Confidence isn’t a personality trait, it’s a learned behaviour. People aren’t all born confident, therefore, the good news is that if you don’t feel sure of yourself now, you can do something about it. Some of the most confident people you know, may not have always been that way.
Confidence is when you have a feeling of being sure of yourself and your abilities. It can be thought of as a state of mind, where you feel at ease and a freedom from uncertainty.
Confidence v competence
Confidence may be related to competence, but it’s not the same thing. You can be very competent, but not have much confidence. This is the position that many doctors find themselves in. Conversely, have you ever met someone who is very confident and is actually not that great at their job?
Remember, it’s also fine to be OK with not being competent at something. No one is going to be brilliant at everything, despite how it might seem at medical school or at work.
Your approach is going to be different, depending on your stage of training:
At a more junior level
If someone asks you to do something as a trainee doctor and you’re not yet competent at it, you will escalate it to a senior. As for your career – there are choices within medicine, so for example, if you aren’t great at hand-eye coordination, then you can choose to move to a specialty where that’s not so important. However, if you’re unpractised at a technique that’s particular to a specialty, as a junior doctor you can often decide whether you’d like to explore this as something you could learn for the future. An activity that you initially shy away from due to lack of confidence, may in fact be something that you enjoy once you’re competent at it. As such, you should be discouraged from making big decisions (e.g. avoiding all surgical specialties, based on a supposed lack of hand-eye coordination) at a relatively junior stage of your career. However, having said this, ultimately you can also tell yourself that this isn’t something that you’d like to get into. The choice is yours.
At a more senior level
If you’re at a doctor at a more senior level in training and are having to complete a procedure or task that you don’t feel fully competent at, then you have to ask yourself whether you can get more practice or get some further training in this area. Sometimes you also need to practice these tasks as they need to be done and can’t be avoided. Practice makes perfect and this builds confidence. In addition, remember that not everyone learns at the same pace. For example, you have no idea how rubbish your consultant might have been at venipuncture earlier in their career!
Other thoughts
If you’re good at what you do, it’s really important to tell yourself that, so that you recognise your own worth. Whether that’s the people skills that are ever present in great doctors, or in some of the practical clinical skills. Doctors and people in general don’t spend enough time giving themselves credit for what they excel at. This is also something that’s ingrained in British society, to be self-depreciating, so it’s worth recognising that too.
What to do if you’ve experienced a confidence-bashing incident
- Do whatever is clinically necessary, e.g. escalate to a senior member of staff (if you haven’t done this already).
- Take some time to decompress and destress from the incident.
- Take the opportunity to write up the incident in a reflection (this is a good habit to get into and also great for your portfolio). For junior doctors in the UK, this can hit several foundation programme Higher Learning Outcomes.
- It is so important to take the above steps so that you can bounce back, so that the task doesn’t become something you dread.
Actions that can be taken:
- Search to see if there are any tutorial videos that can be watched to learn more about whatever it is that has bashed your confidence.
- Check if there is the possibility to practice in non-clinical environments, e.g. dummy arms.
- Find a kind mentor to disclose your problems with (ideally your Clinical Supervisor/Educational Supervisor).
- You may also need another mentor to actually supervise and teach the task.
- When you feel ready, practise the skill again under better conditions, e.g. in situations where there is a non-emergency, there are easier veins, etc. Then reflect again afterwards.
Inner v outer confidence
Inner confidence refers to what you are feeling about yourself. It can differ day to day and can depend on whether you are in a situation that is within your comfort zone or not. Outer confidence is how you are perceived by people out in the world. The truth is that some of the time, most doctors have tasks they’re not completely confident in, but they learn to use some tricks to cover this.
Below are some tips that can help you appear confident, even when you’re not feeling it:
- Posture – avoiding hunched shoulders, slumping and fidgeting
- Speech – loud, clear, direct
- Appearance – smart, appropriate
Using these tips may increase your outer confidence, which in turn my increase your inner confidence. Thankfully this can form a positive feedback loop.
Tips for boosting your confidence
Remember that a lack of confidence is very common (almost universal) amongst doctors at the start of their career. Here are some tips for taking your confidence to higher levels:
- Practice and prepare – for example if you have a presentation to do, or are going for an interview
- Try new things – be aware of your comfort zone, try baby steps to move outside of this
- Get feedback – give and receive this. Work out who you can find who’s going to be the best person to give you feedback. This should be someone who is good at the skill in question and that you can trust. Consider what type of feedback would be best e.g. CBD style, direct observation or group scenarios. If you’re in a position to give feedback, this can really boost your confidence, especially if someone more junior is coming to you for support
- People – choose to spend time with those that are on your side and that you trust
- By controlling your thoughts; coaching can help and I write about this in the next section
- Look after yourself – eat healthily and get appropriate exercise. Give yourself a break from time to time. There is a link between general health, mindset, confidence and competence, so it’s important to give this your attention.
How can coaching help?
Like CBT, Cognitive Behavioural Coaching examines the behaviour, feelings and thoughts of each person. Together these three areas form the cognitive triangle and they all influence each other. When trying to grow your confidence, the easiest part of the triangle to address are your thoughts.
If you find yourself spiralling into negative thoughts, the advice is to try to review how you talk to yourself (your self-talk) and to make this more positive. In fact these thoughts are known as ‘negative automatic thoughts’ or NATs.
Some common NATs are found below:
All or nothing thinking
Thinking that if you can’t have everything, there’s no point in trying at all. This often leads to giving up, rather than persisting with a course of action or exploring alternatives. For example – ‘If I can’t get into X specialty, then I’m just going to give up medicine.’ or ‘I won’t pass the exam, so there’s no point in trying’.
Jumping to conclusions
Predicting that things will turn out badly, when in reality we cannot predict the future as there are too many unknowns. For example – ‘I’ll never be able to manage my anxiety’ or ‘This new boss is going to be a nightmare’.
Over-generalisation
Using a limited amount of evidence to form a sweeping judgement. Using words such as ‘always’ or ‘never’ to describe situations or events, when in fact there may be exceptions. For example – ‘I always mess up job interviews’ or ‘Employers never take on people unless they meet all the selection critieria.’
Disqualifying the positive
Only paying attention to the bad things that happen, ignoring the good things. Focusing too much on criticism and ignoring complements. For example – ‘A couple of people looked bored so I must have done a poor job with that presentation, despite the positive feedback I received’ or ‘1 of my evaluation sheets out of 15 had a critical comment, so the day must have been a disaster.’
Catastophising
Imagining the worst possible thing is about to happen and predicting that you won’t be able to cope with the outcome. In reality, worse-case scenarios rarely happen and even when they do, we’re often surprisingly able to cope with them. For example – ‘I’m going to make an idiot out of myself, everyone will be laughing at me and I’ll die of embarrassment.’
Should or must
Using these words, that are really quite criticising, can make us feel guilty. The result is constant anxiety and disappointment with yourself or others around you (if they don’t meet the same high standards). For example – ‘I must earn more money’ or ‘I should train in a different specialty’ or ‘I must stay in a stable job until the kids grow up.’
Personalisation
Thinking that everything is all your fault, when often the result is out of your control. For example – ‘This patient’s condition has got worse; this might be because I’ve not taken enough care of them’ (it might not be due to the level of care given) or ‘My boss is in a terrible mood and is lashing out at me, it must be something I’ve said or done’ (another colleague’s mood is not within your control).
Challenging your NATs can boost your confidence!
There are some exercises that you can do with a coach here, one is called ‘thought chaining’, where the coach challenges you when you say that you can’t do something, with the question –‘Well, what if you could do x?’ and then going on to review what would happen if this was the case etc.
As a coach, I have helped many doctors with their confidence and if you’d like to work with me, do get in touch. My contact details are [email protected].