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Previous work has drawn attention to an apparent paradox in medical English education: students may report increased confidence in history-taking while still reporting anxiety. The present study examines the persistence of this affective paradox across cohorts using matched pre–post survey data. Participants were second-year medical students enrolled in a six-week English-based history-taking course at Nihon University School of Medicine in two consecutive academic years (2024 and 2025). The course focused on structured clinical interviewing, with emphasis on linguistic clarity, rapport-building, and patient-centred communication in English. Students completed identical self-report measures of confidence and anxiety before and after the course, with responses matched at the individual level.
Across both cohorts, students demonstrated clear gains in self-reported confidence following the course. In contrast, anxiety levels showed little change, resulting in a stable confidence–anxiety paradox across years. The persistence of this pattern suggests that confidence and anxiety do not function as opposing endpoints but may develop along partially independent trajectories during early clinical communication training. The consistency of findings across cohorts indicates that the paradox is unlikely to reflect cohort-specific factors or measurement artefacts.
These findings have important implications for how learning outcomes are interpreted in medical English education. While increases in confidence may reflect improved procedural and linguistic readiness, persistent anxiety may signal heightened awareness of communicative responsibility rather than instructional failure. The study argues for treating confidence and anxiety as related but non-equivalent dimensions of learner development and cautions against relying on confidence gains alone as indicators of emotional readiness for clinical communication.