Annals of Internal Medicine | 2019
A Student Reflection on Doctoring With Confidence
Abstract
TO THE EDITOR: Treadway s commentary (1) opened our eyes to the possibility that we are unwittingly treating learners differently on the basis of gender. We also agree with the author that discussing our own uncertainty among ourselves is as important as doing so with our patients. Further, as medical educators who have told learners countless times to present with confidence, we became curious how these learners might be perceiving and interpreting this feedback. The burden of clarity in setting expectations falls on us as educators, andas Treadway makes clearwe have been missing the mark. For example, an intern who recently was told to be confident responded, So, you want me to speak confidently even if I have no idea what I m doing? Educational literature tells us that the greatest learning takes place when it is effortful and exposes us to the concepts that we do not recognize that we do not know (2). We contend that it takes place when students come to their own decisions and reasoning (by, for example, taking a stand or putting their money down). This is true evenand, we would argue, especiallyif these students are wrong, as long as they are corrected and receive an explanation why (3). Within the context of Treadway s commentary, the response of the intern whom we previously mentioned made us realize that we should not be using the word confidence in this setting. Instead, we should set an expectation for our learners to make a commitment to their plans rather than just present with confidence. Establishing this as a consistent expectation would be far more clear, effective, and equitable than providing the individualized and general feedback to be more confident after the fact. When setting expectations with future learners, we aim to say, I want you to commit to a diagnostic and management plan. I promise I will not let you enact a plan that I know to be wrong or harmful to our patients. However, to help you grow, you need to come to your own decision about diagnostic possibilities and next steps. You do not need to be right, but you do need to have a well-formed opinion. Consistent with Treadway s assertions about the value of discussing uncertainty, we believe that a learner s commitment to a plan should be the beginning of the conversation rather than the end. The clarity of our language matters. We and perhaps others have used the wrong terminology when telling learners to speak with confidence. We are curious about Treadway s thoughts on our suggested approach. We are also curious how she believes we can best achieve our mutual goals of realizing gender equity and encouraging discussions about uncertainty while still requiring commitment.