• Damian Roland, David Matheson, Timothy Coats, and Graham Martin.
• SAPPHIRE Group, Department of Health Sciences, University of Leicester, Leicester, UK Emergency Medicine Academic Group, University Hospitals of Leicester NHS Trust, Leicester, UK.
• BMJ Open. 2015 Nov 4; 5 (11): e008521.

ObjectivesThe terms confidence and competence have been poorly defined and are often misused by junior doctors. Given safe practice relies on healthcare professionals being aware of their own skill sets improving self-assessment of confidence and competence is important. The aim of this work was to explore junior doctors' understanding of how they perceive their own performance in respect of managing feverish children in an emergency department.SettingA children's emergency department in a tertiary hospital in the East Midlands, UK.Participants22 Junior doctors volunteered to undertake focus groups via a meta-planning methodology over 2 years (14 participants in the first year and 8 in the second).ResultsAlthough doctors were aware of the difference between confidence and competence they were not able to distinguish between them in practical terms. The feeling of being 'safe' emerged as a term in which there was a shared understanding compared to reported confidence and competence.ConclusionsA perception of 'safeness' is a concept that may aid self-evaluation and we present a matrix that might be used by supervisors and educators to examine this and its relationship with confidence and competence.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

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