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Does ‘online confidence’ predict application success and later academic performance in medical school? A UK-based national cohort study
  1. Paul A Tiffin1,2,
  2. Lewis W Paton1
  1. 1 Department of Health Sciences, University of York, York, UK
  2. 2 Health Professions Education Unit, Hull York Medical School, Heslington, UK
  1. Correspondence to Dr Paul A Tiffin; paul.tiffin{at}


Objectives The UK Clinical Aptitude Test (UKCAT) previously piloted an assessment of ‘online confidence’, where candidates were asked to indicate how confident they were with their answers. This study examines the relationship between these ratings, the odds of receiving an offer to study medicine and subsequent undergraduate academic performance.

Design National cohort study.

Setting UK undergraduate medical selection.

Participants 56 785 UKCAT candidates who sat the test between 2013 and 2016 and provided valid responses to the online confidence pilot study.

Primary outcome measures Two measures of ‘online confidence’ were derived: the well-established ‘confidence bias’, and; a novel ‘confidence judgement’ measure, developed using Item Response Theory in order to derive a more sophisticated metric of the ability to evaluate one’s own performance on a task. Regression models investigated the relationships between these confidence measures, application success and academic performance.

Results Online confidence was inversely related to cognitive performance. Relative underconfidence was associated with increased odds of receiving an offer to study medicine. For ‘confidence bias’ this effect was independent of potential confounders (OR 1.48, 1.15 to 1.91, p=0.002). While ‘confidence judgement’ was also a univariable predictor of application success (OR 1.22, 1.01 to 1.47, p=0.04), it was not an independent predictor. ‘Confidence bias’, but not ‘confidence judgement’, predicted the odds of passing the first year of university at the first attempt, independently of cognitive performance, with relative underconfidence positively related to academic success (OR 3.24, 1.08 to 9.72, p=0.04). No non-linear effects were observed, suggesting no ‘sweet spot’ exists in relation to online confidence and the outcomes studied.

Conclusions Applicants who either appear underconfident, or are better at judging their own performance on a task, are more likely to receive an offer to study medicine. However, online confidence estimates had limited ability to predict subsequent academic achievement. Moreover, there are practical challenges to evaluating online confidence in high-stakes selection.

  • medical education & training
  • statistics & research methods
  • education & training (see medical education & training)

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  • Contributors PAT lead on study conception, data analysis and drafting the manuscript. LWP contributed to data analysis, interpretation and drafting the manuscript. Both authors approve the manuscript and agree with its submission to BMJ open. Both authors agree to be accountable for all aspects of the work.

  • Funding PAT receives funding for his academic time via an NIHR Career Development Fellowship. This paper represents independent research part-funded by the National Institute for Health Research (NIHR). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. The UKCAT Board provided funding for a portion of LWP’s time on this project.

  • Competing interests PAT has previously received research funding from the ESRC, the EPSRC, the Department of Health for England, the UKCAT board and the GMC. In addition, PAT has previously performed consultancy work on behalf of his employing University for the UKCAT Board and Work Psychology Group, and has received travel and subsistence expenses for attendance at the UKCAT Research Group. LWP has received travel and subsistence expenses for attendance at the UKCAT consortium meeting. The UKCAT Board partly funded this research but did not take an active role in determining the study design or reporting the results.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval for this study was not required as it relied on the analysis of de-identified routinely collected data. This was confirmed in writing by Durham University’s School for Health Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement The data used in this study may be made available from UCAT on an application being approved by the UCAT Board.

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