How to Build Real Confidence in Medicine: Competence, Evidence and Weekly Habits
Sonja Cronjé
February 17, 2026
In this article:
Clients often talk to me about confidence as if it's a personality trait you're born with – either you have it, or you don't.
They tell me about people who seem naturally confident. The consultant who speaks clearly when the MDT discussion is divided. Or the colleague who sets boundaries and says no to extra work without apologising. The registrar who gives their view in the staff meeting as if it's the most natural thing in the world.
Many of my clients compare themselves to these people, especially in their early years as consultants or when they're leading for the first time. They've worked hard, they've passed their exams, and they know their stuff. But they still doubt themselves or feel like imposters. And as a result, they assume it means they aren't truly competent.
I hear this all the time from thoughtful, high-performing clinicians who believe confidence is something other people just have.
Here's the thing: that's not how confidence works.
What Confidence Actually Is (And Why It's Not the Same as Competence)
Psychologist Albert Bandura described self-efficacy as your belief that you can handle a specific task in a specific situation. It's about whether you think you can deal with what's in front of you.
That belief develops through experience. You do something, then do it again. You get feedback. You handle situations you weren't entirely sure you could manage, and over time, your internal picture of yourself updates.
But here's what people get wrong: they tangle up competence and confidence as if they're the same thing.
Competence is what you can actually do. It's your clinical knowledge and procedural skills. It's recognising patterns after seeing enough variation, and using reasoning and judgement when guidelines don't quite fit. This develops through deliberate practice, supervision, feedback and exposure to complexity over time.
K. Anders Ericsson's research on deliberate practice showed that high-level performance grows through focused practice with feedback, not just racking up years. Medicine gives you plenty of reps – case by case, conversation by conversation. That accumulated experience matters.
Confidence is different. It's your internal prediction about how you'll handle what comes next.
And here's where it gets tricky: competence and confidence don't always rise together.
You can be deeply competent and still not feel confident. You can also feel confident without being as competent as you think. The Dunning-Kruger effect captures part of this – people with lower skill often overestimate their ability, while those with higher skill tend to see more nuance and limitation. When you understand the risks and complexity of what you're dealing with, that awareness can feel like doubt. Sometimes it’s actually insight.
If you collapse competence and confidence into the same thing, you end up judging yourself far more harshly than the evidence supports.
Confidence usually grows from three things: competence you've built, evidence you've accumulated, and the habit of backing your own judgment, even when you don't feel entirely certain.
Once you understand it that way, you ask yourself a different question. Not "Why don't I feel confident yet?" but "What am I actually building?"
Why Reassurance Doesn't Stick
Most doctors I work with look for reassurance. Sometimes directly, sometimes in subtler ways – a nod in a meeting, positive feedback, reassuring comments from a superior.
It helps in the moment, but a few days later, the self-doubt often returns.
Here's why: reassurance comes from the outside, but your self-concept lives on the inside. The two don't automatically line up.
If somewhere in your thinking there's a belief that you're only just managing, praise won't override it. Your mind will explain it away. The case wasn't that complex. They didn't notice your hesitation. It was just luck.
Cognitive dissonance theory helps explain this. When new information clashes with an existing belief about yourself, your brain defends the old belief.
Reassurance isn't useless, but it has limits. If your confidence depends entirely on external validation, it will fluctuate with whatever feedback you received last.
Confidence that lasts is built on something more solid: your own accumulated evidence.
Building Real Confidence: The Evidence Loop
Most of us don't need help remembering what went wrong – that replay happens automatically. You can be halfway through dinner, and suddenly you're replaying a conversation from earlier in the day.
What doesn't get equal attention is everything you handled competently.
If you want durable confidence, you need to take your own evidence seriously, just like you would in any other evidence-based situation.
This means two things:
First, actively collect evidence of what's going well – not just what went wrong.
Second, question your automatic negative thoughts the way CBT teaches us to. When your brain says "I'm terrible at this," treat it like any other claim and look at the actual evidence.
When you start doing this consistently, your internal narrative becomes more balanced. You begin to see patterns in your own behaviour – that you think clearly under pressure more often than you realised, or that your clinical reasoning holds up even when you felt uncertain.
That recognition accumulates.
Weekly Habits That Build Self-Trust
This is where it gets practical. You don't need a different personality, you just need repeatable behaviours.
1. Keep an Evidence Log
At the end of the week, take some time to reflect and write down a few things that went well.
Be specific. Not "the case went well" but "I recognised the pattern early and adjusted the management plan." Name your actual contribution and how it made a difference.
Weekly is enough. You're not writing a diary, you're collecting data.
Here's what makes this useful: when something goes well, most doctors immediately write it off as luck or good timing. But is that actually true? Before you dismiss it, check. You were probably better prepared than you're giving yourself credit for. You recognised a pattern because you've seen versions of this before. You asked a question that changed the conversation.
Acknowledging that isn't arrogance. It's accuracy.
If you treat every success as luck and every setback as proof you're inadequate, confidence will always feel fragile. Balanced attribution is what builds authentic confidence.
Over months, this log becomes powerful. When doubt shows up, you're not scrambling through vague memory – you have evidence.
2. A Better Debrief
After something challenging, most clinicians jump straight to self-criticism. What should I have done differently? Where did I get that wrong?
Before going there, widen the frame.
Instead, start with what worked. There's almost always something.
Then ask what you'd adjust next time.
Then consider what the situation genuinely required of you – decisive action without perfect information? Clear communication? Holding a boundary?
Framing it this way keeps the focus on behaviour rather than identity.
"I hesitated to interrupt" gives you something to practise.
"I'm terrible at conflict" shuts down the conversation.
One moves you forward, the other doesn't.
3. Small Acts of Courage
Confidence tends to follow action. It rarely works the other way around.
In practice, this means doing small things you'd normally avoid. Speaking up in a meeting. Making a call without perfect information. Holding a boundary you've already decided is reasonable.
You don't need to feel ready before you act. Behavioural research consistently shows that action shapes emotion more reliably than sitting around waiting to feel brave.
Each small act becomes data. Data changes how you see yourself. Over time, your internal picture updates.
A Note for Healthcare Leaders
If you supervise others, this matters for you too.
When a junior doctor says, "I don't think I handled that well," the instinct is often reassurance. "You're doing really well." "You're one of our strongest registrars."
It may be well-intentioned, but it's often too vague to make a difference.
Feedback works better when it's specific and task-focused rather than broad praise.
Instead of general reassurance, point to something concrete. "Your differential was clear." "You escalated at the right moment." "Your reasoning held up under pressure."
When something needs improvement, be just as specific. Not "you need to work on your communication" but "next time, explain your clinical reasoning to the family before the decision – it helps them understand the why."
Frame it as something to build on, not a deficit.
That specificity gives them something they can actually use. Over time, they start recognising these things in their own work without needing you to point them out.
Confidence Is Built, Not Born
If you're early in your consultant years, it can feel like everyone else settled into the role more easily than you. Like they simply arrived one day and felt confident.
That's rarely how it works.
The doctors who seem naturally confident have usually just been collecting evidence longer. They've built the habit of noticing what they handle well, not only what goes wrong, and they've learned to back their judgment even when they don't feel entirely certain.
You can do the same thing. Not by waiting until you feel ready, but by acting anyway. By keeping track of what you actually contribute. By recognising that uncertainty isn't a sign of incompetence – it often means you understand the complexity of what you're dealing with.
Medicine doesn't get easier. The cases stay complex, the decisions stay hard.
But over time, you start trusting yourself with those harder moments. You realise you can think clearly under pressure, that your clinical reasoning holds up even when information is incomplete and you still need to make a call.
That's not arrogance. That's earned confidence.
And it's built one week, one decision, one piece of evidence at a time.