Background Medical university students’ self-perceived confidence and readiness to initiate advance care planning (ACP) discussion will influence their future clinical practice on delivering patient-centred care and honouring patient autonomy. This study aims to explore the association between medical university students’ self-efficacy in medical decision-making and their readiness to engage ACP in Northern Taiwan.

Methods A cross-sectional questionnaire survey was conducted to collect demographic data, self-perceived healthy status (1-item 0–100 scale, higher the better), self-efficacy (5-item Decision-making Participation Self-Efficacy, DEPS scale) and ACP engagement readiness (4-item ACP engagement survey). Medical university undergraduate and postgraduate students over 20 y/o were invited to complete the survey twice with a one-week interval for answering research questions and also validating translated scale. Descriptive analysis and multiple linear regression were conducted.

Results One hundred students completed the survey. The majority were single (62%) females (80%) with average of 34.6 ± 12.8 years old. Students reported having good health above average (mean (SD):76.9 ± 16.2) and high self-efficacy in medical decision-making (mean: 18.8/25), but moderate readiness for ACP engagement (mean: 11.4/20). Better self-efficacy (p=0.036) and older age (p=0.017) were significantly associated with higher readiness on ACP engagement (adjust R2=.15, p=0.008). DEPS scale and ACP engagement survey were proved to have acceptable internal reliability (ICC= 0.64 and 0.73, respectively).

Conclusion Mature medical university students with higher self-efficacy in decision-making were found to be more prepared to engage ACP. This finding highlights the importance to embed training in senior students’ curricula to improve their confidence in initiating challenging conversations with patients and assisting them in making difficult end-of-life care decisions in practice.