Knowledge and confidence about concussion among medical students: a repeated cross-sectional study

Abstract Background Concussion is a common form of brain injury and doctors have an important role in its diagnosis and management. However, most medical schools do not provide concussion teaching about concussion, and as a result, doctors lack knowledge and confidence on the subject. To inform medical student concussion education, we assessed concussion knowledge and confidence among students at a UK medical school. Methods We conducted a repeated cross-sectional online survey of penultimate-year medical students at the University of Oxford over four academic years (2022–2026). Knowledge was assessed using six multiple-choice questions with dichotomous and partial-credit scoring, and confidence using three Likert-scale questions concerning perceived ability to recognise and manage concussion. Associations were assessed using non-parametric tests and multivariable linear regression. Results 384 students out of 700 eligible participants completed the survey (55.0%). The average knowledge score was 68.8%. Knowledge of concussion symptoms (93.5%), signs (85.7%), and ‘red flags’ (90.9%) was high, while knowledge of the proportion of concussions involving loss of consciousness (55.7%), risk factors for prolonged recovery (56.6%), and expected symptom duration (30.5%) was lower. Knowledge increased across participants in non-contact (66.5%), contact (71.0%), and collision (76.2%) sports (p < 0.001). Regular participation in contact and collision sport was associated with 4.7 (95% CI 1.6–7.8, p = 0.003) and 9.5 (95% CI 5.3–14.2, p < 0.001) percentage-point higher knowledge scores, respectively, compared with non-contact sports after adjustment for age, gender, medical programme, and frequency of sporting activity. Students expressed low confidence about concussion. Only one in four felt able to recognise concussion (25.0%) or ‘red flags’ (22.9%), and one in eight felt able to recognise persistent post-concussion symptoms (12.5%). Regular participation in collision sports was associated with greater confidence about concussion after adjustment (+ 0.41, 95% 0.11–0.70, p = 0.007). Concussion knowledge and confidence were weakly positively correlated (ρ = 0.175, p < 0.001). Conclusions Medical students demonstrated variable concussion knowledge and low confidence in recognising and managing concussion. Contact and collision sport participation was associated with greater knowledge, while collision sport participation was also associated with greater confidence. Concussion education should build on existing knowledge, correct misconceptions, and prioritise translating knowledge into clinical decision-making.