Introduction: The objective structured clinical examination (OSCE) is commonly used as a standard assessment approach in midwifery education. Student's confidence may impact on the OSCE performance but the evidence on this is very limited. Objectives: This study aimed to evaluate the relationship between confidence and OSCE performance in midwifery students. Methods: 103 pre-registration midwifery students (42 year one students: 61 year three students) from Sheffield Hallam University took part in this study as part of their routine OSCE assessment. They completed pre-and post-exam questionnaires, which asked them to rate their confidence in the clinical skills being assessed on a scale from 1 to 10 (1=not confident; 10 =totally confident). Results: The results showed significant increases in mean confidence levels from before to after OSCE for both first and third year students (5.52 (1.25) to 6.49 (1.19); P=0.001 and 7.49(0.87) to 8.01(0.73); P0.001, respectively). However, there was no significant correlation between confidence levels before undertaking the OSCE and the final OSCE test scores (r= 0.12; P=0.315). Conclusions: The increased level of confidence after the OSCE is important but how this is transformed into improved clinical skills in practical settings requires further investigation. The lack of significant correlation between OSCE results and student's confidence, may indicate additional evidence for the objectivity of the OSCE. This, however, may be due to the inherent complexity of assessing such relationships. Larger studies with mixed methodology are required for further investigation of this important area of education and assessment research.