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I was interested to read Sir Christopher Ball's article on students' low self-esteem ("Inspire your students to blow their own trumpet", Opinion, THES, June ).

I have found lack of confidence to be common among students "performing poorly" in their clinical work with patients.

The problem is often deep-seated, and sometimes counselling helps more than inspiration.

I have worked with many female students whose belief that they are "not good enough" stems from a rather too rigorous religious schooling. They often need counselling, as well as the environment that Ball mentions, to come to terms with the reasons for their past performance and gain far more self-belief.

Barbara Judge
Clinic coordinator
British College of Osteopathic Medicine