Longitudinal assessments use spaced repetition of items to facilitate learning. Algorithms selecting repetition items can prioritize various properties for future presentation. The purpose of this pilot study was to evaluate the relationship between participant ratings of item-specific confidence and/or practice relevance and participant age, sex, and response correctness. This is a prospective quality improvement study of 403 American Board of Physical Medicine and Rehabilitation diplomates with time-limited certificates. Participants answered 20 items quarterly over four quarters, rating each item on its relevance to their practice and their confidence in their response. The relationship between sex and ratings of response confidence was significant, with women less likely than men to be confident in their responses, regardless of correctness. Younger physicians were significantly more confident in their responses and rated items as more practice relevant. Women physicians were less confident than men in their item-specific confidence ratings, regardless of correctness, on the American Board of Physical Medicine and Rehabilitation continuing certification longitudinal knowledge assessment. Older physicians were less confident in their responses than younger physicians. The findings supported the American Board of Physical Medicine and Rehabilitation prioritization of response correctness and practice relevance, rather than response confidence, to select items for spaced repetition in American Board of Physical Medicine and Rehabilitation's continuing certification longitudinal assessment.