From Uncertainty to Competence: A Longitudinal Study of Confidence Development in Occupational Therapy Education

Confidence plays a critical role in students' academic performance, particularly in complex foundational content such as neuroscience. While confidence is often discussed interchangeably with self-efficacy, the two constructs are distinct yet complementary. Few studies have examined how confidence changes over time in occupational therapy neuroscience courses or what factors contribute to its development. This longitudinal mixed-methods study examined confidence changes throughout a 15-week neuroscience course in an Occupational Therapy Doctorate program. The study integrated quantitative measurements with qualitative reflections to understand both the magnitude and mechanisms of confidence development. Data were collected from 73 students across two independent cohorts in consecutive years (2023: n = 37; 2024: n = 36). Students completed weekly surveys with four Likert scale questions assessing neuroscience-related confidence and three open-ended questions at baseline, mid-course, and end-of-course exploring factors influencing confidence. Analysis included nonparametric statistical tests for quantitative data and thematic analysis with sentiment analysis for qualitative responses. Both cohorts demonstrated statistically significant confidence increases from baseline to end-of-course (p < 0.001). Qualitative analysis revealed four themes replicating across both years: prior academic experiences (mixed effect), instructional support and learning environment (facilitator), interest in neurological practice (facilitator), and content complexity with anticipatory anxiety (barrier). Students attributed confidence gains to hands-on learning activities, peer collaboration, and structured feedback. Sentiment patterns showed predominantly positive baseline attitudes despite concerns, shifting to more neutral mid-course assessments reflecting realistic recalibration, then highly positive end-of-course reflections on self-assessment value. Integration of quantitative and qualitative findings revealed that confidence development follows predictable patterns influenced by cognitive and emotional factors. Replication across two independent cohorts strengthens validity. Implications for occupational therapy education include intentional scaffolding, active learning opportunities, peer collaboration, and attention to Generation Z learners' needs for external validation and structured support. These findings inform curriculum design strategies to enhance confidence, self-efficacy, and clinical reasoning preparation.