Skip to main content
Log in

Understanding self-assessment as an informed process: residents’ use of external information for self-assessment of performance in simulated resuscitations

  • Published:
Advances in Health Sciences Education Aims and scope Submit manuscript

A Commentary to this article was published on 25 October 2012

Abstract

Self-directed learning requires self-assessment of learning needs and performance, a complex process that requires collecting and interpreting data from various sources. Learners’ approaches to self-assessment likely vary depending on the learner and the context. The aim of this study was to gain insight into how learners process external information and apply their interpretation of this information to their self-assessment and learning during a structured educational activity. The study combined quantitative performance data with qualitative interview data. Pediatric residents led video-recorded simulated resuscitations and rated their crisis resource management skills on a validated 6-item instrument. Three independent observers rated the videos using the same instrument. During semi-structured interviews, each resident reviewed the video, rerated performance, discussed the self-assessment process, and interpreted feedback and observer scores. Transcripts were analyzed for themes. Sixteen residents participated. Residents’ self-assessed scores ranged widely but usually fell within two points of the observers. They almost universally lowered their scores when self-assessing after the video review. Five major themes emerged from qualitative analysis of their interviews: (1) residents found self-assessment important and useful in certain contexts and conditions; (2) residents varied in their self-directed learning behaviors after the simulated resuscitation; (3) quantitative observer assessment had limited usefulness; (4) video review was difficult but useful; and (5) residents focused on their weaknesses and felt a need for constructive feedback to enhance learning. The residents in our study almost uniformly embraced the importance of self-assessment for all medical professionals. Even though video review had a negative impact on their self-assessment scores and was perceived as painful, residents saw this as the most useful aspect of the study exercises residents. They were less accepting of the quantitative assessment by observers. Residents explained their tendency to focus on weaknesses as a way to create an incentive for learning, demonstrating that self-assessment is closely linked to self-directed learning. How learners can use video review and external assessment most effectively to guide their self-directed learning deserves further study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • ABMS. (2006). Maintenance of certification. Retrieved April 19, 2009, from http://www.abms.org/Maintenance_of_Certification/ABMS_MOC.aspx.

  • ACGME. (2007). Common program requirements: General competencies. Retrieved April 16, 2009, from http://www.acgme.org/outcome/comp/GeneralCompetenciesStandards21307.pdf.

  • Barnsley, L., Lyon, P. M., Ralston, S. J., Hibbert, E. J., Cunningham, I., Gordon, F. C., et al. (2004). Clinical skills in junior medical officers: A comparison of self-reported confidence and observed competence. Medical Education, 38(4), 358–367.

    Article  Google Scholar 

  • Biernat, K., Simpson, D., Duthie, E. Jr, Bragg, D., & London, R. (2003). Primary care residents self assessment skills in dementia. Advances in Health Sciences Education : Theory and Practice, 8(2), 105–110.

    Article  Google Scholar 

  • Boud, D. (1999). Avoiding the traps: Seeking good practice in the use of self assessment and reflection in professional courses. Social Work Education, 18, 121–132.

    Article  Google Scholar 

  • Boyatzis, R. E. (1998). Transforming qualitative information: Thematic analysis and code development. Thousand Oaks: Sage Publications.

    Google Scholar 

  • Claridge, J. A., Calland, J. F., Chandrasekhara, V., Young, J. S., Sanfey, H., & Schirmer, B. D. (2003). Comparing resident measurements to attending surgeon self-perceptions of surgical educators. American Journal of Surgery, 185(4), 323–327.

    Article  Google Scholar 

  • Colthart, I., Bagnall, G., Evans, A., Allbutt, H., Haig, A., Illing, J., et al. (2008). The effectiveness of self-assessment on the identification of learner needs, learner activity, and impact on clinical practice: BEME Guide no. 10. Medical Teacher, 30(2), 124–145.

    Article  Google Scholar 

  • Creswell, J. W., & Clark, V. L. P. (2011). Designing and conducting mixed methods research (2nd ed.). Thousand Oaks: Sage Publications.

    Google Scholar 

  • Davis, D. A., Mazmanian, P. E., Fordis, M., Van Harrison, R., Thorpe, K. E., & Perrier, L. (2006). Accuracy of physician self-assessment compared with observed measures of competence: A systematic review. JAMA, 296(9), 1094–1102.

    Article  Google Scholar 

  • Eppich, W. J., Adler, M. D., & McGaghie, W. C. (2006). Emergency and critical care pediatrics: Use of medical simulation for training in acute pediatric emergencies. Current Opinion in Pediatrics, 18(3), 266–271.

    Article  Google Scholar 

  • Epstein, R. M., Siegel, D. J., & Silberman, J. (2008). Self-monitoring in clinical practice: A challenge for medical educators. The Journal of Continuing Education in the Health Professions, 28(1), 5–13.

    Article  Google Scholar 

  • Eva, K. W., & Regehr, G. (2005). Self-assessment in the health professions: A reformulation and research agenda. Academic Medicine, 80(10 Suppl), S46–S54.

    Article  Google Scholar 

  • Eva, K. W., Armson, H., Holmboe, E., Lockyer, J., Loney, E., Mann, K., et al. (2012). Factors influencing responsiveness to feedback: On the interplay between fear, confidence, and reasoning processes. Advances in Health Sciences Education: Theory and Practice, 17(1), 15–26.

    Article  Google Scholar 

  • Fanning, R. M., & Gaba, D. M. (2007). The role of debriefing in simulation-based learning. Simulation in Healthcare, 2(2), 115–125.

    Article  Google Scholar 

  • Gaba, D. M., Fish, K. J., & Howard, S. K. (1994). Crisis management in anesthesiology. New York: Churchill-Livingstone.

    Google Scholar 

  • Jones, R., Panda, M., & Desbiens, N. (2008). Internal medicine residents do not accurately assess their medical knowledge. Adv Health Sci Educ Theory Pract, 13(4), 463–468.

    Article  Google Scholar 

  • Kim, J., Neilipovitz, D., Cardinal, P., Chiu, M., & Clinch, J. (2006). A pilot study using high-fidelity simulation to formally evaluate performance in the resuscitation of critically ill patients: The University of Ottawa Critical Care Medicine, High-Fidelity Simulation, and Crisis Resource Management I Study. Critical Care Medicine, 34(8), 2167–2174.

    Article  Google Scholar 

  • Kluger, A. N., & DeNisi, A. (1996). The effects of feedback interventions on performance: A historical review, a meta-analysis, and a preliminary feedback intervention theory. Psychological Bulletin, 119(2), 254–284.

    Article  Google Scholar 

  • Kruger, J., & Dunning, D. (1999). Unskilled and unaware of it: How difficulties in recognizing one’s own incompetence lead to inflated self-assessments. Journal of Personality and Social Psychology, 77(6), 1121–1134.

    Article  Google Scholar 

  • Leopold, S. S., Morgan, H. D., Kadel, N. J., Gardner, G. C., Schaad, D. C., & Wolf, F. M. (2005). Impact of educational intervention on confidence and competence in the performance of a simple surgical task. The Journal of Bone and Joint Surgery American, 87(5), 1031–1037.

    Article  Google Scholar 

  • Mann, K., van der Vleuten, C., Eva, K., Armson, H., Chesluk, B., Dornan, T., et al. (2011). Tensions in informed self-assessment: How the desire for feedback and reticence to collect and use it can conflict. Academic Medicine, 86(9), 1120–1127.

    Article  Google Scholar 

  • Mort, J. R., & Hansen, D. J. (2010). First-year pharmacy students’ self-assessment of communication skills and the impact of video review. American Journal of Pharmaceutical Education, 74(5), 1–7, Article 78.

    Article  Google Scholar 

  • Parker, R. W., Alford, C., & Passmore, C. (2004). Can family medicine residents predict their performance on the in-training examination? Family Medicine, 36(10), 705–709.

    Google Scholar 

  • Patton, M. Q. (2002). Qualitative research and evaluation methods (3rd ed.). Thousand Oaks: Sage Publishers.

    Google Scholar 

  • Sargeant, J. (2008). Toward a common understanding of self-assessment. The Journal of Continuing Education in the Health Professions, 28(1), 1–4.

    Article  Google Scholar 

  • Sargeant, J., Mann, K., van der Vleuten, C., & Metsemakers, J. (2008). “Directed” self-assessment: practice and feedback within a social context. The Journal of Continuing Education in the Health Professions, 28(1), 47–54.

    Article  Google Scholar 

  • Sargeant, J., Mann, K. V., van der Vleuten, C. P., & Metsemakers, J. F. (2009). Reflection: A link between receiving and using assessment feedback. Advances in Health Sciences Education: Theory and Practice, 14(3), 399–410.

    Article  Google Scholar 

  • Sargeant, J., Armson, H., Chesluk, B., Dornan, T., Eva, K., Holmboe, E., et al. (2010). The processes and dimensions of informed self-assessment: A conceptual model. Academic Medicine, 85(7), 1212–1220.

    Article  Google Scholar 

  • Sargeant, J., Eva, K. W., Armson, H., Chesluk, B., Dornan, T., Holmboe, E., et al. (2011). Features of assessment learners use to make informed self-assessments of clinical performance. Medical Education, 45(6), 636–647.

    Article  Google Scholar 

  • Stemler, S. E., & Tsai, J. (2008). Best practices in interrater reliability: three common approaches. In J. Osborne (Ed.), Best practices in quantitative methods. Thousand Oaks: Sage Publications.

    Google Scholar 

  • Tuckman, B. W. (1999). Conducting educational research (5th ed.). New York: Harcourt Brace College Publishers.

    Google Scholar 

  • Ward, M., MacRae, H., Schlachta, C., Mamazza, J., Poulin, E., Reznick, R., et al. (2003). Resident self-assessment of operative performance. American Journal of Surgery, 185(6), 521–524.

    Article  Google Scholar 

Download references

Acknowledgments

This study was funded by a AAMC WGEA Medical Education Research Grant. Thanks to Kadriye O. Lewis, Ed.D. and LihShing Leigh Wang, Ph.D. for their guidance and feedback on this project.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jennifer L. Plant.

Appendix

Appendix

See Tables 3 and 4.

Table 3 Difference between resident self-assessment scores and observer scores on individual Ottawa GRS items
Table 4 Change in resident self-assessment score after video review

Rights and permissions

Reprints and permissions

About this article

Cite this article

Plant, J.L., Corden, M., Mourad, M. et al. Understanding self-assessment as an informed process: residents’ use of external information for self-assessment of performance in simulated resuscitations. Adv in Health Sci Educ 18, 181–192 (2013). https://doi.org/10.1007/s10459-012-9363-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10459-012-9363-2

Keywords

Navigation