COMMENTARY

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

Shiv M. Gaglani

Disclosures

October 02, 2018

The Confidence Gender Gap

Given this long-standing interest in the topic, the Osmosis team wanted to see whether we could quantify calibration and feed that information back to users of our learning platform. Our first innovation in this area, dating back to 2011, was to ask our users for their confidence before they answered a flashcard or question, using a three-point scale: "I'm sure," "I'm feeling lucky," or "No clue."

Our adaptive algorithm uses their confidence, accuracy, and elapsed time to determine when to show the question again. For example, if someone answers a question correctly with a "No clue" confidence level, they were probably guessing and need to be quizzed on that concept again; conversely, if someone answers with an "I'm sure" confidence level and is incorrect, they need to see that item immediately to correct a misconception before it becomes ingrained.

In 2015, we analyzed data from more than 1000 of our learners who had answered items more than 600,000 times. Corroborating numerous studies showing a gender gap in confidence, we found that male medical students answered using the "I'm sure" option at a significantly higher rate than female medical students (44.4% vs 39.5%; P < .001), even though female students actually answered questions correctly more often (61.4% vs 60.3%; P = .040). We published this short report in the Annals of Internal Medicine with the concluding thoughts that "new educational interventions like the Calibration Index may help future physicians align confidence with accuracy to improve patient care and promote career advancement."

Medicine requires its practitioners to be self-aware, self-directed, lifelong learners because the information is vast, dynamic, and high-stakes. It is critical that providers not only understand the limits of one's knowledge and skills but also recognize when it's important to convey genuine expertise to provide the best care and comfort to patients. Conversations such as the one Treadway initiated can help us make progress toward this goal.

Shiv Gaglani is a medical student at Johns Hopkins and the cofounder and CEO of Osmosis.org, a health and medical education company with an audience of more than 750,000 current and future health professionals.

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