Looking at the Concept of “Confidence” in Feedback

Sonia Ananthakrishnan and Craig Noronha

Department of Medicine, Boston University School of Medicine

Learning Objectives:

Appreciate the varied meanings and potential negative impact of the word “confidence” in the context of feedback of trainees
Apply behavior-based language in feedback that allows for actionable changes and avoids ambiguity engendered by the term “confidence”

Background and Rationale

Feedback is a valuable tool used to describe an individual’s performance in a specific activity, with the intention of guiding future performance. A common characteristic that is frequently discussed in feedback exchanges is a supervisor’s perception of a trainee’s confidence. Concerns have been raised both at the local and national level regarding the potential negative effects of the word confidence in medical education. The word confidence can have multiple meanings to both the giver and receiver in feedback. Complexity around perceived meanings of the word “confidence” may be derived from cultural, gendered, and racial biases. In addition, other factors that can complicate the interpretation of confidence in feedback include academic hierarchy, perceptions around team and leadership skills, clinical setting, or an individual’s personality traits.

At Boston University Medical Campus, we obtained pilot data from a survey administered to DOM Internal Medicine residents (n=31) that indicated 66.67% of residents have received feedback about their level of confidence demonstrated in the clinical setting. But over 70% of residents surveyed felt that the feedback they were receiving was actionable less than half the time. A theme emerging from the pilot data indicates frustration and ambiguity, as represented by a sample quote from a respondent on how they interpreted the feedback about confidence “Offensive – told to be more confident, but if I am too confident it is interpreted as arrogance.”

The purpose of this seminar is to improve the knowledge, skills and attitudes of faculty who are student, resident and fellow supervisors around use and impact of the word “confidence” in feedback exchanges. The presenters will lead a case-based interactive discussion for attendees to gain a better understanding of why the word “confidence” is used in feedback and how it may be interpreted by trainees. Strategies on how to move past use of the word “confidence” to provide more specific, behavioral based feedback will be reviewed.

The seminar will review recent literature that highlights potential biases in medical education and how the word “confidence” may be misused in this context. Discussions will also illustrate the potential impact that word “confidence” has on our trainees.
There has been a larger focus within medical education for learning tolerance for ambiguity within medical decision making and this seminar will highlight that the successful learner can balance medical uncertainty with communicating effectively and providing a high level of care.

Online Facilitation

This session will include large group didactic, small group break out sessions, sharing of case-based materials, and poll and chat features to support attendee engagement.