Feasibility and Preliminary Educational Outcomes of Self-Reported Clinical Confidence After a Global Health...

Background Short-term international medical mission trips are a ubiquitous but understudied component of preclinical medical education, especially in the United States. Self-efficacy -- a trainee's belief in their own capacity to execute a clinical task -- is theorized to precede and shape skill acquisition. However, item-level changes in self-reported clinical confidence surrounding a brief, immersive mission trip, particularly among students without prior fluency in the trip's local language, have not been well characterized. Methods Preclinical (M1), non-Spanish-speaking students from a Christian Medical Association chapter completed an investigator-developed, 10-item clinical confidence questionnaire (5-point Likert scale) before and after a one-week, pop-up, free clinic mission trip to Lima, Peru (10-14 March 2025). The questionnaire has not been formally validated. Ten students completed the pre-trip survey, seven completed the post-trip survey, and five completed both and formed the matched analytic sample. Paired t-tests, Wilcoxon signed-rank tests, and paired Cohen's d were used to explore pre-to-post-trip change, with inferential results interpreted cautiously because of the very small matched sample. Results Among the five matched students, composite self-reported clinical confidence increased from a mean of 28.8 pre-trip to 43.0 post-trip, a 49% relative increase (Cohen's d = 3.08; Wilcoxon p = 0.063). The largest observed increases were in confidence during a foreign-language patient encounter (1.4 to 4.0, d = 4.75) and generating treatment recommendations (1.4 to 3.8, d = 4.38). The smallest observed increases were in skills already rated highly at baseline, including communicating with a patient (4.2 to 4.4) and taking vital signs (4.2 to 4.6). Conclusions In this pilot cohort, higher post-trip scores were observed across several self-reported clinical confidence domains. However, 50% attrition from the pre-trip survey to the matched analytic sample, absence of a comparison group, use of an investigator-developed and unvalidated questionnaire, and variable post-trip survey timing (13-24 days after return) substantially limit inference. These findings are hypothesis-generating and describe changes in self-reported confidence only; they should not be interpreted as evidence of improved objective clinical competence.