Medical undergraduates' competence and confidence in basic life support skills: an observational study of subjective and objective assessments

Introduction: Competency in cardiopulmonary resuscitation (CPR) skills is essential for all graduating doctors. However there are several challenges to educators in ensuring this skill which is practised in a simulated environment is transferred to the reality of practice particularly in the stressful situation of a cardiac arrest when both technical and non technical skills are required. In addition for newly qualified doctors there is the issue of confidence to consider. BLS and ALS are essential skills which every medical student should possess and in virtually all medical schools the OSCE is used to assess the technical component. This study focused on whether students were able to self assess their level of both competence and confidence prior to being externally assessed as part of an OSCE examination on CPR. We then looked at the correlation between perceived confidence and competence levels, and also at the correlation between perceived competence and actual competence as assessed by OSCE examination.
Methods: Students in years 2, 3 and 4 completed a Candidate Self Assessment Sheet prior to entering the CPR OSCE station. They graded their responses on a Likert scale from 1-5, which was used to measure perceived confidence and perceived competence. These results were then entered onto Excel sheets and a correlation co-efficient established for each set of data. The OSCE results were then also entered on the data sheet and the correlation factor established for the relationship between perceived competence and observed competence.
Results: The majority of the results showed a moderate correlation between perceived confidence and perceived competence. This did not vary with progression through the curricular programme. There was no correlation between perceived competence and observed competence in any of the year groups. The other noticeable factor observed was that the student’s self-assessment was consistently lower than the marks awarded at OSCE.
Discussion: The fact that there was a moderate correlation between self assessed confidence and self assessed competence suggests that their self assessment depends on how confident they are feeling at the time of assessment. The fact that they were being asked to self assess during an OSCE examination may have contributed to their low perceived confidence and competence. It is difficult to interpret whether the stress of an exam situation is similar to that of a cardiac arrest. The external assessments produced higher marks compared to students self assessment demonstrating students have difficulty accurately self assessing themselves at this early stage of their clinical experience.