gms | German Medical Science

Introduction: The purpose of this study is to evaluate if measuring students’ confidence may provide useful information and if it is influenced by patient safety, ambition level and question type.

Methods: Two reviewers rated question’s ambition complexity (low, medium, high), potential patient hazard (not relevant, risky to harmful) and question type in a blueprint model. 89 students participated in a 30 SCQ neurology exam and indicated their confidence status (CS) as very sure, sure, unsure or very unsure for each answered SCQ. Correct SCQ were classified as informed if CS was very sure or sure, or guessed if CS was unsure or very unsure. Incorrect responses were classified as misinformed if CS was very sure or sure and in uninformed if CS was unsure or very unsure. Additionally, sex, age and previous experience were assessed. Epidemiological data and mean confidence differences were analysed with linear regression model and repeated measure ANOVA.

Results: A total of 2670 responses were analysed and 1806 (68%) were classified as informed, 634 (24%) as guessed, 168 (6%) as uninformed and 62 (2%) as misinformed. Lower age (p=0.014) and male gender (p=0.004) had significant increasing influence on confidence. Mean confidence was not significantly associated with previous experience in neurology but was significantly higher (p<0.001) in negative SCQ comparing to positive SCQ (p<0.001). Mean confidence was significantly lower in new SCQ (p<0.001) than in SCQ used in prior exams, and significantly lower in SCQ with higher ambition level (p=0.001). Students did not show lower confidence in SCQ which might result in harmful patient hazard.

Discussion: Students’ CS allows to detect informed, guessed, misinformed and uninformed responses. CS is influenced by age, sex, ambition level and question type. Contrary to expectations, CS is not decreasing in questions which may contain potentially harmful facts.