The Incidence of Overconfidence and Underconfidence Effects in Medical Student Examinations

BACKGROUND

Overconfidence is the tendency to overestimate the knowledge, capacity, or performance one really possesses. This cognitive bias could be potentially dangerous in medical decision-making, considering the impact it could have on patient health care. The aim of this study was to evaluate the incidence of overconfidence and underconfidence in medical student knowledge on general surgery by using traditional and new statistical approaches.

METHODS

During the application of a multiple-choice examination, 251 next-to-graduate medical students were invited to express the accuracy of their responses by choosing their own perceived confidence level for a set of questions. Analysis was done by comparing the difference between percentage of right answers (student's actual knowledge or accuracy) and self-estimated confidence level (student's perceived knowledge or confidence). Overconfidence was defined as a positive difference between confidence and accuracy, and underconfidence as a negative difference.

RESULTS

Nearly 12% of students showed significant overconfidence regarding their actual knowledge or accuracy levels. Better students showed a lower overconfidence effect than students with poorer performance. On the other hand, underconfidence was less likely than overconfidence (8.3% of students), and that effect was most frequently found in students who performed better in examinations.

CONCLUSIONS

The small proportion of our students exhibiting overconfidence or underconfidence behaviors moderates the need for educational interventions. Nevertheless, promoting prudence in individualized students manifesting overconfidence, and trust in those reporting significant underconfidence could increase the reliability of medical judgment during their future professional life. Overconfidence in individuals with lower scores in examinations may depend on a ceiling-like effect, since worst ranked students have a wider upper margin to manifest their confidence perceptions. The most confident students showed higher scores in examinations than the less confident ones. From this point of view, confidence could be considered an essential ingredient of success in examination performance.

Unlicensed residential programs: the next challenge in protecting youth

Over the past decade in the United States, the number of private residential facilities for youth has grown exponentially, and many are neither licensed as mental health programs by states, nor accredited by respected national accrediting organizations. The Alliance for the Safe, Therapeutic and Appropriate use of Residential Treatment (A START) is a multi-disciplinary group of mental health professionals and advocates that formed in response to rising concerns about reports from youth, families and journalists describing mistreatment in a number of the unregulated programs. This article summarizes the information gathered by A START regarding unregulated facilities. It provides an overview of common program features, marketing strategies and transportation options. It describes the range of mistreatment and abuse experienced by youth and families, including harsh discipline, inappropriate seclusion and restraint, substandard psychotherapeutic interventions, medical and nutritional neglect, rights violations and death. It reviews the licensing, regulatory and accrediting mechanisms associated with the protection of youth in residential programs, or the lack thereof. Finally, it outlines policy implications and provides recommendations for the protection of youth and families who pursue residential treatment.

Ethics Content in Nursing Education: Pondering with the Possible

Accrediting bodies of nursing as well as other healthcare organizations require that nursing ethics content be incorporated in programs of study. How does nursing define the termnursing ethics? How is it distinguished or viewed in various levels of higher degree nursing education? What is the role of codes for nursing? These are but a few of the questions pondered in the following article that includes personal correspondence with two distinguished authors, educators, and consultants for biomedical ethics, Dr. Sara T. Fry and Dr. Nancy Berlinger of the Hastings Center.

Current guidelines regarding industry-sponsored continuing medical education

The importance of continuing medical education has been long recognized by the orthopaedic profession as vital in maintaining a current knowledge and skills base. There has been increasing concern over the expanding involvement of industry in sponsoring continuing medical education. Concomitant with rising costs of medical education is a decreasing source of funds from government and other sources; therefore industry has taken an active role in sponsoring continuing medical education, leading to a potential for serious conflict of interest. National and federal guidelines have been created to allow commercial sponsorship, yet leave the responsibility for the design, faculty, and content to the accredited provider. The guidelines are intended to prevent bias, keep commercial displays separate from educational presentations, and clearly state that industry-sponsored events should be primarily educational in nature and directly benefit the patient. Because of the potential conflict inherent within industry-sponsored continuing medical education, a cooperative relationship between educators, industry, and attendees of educational activities must be achieved to prevent bias and to keep the patient's best interest as paramount. Each orthopaedic surgeon has an ethical obligation to resolve any conflicts of interest in the best interest of the patient.