Developing self-assessment skills amongst doctors in Nepal

Figures & data

Table

Practice points

The mini-CEX can be usefully adapted as a self-assessment tool. Clinical case analysis helped doctors to develop a habit of self-study and encouraged evidence-based practice. The use of the “intra individual approach” enabled important differences in self-assessment ability to be identified. The process of self-assessment helped to enhance critical thinking. Constructive feedback from a tutor was important.

Table 1.  PC for mini-CEX: changes in accuracy of self-assessment of individual criteria over 6 successive months

Student code	History a	History b	Exam a	Exam b	Communication skill a	Communication skill b	Diagnosis	Investigation	Respect	Referral	Organization	Overall
2	0.414	−0.414	−0.169	0.186	−0.828*	−0.414	−0.393	−0.845	−0.655	−0.277	a	0.169
3	−0.707	0.000	0.354	0.447	0.354	0.258	−0.707	0.000	0.354	0.000	−0.577	−0.707
4	0.393	−0.414	0.717	0.447	−0.655	0.039	0.707	0.523	0.414	a	0.923**	0.414
5	−0.548	0.775	a	−0.632	0.674	0.447	0.632	0.000	0.674	0.945	−0.632	0.447
1	0.393	0.488	−0.393	−0.289	−0.098	−0.621	−0.104	−0.169	0.414	a	0.781	0.098
6	−0.474	0.707	−0.884*	−0.577	0.289	−0.289	−0.354	−0.971	0.354	a	0.289	0.289
9	−0.354	−0.884*	−0.354	a	−0.289	0.289	0.000	−0.098	−0.354	−0.189	a	a
10	0.703	0.828*	−0.393	−0.338	−0.655	0.098	0.828*	0.832	−0.355	a	−0.169	0.878*
11	−0.355	−0.078	0.153	−0.414	−0.262	−0.598	−0.064	a	0.878*	a	0.262	0.131
7	−0.131	0.131	−0.663	−0.338	−0.828*	−0.655	−0.393	0.000	−0.655	−0.971	a	−0.338
8	−0.207	0.381	0.131	0.390	−0.213	0.071	−0.828*	−0.835	0.338	−0.866	−0.355	−0.655
12	−0.131	−0.828*	−0.923**	0.594	−0.338	−0.442	−0.393	0.169	−0.393	a	0.488	a
13	0.497	−0.169	−0.828*	−0.431	−0.235	−0.355	a	a	−0.703	a	0.414	−0.621
14	−0.131	−0.828*	−0.393	−0.655	−0.131	−0.507	0.497	0.000	a	a	a	−0.655
15	−0.655	0.447	−0.255	0.814	−0.272	−0.169	a	a	−0.655	0.420	0.639	−0.845*

Notes: A negative correlation shows the doctor initially over-assessed his/her work and then moved either to accurate or under-assessment over the 6-month study period. A positive correlation shows the doctor initially under-assessed his/her work and then moved to either accurate or over-assessment over the 6-month study period.

History a: Facilitates patient telling of story by listening and appropriate use of open and closed questions. History b: Responds appropriately to verbal and non-verbal cues. Exam a: Efficient logical sequence appropriate to clinical problem. Exam b: Sensitive to patients’ comfort and modesty. Communication skills a: Exploring patient perspectives demonstrating empathy. Communication skills b: Clearly explains problem and shared plan of action with patient. Diagnosis: Appropriate diagnosis and management plan. Investigation: Appropriate selective use of investigations. Respect: Shows respect and compassion. Referral: Aware of limitations and refers appropriately. Organization: Timely and prioritizes. Overall: A global “impression” of how the consultation went; a: cannot be computed because at least one of the variables is constant; *p < 0.05; **p < 0.01.

Figure 1. Relation between self and tutor assessment of total score using mini-CEX (Student 10).

Table 2.  PC for clinical case analysis: changes in accuracy of self-assessment of individual criteria over 6 successive months

Student code	History	Differential diagnosis	Question	Answer	Application
2	0.567	0.213	0.224	0.956*	0.886
3	0.131	0.000	−0.869*	−0.717	0.488
5	0.718	0.755	0.258	0.775	a
1	0.478	−0.071	−0.497	−0.272	0.000
6	0.354	−0.433	−0.237	−0.139	−0.189
9	−0.338	0.064	0.169	−0.293	−0.488
10	0.866	0.289	0.289	−0.567	−0.728
11	−0.500	a	a	−0.500	0.866
7	−0.112	−0.289	−0.474	−0.577	−0.354
8	0.781	0.131	0.338	−0.621	−0.704
12	−0.354	−0.949*	0.224	−0.567	−0.671
14	0.338	0.489	0.131	−0.311	0.098

Notes: A negative correlation shows the doctor initially over-assessed his/her work and then moved either to accurate or under-assessment over the 6-month study period. A positive correlation shows the doctor initially under-assessed his/her work and then moved to either accurate or over-assessment over the 6-month study period; a: cannot be computed because at least one of the variables is constant;

*p < 0.05.

Table 3.  PC for significant event analysis: changes in accuracy of self-assessment of individual criteria over 6 successive months

Student code	Event	Underlying issues	Reflection on actions	Plan for future	Awareness strength and weakness
2	−0.866	−0.707	−0.756	−0.354	−0.894*
1	0.707	−0.834	−0.289	0.567	0.000
6	0.000	−0.189	0.112	−0.722	−0.224
9	−0.311	−0.447	0.676	0.163	0.213
10	0.000	0.139	−0.289	0.832	a
11	a	0.866	0.866	−0.500	1.000**
7	−0.671	−0.447	−0.493	−0.224	−0.348
8	−0.683	−0.207	−0.414	−0.414	−0.831*
14	−0.207	0.071	0.098	0.488	−0.104

Notes: A negative correlation shows the doctor initially over-assessed his/her work and then moved either to accurate or under-assessment over the 6-month study period. A positive correlation shows the doctor initially under-assessed his/her work and then moved to either accurate or over-assessment over the 6-month study period; a: cannot be computed because at least one of the variables is constant; *p < 0.05; **p < 0.01.

Table 4.  PC for total score student assessment compared to tutor assessment for each of the three assessment tools

	Assessment tools
Student code	Mini-CEX	Clinical case analysis	Significant event analysis
1	NS	0.821*	NS
2	NS	NS	NS
3	NS	NS	□
4	NS	NS	□
5	NS	NS	□
6	NS	NS	NS
7	NS	NS	NS
8	NS	NS	NS
9	NS	NS	0.818*
10	0.861*	NS	NS
11	NS	NS	NS
12	NS	NS	□
13	NS	□	□
14	0.913*	NS	NS
15	NS	□	□

Note: NS denotes not significient; □ insufficient data returned data returned to make a calculation; *p < 0.05

Figure 2. Relation between self and tutor assessment of total score in clinical case analysis (Student 1).

Figure 3. Relation between self and tutor assessment of total score in significant event analysis (Student 9).