Medical Student Confidence Research Articles

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

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. 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. 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). 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.

Closing the Gap: A Needs Assessment of Medical Students and Handoff Training

Closing the Gap: A Needs Assessment of Medical Students and Handoff Training

Medical student self-reported confidence in obstetrics and gynaecology: development of a core clinical competencies document

BackgroundClinical competencies in obstetrics and gynaecology have not been clearly defined for Australian medical students, the growing numbers of which may impact clinical teaching. Our aim was to administer and validate a competencies list, for self-evaluation by medical students of their confidence to manage common clinical tasks in obstetrics and gynaecology; to evaluate students’ views on course changes that may result from increasing class sizes.MethodsA draft list of competencies was peer-reviewed, and discussed at two student focus groups. The resultant list was administered as part of an 81 item online survey.ResultsSixty-eight percent (N = 172) of those eligible completed the survey. Most respondents (75.8%) agreed or strongly agreed that they felt confident and well equipped to recognise and manage most common and important obstetric and gynaecological conditions. Confidence was greater for women, and for those who received a higher assessment grade. Free-text data highlight reasons for lack of clinical experience that may impact perceived confidence.ConclusionsThe document listing competencies for medical students and educators is useful for discussions around a national curriculum in obstetrics and gynaecology in medical schools, including the best methods of delivery, particularly in the context of increasing student numbers.

Innovation in internship preparation: an operative anatomy course increases senior medical students' knowledge and confidence

BackgroundAn operative anatomy course was developed within the construct of a surgical internship preparatory curriculum. This course provided fourth-year medical students matching into a surgical residency the opportunity to perform intern-level procedures on cadavers under the guidance of surgical faculty members. MethodsSenior medical students performed intern-level procedures on cadavers with the assistance of faculty surgeons. Students' confidence, anxiety, and procedural knowledge were evaluated both preoperatively and postoperatively. Preoperative and postoperative data were compared both collectively and based on individual procedures. ResultsStudent confidence and procedural knowledge significantly increased and anxiety significantly decreased when preoperative and postoperative data were compared (P < .05). Students reported moderate to significant improvement in their ability to perform a variety of surgical tasks. ConclusionsThe consistent improvement in confidence, knowledge, and anxiety justifies further development of an operative anatomy course, with future assessment of the impact on performance in surgical residency.

Teaching Cricothyrotomy: A Multisensory Surgical Education Approach for Final-Year MedicalStudents

This study sought to evaluate the efficacy of a multisensory teaching approach in imparting the necessary knowledge, technical skills, and confidence to perform a cricothyrotomy to a cohort of fourth-year medical students. One hundred twenty students were recruited into the study. Subjects commenced by viewing an upper airway obstruction vodcast. Students subsequently observed an expert demonstration of cricothyrotomy on human cadavers. Following this, students were able to practice on cadaveric simulators guided by experts. The students' confidence was assessed with pre- and post-session confidence-level questionnaires. Thirty randomly selected students were then assessed with a post-session objective skill assessment test. Finally, a multiple choice examination was administered to test knowledge. Ninety-five percent of student subjects achieved a score of at least 80% on the knowledge examination. All sampled students were considered competent to perform cricothyrotomy as judged by 2independent expert observers using the objective skill assessment test instrument. There was a statistically significant improvement between the pre- and post-CLQ scores (p<0.001). In keeping with current education theories on multisensory learning, qualitative feedback suggested a student preference for this teaching approach. This study provides further evidence that a multisensory teaching intervention effectively improves the knowledge, skill, and confidence of fourth-year medical students in performing cricothyrotomy.

1013 Simba Study: Undergraduate Module in Simulation Training and Basic Life Support to Improve Undergraduate Confidence in Paediatrics

There are significant differences in resuscitation algorithms for children versus adults. We aimed to enhance confidence of our students in the assessment and management of sick children by developing a...

1012 The Perception and Impact of a ‘Breaking Bad News’ Module on Paediatric Medical Students

BackgroundAlthough, communication is an integral part of medical practice, it is also the source of 20–50% of patient complaints. Breaking bad news is a challenge across all disciplines yet little...

Lumbar Puncture Simulation Training Improves Medical Student Knowledge and Confidence (P06.027)

Objective: Investigation into whether lumbar puncture training with a simulator improves confidence and knowledge in medical students during a neurology clerkship. Background Patients typically are apprehensive about undergoing a lumbar puncture. A physician9s ability to understand and explain the procedure with confidence results in reassurance and acceptance of the procedure by the patient. Practice on models has been shown in other specialties to improve outcomes, performance and confidence of practitioners. Design/Methods: Medical students during the neurology rotation were surveyed on their perspective on lumbar puncture simulation. Using six questions on a Likert scale ranging from 1-5 (5 being expert, 1 being unconfident, score total 30) medical students were surveyed before and after their use of a lumbar puncture simulator. Results: A total of 17 students were surveyed (11 MSIII and 6 MS IV). All students recorded an increase in confidence after use of the simulator. Typically fourth year students were confident at baseline than third year students (13/30; 11/30) with greatly improved scores in comfort levels after use of the simulator (21/30, 22/30). Additional comments were all positive and students felt more prepared for the wards. Conclusions: Medical students find the lumbar puncture simulation training useful. It increases their levels of confidence and understanding of the indications and risks and benefits of the procedure. Further study into the translation of simulation expertise to positive procedure outcome will be explored. Disclosure: Dr. Westwood has nothing to disclose. Dr. Hohler has received personal compensation for activities with Teva Neuroscience as a speaker.

Integrated approach to training of medical students for chronic care of diabetes - an educational intervention project experience from MIMS, Mandya, Karnataka

Back Ground: Nearly 51 million Indians are living with diabetes in India. With an estimated three fold rise in the prevalence of diabetes over the next 25 years, it is important that we plan ahead and make strategic changes, embarking seriously on capacity building of medical students for chronic care of diseases like diabetes. Objective: To assess the effectiveness of an integrated training workshop for chronic care of diabetes among medical students of MIMS, Mandya. Methodology: Three days intensive integrated training workshop was conducted for 30 randomly selected MBBS Phase III – Part I students with must know aspects of Diabetes using the World Health Organization’s Integrated Management of Adult and adolescent Illnesses (IMAI) model of chronic care, based on 5A’s (Assess, Advice, Agree, Assist and Arrange) and TEAM-P (Triage, Education, Assessment, Management and support for Positive living) approach. Written, structured pre-test, post test and feedback from the students was taken and the observations are being presented in this paper. Results: There was significant increase in the mean scores from 14.96 (S.D. = 4.66, 99% C.I = 12.62-17.30) to a post test score of 26.76(S.D. = 3.21, 99% C.I = 25.16-28.36), p<0.00001. 5A’s and TEAM –P approaches were easy to remember and practice. Conclusion: An integrated training workshop is effective in increasing the knowledge, understanding and confidence of medical students, and thus molding them in handling the patients of diabetes for continuum of care.

Maturation of medical student musculoskeletal medicine knowledge and clinical confidence

Purpose: Despite the prevalence of musculoskeletal (MSK) disorders, the degree to which medical schools are providing students the knowledge and confidence to treat these problems is unclear. This study evaluated MSK knowledge in second and fourth year medical students using a newly developed written assessment tool and examined the maturation of clinical confidence in treating core MSK disorders.Methods: Over a 3-year period, the National Board of Medical Examiners (NBME) MSK subject examination consisting of 75 items was administered to 568 second and fourth year students at a single institution. Students were also asked to rate their confidence in treating a selection of medicine/pediatric and MSK clinical scenarios on a 5-point Likert scale.Results: Participation rate was 98%. The NBME MSK assessment score was 59.2±10.6 for all second year medical students and 69.7±9.6 for all fourth year medical students. There was a significant increase in NBME scores between the second and fourth years (p<0.0001). Students were more confident in treating internal medicine/pediatric conditions than MSK medicine conditions (p=0.001). Confidence in treating MSK medicine conditions did not improve between the second and fourth years (p=0.41).Conclusions: To our knowledge, this is the first study to report increased MSK medicine knowledge as measured by a standardized examination after completing medical school core clinical rotations. Despite increased MSK knowledge, low levels of MSK clinical confidence among graduating students were noted. Further research is needed to determine the factors that influence MSK knowledge and clinical confidence in medical students.

Pre-clerkship Preparation from Live Patient Practice Pelvic Examinations

Our previous survey found students perceived live patient practice pelvic examinations (PPE) helpful for clinical rotations. Therefore, we wanted to follow up after Obstetrics and Gynecology (Ob/Gyn) rotations to determine if the experience was truly preparatory. This study tested the hypothesis that practice pelvic examinations on a live teaching patient during the pre-clinical medical school curriculum increases students’ knowledge, confidence and comfort during the clinical years Ob/Gyn clerkships. Questionnaires were emailed to third and fourth year medical students. Sixteen questions were asked related to demographics, pelvic examination experience, and perceptions regarding experience during Ob/Gyn clerkship. Data were collected and descriptive statistics generated. Ninety-seven students (28%) completed the survey (36 male, 61 female). As a result of the PPE experience with a live teaching patient, 96% students felt prepared for their first pelvic examination during rotations. During rotations, 91% students felt more confident/comfortable performing their first examination; 92% indicated knowing what (and how) to tell the patient about the examination; 92% knew how to hold a speculum; 91% knew how to bimanually locate the cervix. Additionally, 92% students would feel confident/capable performing a pelvic examination, without physician assistance. Furthermore, 95% students agreed/strongly agreed that the teaching patient pelvic examination experience during pre-clinical medical school curriculum helped prepare them for clinical rotations. Results indicate that PPEs, utilizing a live teaching patient, improve medical student confidence and comfort during this examination in clinical clerkships. By alleviating anxiety during sensitive examinations, this experience will improve the clinical experience of medical students, physicians, and patients.

Simulation Training in an Obstetric Clerkship

To estimate the effect of simulation training on the confidence of medical students to perform a vaginal delivery. Medical students on 12 consecutive rotations were recruited and randomly assigned to a traditional lecture on performing a vaginal delivery or a lecture plus hands-on vaginal delivery simulation. Participants completed confidence assessment questionnaires at baseline and 4 weeks after training. End-of-rotation examination scores were also compared. One-hundred thirteen students participated (94.9% of those eligible). Students receiving simulation training were significantly more confident in their ability to perform a vaginal delivery immediately after assessment than students who did not receive the simulation training (P<.01); however, these differences narrowed over time. Compared with lecture-only students, simulation students scored significantly higher on their oral (P=.004) and written examinations (P=.009) 4 weeks after the intervention. A single obstetric simulation is more effective than lecture only for increasing students' end-of-rotation oral and written examination scores. I.

Effects of a Ninety-Minute Teaching Module for Fourth-Year Medical Students on a Palliative Care Ward with Student–Patient Encounter

The encounter of students and patients with a terminal illness plays an important role in this teaching. However, for ethical as well as practical reasons, there are limitations regarding the involvement of patients in palliative care teaching. In this study we investigate the effects of an obligatory 90-minute teaching intervention on a palliative care ward by means of quantitative and qualitative methods. Self-perceived knowledge, confidence and attitudes were elicited by means of a questionnaire which has been developed by the authors. The instrument includes statements which could be answered by means of numerical rating scales - NRS (1 = very low, 10 = very high). In addition, open-ended questions regarding students' self-perceptions and evaluation of the teaching were analyzed according to the principles of content analysis. All 163 participants completed the questionnaire. Participants rated their knowledge in palliative care as poor prior to the course (median, 3). Medical students indicated significantly improved confidence regarding the encounter with patients in palliative care (p < 0.001; median, 3 before versus 5.5 after), and higher interest for the subject of palliative care (median 7 before vs. 8 after). The student-patient encounter could be identified as a relevant factor contributing to the positive evaluation as part of the analysis of qualitative data. This evaluation study of an obligatory course in palliative care indicates that even a short teaching module that includes a student-patient encounter has significant effects on the medical students' self-perceived knowledge, confidence and attitudes, and their interest in palliative care.

Mannequin Simulation Improves the Confidence of Medical Students Performing Tube Thoracostomy: A Prospective, Controlled Trial

This study was undertaken to determine the educational benefits of mannequin simulation for performance of tube thoracostomy in a porcine model by medical students. Thirty medical students were randomized into two groups; the first performed tube thoracostomy on a mannequin simulator and then a porcine model; the second used only the porcine model. Performance measures included completion of subtasks, time to perform the procedure, a global score assigned by faculty raters, and a self-evaluation survey. Subtask completion rate was similar in both groups (P > 0.05). Mean time to perform the procedure was 9.8 minutes (+/- 0.9, simulator), and 9.3 minutes (+/- 1.0, nonsimulator, P > 0.05). Global scores were 12.3 (+/- 1.3, simulator) and 11.0 (+/- 1.4, non-simulator, P > 0.05). Self-evaluation of confidence (1 = "very", 7 = "not at all") showed the simulator group was significantly more confident (3.4 +/- 0.42) than the nonsimulator group (4.7 +/- 0.49, P < 0.05). All students met basic competencies to perform tube thoracostomy. The simulator group felt significantly more confident to subsequently perform the procedure on a patient, whereas performance was not statistically significantly different for the two groups. Further trials may be needed to delineate the optimal role for these simulators in teaching tube thoracostomy.

Effects of the Emergency Trauma Training Course on the Confidence of Final-Year Medical Students Dealing with Trauma Patients

Trauma is an important issue that has been neglected in the training of medical students. This study evaluated the effects of the Emergency Trauma Training Course (ETTC), after completion of standard medical training, on seventh-year medical students. The ETTC was designed in Taiwan by the Taiwan Society of Emergency Medicine to train physicians and registered nurses who care for trauma patients in the emergency department (ED). We implemented the course for our medical students' internship. One hundred and fifty-one participants were divided into three groups: Group A included 36 medical students before they entered their internship in hospital; Group B included 41 medical students who had received 6 months of internship training in hospital; and Group C included 74 ED nurses. Group C was used to test Cronbach's alpha coefficient of the questionnaire. After the training course, the participants had a final examination and filled out a questionnaire about the training course and their levels of self-confidence. There were no differences in scores between the medical students in Groups A and B (p = 0.064). Using repeated measures analysis of variance, we found that confidence before training was low, with no difference between Groups A and B. Confidence improved after training, but there was still no significant difference between the groups (p = 0.875). However, there were significant differences between confidence levels before and after the training course (p < 0.001). Therefore, although inhospital training for 6 months failed to increase confidence, the confidence of final year medical students after completion of their training was improved by the ETTC. This indicates that the ETTC could increase the confidence of participants. This is the first evaluation of the implementation of the ETTC for final-year medical students in Taiwan. Based on our results, we highly recommend that this training course be taught to final-year medical students before they practice in hospital.

Simulation Training Improves Medical Students’ Learning Experiences When Performing Real Vaginal Deliveries

To determine the relationship between simulation training for vaginal delivery maneuvers and subsequent participation in live deliveries during the clinical rotation and to assess medical students' performance and confidence in vaginal delivery maneuvers with and without simulation training. Medical students were randomized to receive or not to receive simulation training for vaginal delivery maneuvers on a mannequin simulator at the start of a 6-week clerkship. Both groups received traditional didactic and clinical teaching. One researcher, blinded to randomization, scored student competence of delivery maneuvers and overall delivery performance on simulator. Delivery performance was scored (1-5, with 5 being the highest) at weeks 1 and 5 of the clerkship. Students were surveyed to assess self-confidence in the ability to perform delivery maneuvers at weeks 1 and 5, and participation in live deliveries was evaluated using student obstetric patient logs. Thirty-three students were randomized, 18 to simulation training [simulation group (SIM)] and 15 to no simulation training [control group (CON)]. Clerkship logs demonstrated that SIM students participated in more deliveries than CON students (9.8 +/- 3.7 versus 6.2 +/- 2.8, P < 0.005). SIM reported increased confidence in ability to perform a vaginal delivery, when compared with CON at the end of the clerkship (3.81 +/- 0.83 versus 3.00 +/- 1.0, respectively, P < 0.05). The overall delivery performance score was significantly higher in SIM, when compared with CON at week 1 (3.94 +/- 0.94 versus 2.07 +/- 1.22, respectively, P < 0.001) and week 5 (4.88 +/- 0.33 versus 4.31 +/- 0.63, P < 0.001) in the simulated environment. Students who receive simulation training participate more actively in the clinical environment during the course of the clerkship. Student simulation training is beneficial to learn obstetric skills in a minimal risk environment, demonstrate competency with maneuvers, and translate this competence into increased clinical participation and confidence.

The Relationship Between Medical Students' Knowledge, Confidence, Experience, and Skills Related to Colorectal Cancer Screening

Medical student colorectal cancer prevention education is crucial to improving cancer screening rates. We surveyed 146 medical students about their knowledge, confidence, and experience with colorectal cancer screening. We then used a multivariate general linear model to assess the relationships between these variables and colorectal cancer screening skills as measured in a standardized patient evaluation. Type and amount of experience providing colorectal cancer screening counseling predicted student performance in the standardized patient encounter, although knowledge and confidence did not. Increased practice performing cancer screening may improve medical students' ability to implement cancer prevention strategies with patients.

Medical student gender and issues of confidence

Objective To review the literature on gender differences and issues of self-confidence in medical students and to present original research on observers’ perceptions of medical student confidence. Methods One hundred forty-one 3rd year medical students at Indiana University School of Medicine were videotaped during their objective structured clinical examination (OSCE). Trained coders rated how confident the student appeared and coded a variety of nonverbal behaviors at the beginning, middle, and end of the interaction. Analysis focused on gender differences in coders’ ratings of perceived confidence. Results Female medical students were viewed as significantly less confident than male medical students ( F(1,133) = 4.45, p < 0.05), especially at the beginning of the interaction. Conclusion Past research indicates that despite performing equally to their male peers, female medical students consistently report decreased self-confidence and increased anxiety, particularly over issues related to their competence. In a standardized patient interaction examination situation, female medical students also appeared significantly less confident than male medical students to independent observers. Practice implications Medical educators should focus on issues of female students’ confidence, increasing faculty sensitivity, and publicly recognizing and discussing perceptions of confidence.

Improving medical students' success in promoting health behavior change: a curriculum evaluation.

Effective behavior change counseling is an important component of the optimal care of patients, yet only a minority of medical schools currently include such training in their curriculum. To design and evaluate a formal curriculum to teach medical students the principles of motivational interviewing (MI) that will improve knowledge, skills, and confidence in the area of counseling patients for health behavior change. Fifty-three 3rd year medical students at the University of California, San Diego. A 4-week curriculum consisting of four 2-h sessions, in a small group format (8-12 students). Educational strategies included a combination of short didactics, video demonstrations, small group role plays, and interactive exercises. Students completed identical pre- and post-assessments, consisting of a questionnaire measuring confidence and knowledge, and a performance assessment using the Video Assessment of Simulated Encounters-Revised (VASE-R) tool. Knowledge improved significantly (pre-mean: 7.04, post-mean: 11.54; P < 0.001), as did skill development (pre-mean: 7.02, post-mean: 9.47; P < 0.001). Student satisfaction with behavior change counseling training improved from 3.6 to 8.1 (P < 0.001). Students were significantly more confident (P < 0.001) in their abilities to assess a patient's readiness for change and counsel the patient on behavior change after the course. Participation in a focused curriculum on the use of motivational interviewing techniques significantly improved 3rd year medical students' knowledge, confidence, and skills in the area of behavior change counseling. These gains may help students succeed in promoting good health habits in their future patients.

Does ultrasound training boost Year 1 medical student competence and confidence when learning abdominal examination?

Learning to perform physical examination of the abdomen is a challenge for medical students. Medical educators need to find engaging, effective tools to help students acquire competence and confidence in abdominal examination techniques. This study evaluates the added value of ultrasound training when Year 1 medical students learn abdominal examination. The study used a randomised trial with a wait-list control condition. Year 1 medical students were randomised into 2 groups: those who were given immediate ultrasound training, and those for whom ultrasound training was delayed while they received standard instruction on abdominal examination. Standardised patients (SPs) used a clinical skills assessment (CSA) checklist to assess student abdominal examination competence on 2 occasions - CSA-1 and CSA-2 - separated by 8 weeks. Students also estimated SP liver size for comparison with gold-standard ultrasound measurements. Students completed skills confidence surveys. Proficiency in abdominal examination technique acquired from traditional instruction boosted with ultrasound training showed no advantage at CSA-1. However, at CSA-2 the delayed ultrasound training group showed significant improvement. Students uniformly underestimated SP liver sizes and the estimates were not affected by ultrasound training. Student confidence in both groups improved from baseline to CSA-1 and CSA-2. Ultrasound training as an adjunct to traditional means of teaching abdominal examination improves students' physical examination technique after students have acquired skills with basic examination manoeuvres.