PubMed] [Google Scholar]
  11. Marteau T. M., Wynne G., Kaye W., Evans T. R. Resuscitation: experience without feedback increases confidence but not skill. BMJ. 1990 Mar 31;300(6728):849–850. doi: 10.1136/bmj.300.6728.849. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Morgan P. J., Cleave-Hogg D. Comparison between medical students' experience, confidence and competence. Med Educ. 2002 Jun;36(6):534–539. doi: 10.1046/j.1365-2923.2002.01228.x. [DOI] [PubMed] [Google Scholar]
  13. Morgan P. J., Cleave-Hogg D. Evaluation of medical students' performance using the anaesthesia simulator. Med Educ. 2000 Jan;34(1):42–45. doi: 10.1046/j.1365-2923.2000.00462.x. [DOI] [PubMed] [Google Scholar]
  14. Owen Harry, Plummer John L. Improving learning of a clinical skill: the first year's experience of teaching endotracheal intubation in a clinical simulation facility. Med Educ. 2002 Jul;36(7):635–642. doi: 10.1046/j.1365-2923.2002.01260.x. [DOI] [PubMed] [Google Scholar]
  15. Passmore K., Leung W-C. Defensive practice among psychiatrists: a questionnaire survey. Postgrad Med J. 2002 Nov;78(925):671–673. doi: 10.1136/pmj.78.925.671. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Stewart J., O'Halloran C., Barton J. R., Singleton S. J., Harrigan P., Spencer J. Clarifying the concepts of confidence and competence to produce appropriate self-evaluation measurement scales. Med Educ. 2000 Nov;34(11):903–909. doi: 10.1046/j.1365-2923.2000.00728.x. [DOI] [PubMed] [Google Scholar]
  17. Weinger M. B., Herndon O. W., Gaba D. M. The effect of electronic record keeping and transesophageal echocardiography on task distribution, workload, and vigilance during cardiac anesthesia. Anesthesiology. 1997 Jul;87(1):144–30A. doi: 10.1097/00000542-199707000-00019. [DOI] [PubMed] [Google Scholar]
  18. Whitehouse Carl R., O'Neill Paul, Dornan Tim. Building confidence for work as house officers: student experience in the final year of a new problem-based curriculum. Med Educ. 2002 Aug;36(8):718–727. doi: 10.1046/j.1365-2923.2002.01287.x. [DOI] [PubMed] [Google Scholar]
  19. Williams S., Dale J., Glucksman E., Wellesley A. Senior house officers' work related stressors, psychological distress, and confidence in performing clinical tasks in accident and emergency: a questionnaire study. BMJ. 1997 Mar 8;314(7082):713–718. doi: 10.1136/bmj.314.7082.713. [DOI] [PMC free article] [PubMed] [Google Scholar]

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