Vasileios Kiosses, Claire de Burbure, Ioannis D K Dimoliatis


The objective of the present study was to determine whether bias (over- or under-estimation of self-competence) affects pre-training ratings and hence distorts the actual participation effect of experiential workshops.

Assessments were held during “empathy in doctor-patient relationship” elective coursesheld during winter 2014, spring 2015 and winter 2016 at Ioannina's Medical School, University of Ioannina, Greece.

Twenty-eightwomen and 19men aged 21-28 years (mean=22.8, SD =1.52),in 4th (n=18), 5th (n=19) and 6th (n=10) year of medical studies took part, voluntarily, in the empathy training.

The Jefferson Scale of Physician Empathy was used on a total of 47 medical undergraduates to measure empathic performance both before (B) and a-posteriori-before (P) training. Overestimation of empathic ability was calculated as the difference B-P, and its significance was checked through paired t-test, while effect size (Cohen’s d) was used to reveal any practical importance.

Participants’ mean B score (+SD) was 110.6 (10.5) whereasPwas 88.6 (13.8; p(B-P)<0.001).Assuming total P as the basis (100), total B was 124.8, i.e 24.8% overestimation. A very large effect size was found (d=1.81) for B-P indicating a highly practical importance.There were no significant differences between the 3 cohorts nor between men &women.

This study revealed the existence of the “do not know that they do not know” bias, offered a simple and easy method to measure it, and estimated it to be 24.8%.


The Socrates bias, medical education, self-assessment, questionnaire, bias.

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