Figure 5.1 The Dunning‐Kruger effect. (a): The unbiased relationship between the confidence or perceived ability and performance or actual ability is represented by a linear line. Imposter syndrome is a component of Dunning‐Kruger effect, in which a highly performing individual presents a low confidence and has inappropriately low perception of his abilities. (b): The biased relationship between confidence and experience is represented by a curve, reflecting the Dunning‐Kruger effect. At one end of the spectrum are inexperienced individuals who have inappropriately inflated confidence toward the task at hand. At the other end of this spectrum are experts whose levels of experience are closely related to their perceived ability and confidence. In the middle are a large proportion of professionals with an inappropriately low confidence toward the performed task.

Kruger and Dunning (2009) noted that there was an undue modesty of top performers and an inflated assessment of lower performers. This study leads to questions of where perceptions of competence come from. It has been reported that the esteem of performances arise from a top‐down approach. People start with a preconceived belief about their skills and use those beliefs to estimate how they are doing on a specific task (Kang 2014). This does not correlate with their actual performance. The top‐down nature of esteem associated with performance can thus have important behavioral consequences. Starting in adolescence, beliefs about oneself generally rise, causing these beliefs to be integrated into the inner aspects of people's lives. This is true in real‐life examples, such as women who rate themselves less scientifically talented than men; with this mindset, they become less enthusiastic in performing scientific or medical activities even though tests show no such difference in their actual performance (Eccles 1987; Ehrlinger and Dunning 2003). It is postulated that perception of performance, and not reality, influences decisions about future activities.

      Ignorance more frequently begets confidence than does knowledge.

      – Charles Darwin (1871)

5.6 Importance of Feedback

      The Dunning‐Kruger effect describes how people are unaware of their incompetence and fail to take self‐improvement measures to rid the incompetence. Feedback plays a very crucial role in reversing this thought process and improving self‐awareness. Individuals who are overconfident will perform tasks that they are not adequately equipped to undertake and attempt tasks without evaluating for risk. For those without confidence, they may not be able to work independently or may experience severe levels of anxiety and stress when working alone, even when others consider them to be competent. Competence is defined as the “habitual and judicious use of communication, knowledge, technical skills, critical reasoning, emotions, values, and reflection in daily practice for the benefit of the individual and community being served” (Epstein and Hundert 2002). Competence is a cognitive and integrative function: acquiring and using knowledge to solve problems that require confidence and vice‐versa. However, personal confidence and experience have been found not to serve as a direct predictor of competence (Morgan and Cleave‐Hogg 2002; Stewart et al. 2000). Confidence represents a judgment, which influences whether an individual is willing or not to undertake an activity; therefore, it is not necessarily based on actual levels of competence.

      Confidence, like art, never comes from having all the answers; it comes from being open to all the questions.

      – Earl Gray Stevens (cited by Merkel and Al‐Falaij, 2003)

      The Dunning‐Kruger effect has been replicated among undergraduate students completing a classroom exam (Dunning et al. 2003), medical students assessing their interviewing skills, medical students evaluating their performance on clerkships (Edwards et al. 2003), and medical laboratory technicians evaluating their job expertise and problem‐solving ability in the workplace (Haun et al. 2000). Consistent with the Kruger and Dunning studies, other studies have shown that overconfident students, yet incompetent, evaluated their performance nearly the same as students that performed well. In medicine, self‐evaluation and self‐assessment can measure one's confidence in relation to competence (Stewart et al. 2000). Medical students' levels of confidence in the performance of specific skills and patient management correlated to their clinical experience, but neither clinical experience nor level of confidence was able to predict outcomes in standardized performance exams (Morgan and Cleave‐Hogg 2002). These findings may be accounted for by the differences in educational experiences; however, the lack of correlation between educational experience and outcomes on standardized assessments requires further explanation and research.

The aforementioned self‐assessment and self‐evaluation tools are helpful because they enable advisors to focus on the individuals who scored poorly; thus providing feedback to help them improve or at least begin to recognize their own limitations. It is an essential practice to recalibrate your ability to self‐assess, as it provides motivation to seek training or assistance and better yourself. Furthermore, the ability to assess your knowledge and learning needs is important in continuing educational activities to address specific gaps in knowledge. Experience may improve the accuracy of self‐assessment with more intensive feedback. This can help in identifying and correcting deficiencies. Some ideas to incorporate such feedback include self‐assessment of your ability during or prior to training, modeling of self‐assessment and self‐directed learning by teachers and mentors, introduction of self‐assessment skills during early education, and continuous feedback and constructive criticism during performances of any sort.

5.7 Overcoming Confidence Issues

      Many methods have been developed to help overcome confidence issues arising from underconfidence or overconfidence. Counseling can assist people to become more self‐aware and to analyze the impact that experiences and the environment have had on them. This can allow you to make a plan to overcome feelings of doubt or arrogance and become more confident in your abilities as well as acknowledge the factors that impact your achievements and personal life. Counseling can also be effective with improving your self‐image. It is important to acknowledge the difference between being evaluated and being valued. Recognizing this difference can help people to remove themselves from cycles of decreased or inflated confidence and improve their self‐image.

      Other methods of improving your self‐image include acknowledging your strengths and weaknesses, making an effort to improve your weak points, and reminding yourself of your strengths through regular affirmations. Additionally, seeking out trusted mentors for feedback, mapping goals, dealing with criticism constructively, and avoiding overanalysis help in overcoming confidence issues. An example of turning a weakness into a strength is turning worry into a positive driving force. Utilizing worry as a source of motivation