Learners often assume they have achieved a level of competency if they have been working in their field for some time. This is especially true of professions where the stakes are high: think doctors, ship captains, and pilots. They might assume that because they have been doing something for a long time that it MUST be right. What they don't realize is that in many situations they can't consciously evaluate what they truly know. Or worse, DON'T know. In effect, they are making guesses—some of which can lead to disastrous results.

Learners need to be able to critically evaluate their competency consciously by assessing their own confidence in any knowledge they apply. This is especially true when guessing may endanger a life. We developed a confidence-based assessment tool for Family Physicians enrolled in an immersive 12-week program in a busy emergency department in downtown Toronto. The tool helped the physicians to identify where and how often they might be unconsciously and even over-confidently applying incorrect knowledge and practice. A simple visual metric at the end of each assessment clearly showed the physicians just how often their confident answers were in fact wrong. The confidence-based assessments were pivotal to helping the physicians overcome long-held biases and beliefs, which ultimately helped them to improve practice, identify competency "danger zones", and increase their overall self-efficacy.