COMMENTARY

Confidence Crisis: Is It Okay to Admit What You Don't Know?

Shiv M. Gaglani

Disclosures

October 02, 2018

In a recent thoughtful and nuanced piece in the Annals of Internal Medicine, Emory University medical student Nicole Treadway writes about the role that confidence plays in doctoring. She describes how certainty can be valued in and of itself on the wards, and reflected on whether this should be the case, given the evolving patient-clinician relationship: "I wonder whether speaking with confidence should be a highly prioritized skill. Proponents of a 'partner in health' model of care embrace a clinical relationship with patients that is characterized by nuanced discussion of medical uncertainty."

Assessing Your Calibration

During medical and business school, I also encountered situations that reminded me of the oft-cited saying about surgeons (which applies equally to some business leaders): "Sometimes wrong, never in doubt." For example, in a commentary with Eric Topol for Academic Medicine, I described a clinical training session in which numerous students confidently told their attendings that they were able to see an optic disc using an ophthalmoscope. However, those same students later privately admitted to classmates that they weren't actually able to see the disc; they had only said they did to avoid "looking and feeling stupid." Treadway articulately captures the problem with this behavior by writing, "[I]f students do not utilize moments of uncertainty to receive clarification or ask follow-up questions for fear of betraying a lack of confidence, they may not learn as effectively or act as precisely."

As a future clinician, as well as cofounder of Osmosis.org—a health education organization with more than 40 people—I have been intrigued by the relationship between confidence and accuracy, also known as "calibration," for some time. At Osmosis, we are trying to help our teammates become more self-aware of their calibration so that they can ask for help when needed, as well as speak up when they have something genuine to contribute. This interplay between confidence and competence often comes up during hiring and promotion discussions.

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