Self-assessment: With all its limitations, why are we still measuring and teaching it? Lessons from a scoping review

Abstract

Introduction

Self-Assessment (SA) is often assumed to be essential for learning, however, this assumption has been extensively rebutted. Research shows SA has significant limitations, including its lack of correlation with competence.

Method

We undertook a scoping review of SA in medical education (2011–2021) and surprisingly discovered substantial research where SA was erroneously assumed to be a valid measure of successful learning, or a skill needing to be taught. Although the initial intent of our scoping review was to explore where SA is being effectively used to advance lifelong learning, we paused to explore the extent of the problem of its misuse and resulting in wasted research, by examining excluded studies.

Results

From 1151 articles, we identified 207 which ignored the documented limitations of SA. Thirty-nine studies explored SA of learning. This research has limited utility: increasing the accuracy of SA does not improve performance or lifelong learning. One hundred and sixty-eight used SA as an outcome measure to assess a program or intervention, including 63 where self-assessed improvement in knowledge/skills was the sole measure. SA of self-confidence was measured in 62 studies. When confidence was compared with an objective measure of performance, both invariably increased, but confidence did not always align with competence when measured.

Discussion

Many researchers mistakenly assume the ability to accurately self-assess is essential for learning, so focus on teaching self-calibration rather than evidence-based methods of advancing learning. Other researchers incorrectly suppose that self-reported improvements in knowledge/skills provide evidence of the efficacy of a program/intervention. This is particularly troubling with regards to novices, who may believe that because they self-assess to have improved/gained confidence, they are now competent.

Conclusion

Our findings highlight the significant volume of research being done where SA is misunderstood and/or misused as a measurement. We posit reasons that such research continues to take place and suggest solutions moving forward.

Keywords:

• Self-assessment
• life-long learning
• medical education
• research wastage

Acknowledgements

We would like to thank Justin Clarke at the Centre for Evidence-Based Practice who assisted with the use of the Systematic Review Accelerator and Search Refining tool.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Additional information

Notes on contributors

Natasha Yates

Natasha Yates, MBBS, FRACGP, PhD Candidate, is an Assistant Professor of General Practice and the Deputy Lead of General Practice at Bond University, Australia. She is a Clinician Educator, practicing part-time as a community GP and teaching in the Clinical Practice domain at Bond. She has written extensively as a health translator for the community. Natasha is undertaking a Ph.D. in Medical Education, with a special interest in the use of Simulation as a mode of enhancing non-technical skills in medical students. Her Ph.D. started with an exploration of self-evaluation in the learning process and is now focussed on co-regulated learning.

Suzanne Gough

Suzanne Gough, PhD, PFHEA, MA Ed (Research), PgCert Academic Practice, BSc (Hons) Physiotherapy (UK), is an Associate Professor in Physiotherapy and Associate Dean, Learning and Teaching, at Bond University, Australia. She is also a member of the Bond Translational Simulation Collaborative team, with national and international experience in healthcare simulation education in the United Kingdom and Australia. Suzanne transitioned to academia in 2004, at Manchester Metropolitan University after working clinically as a Physiotherapist. Suzanne’s Ph.D. explored the use of simulation-based education in cardiorespiratory physiotherapy and developed the Integrated Simulation and Technology Enhanced Learning Design Framework. As Principal Investigator, she has led international project teams to develop simulated patient governance frameworks and training resources for use across the United Kingdom, on behalf of Health Education England. Suzanne’s research interests are currently focused on the use of virtual reality across diverse patient groups, First Nations health, stress and burnout, simulation and technology enhanced learning, curriculum design, and gamification.

Victoria Brazil

Victoria Brazil, MBBS, FACEM, is an emergency physician and educator. She is a Professor of Emergency Medicine and Director of Simulation at the Gold Coast Health Service and leads the Bond University Translational Simulation Collaborative. Victoria’s main interests are in connecting education with patient care—through translational simulation for healthcare, and in developing high-performing teams. Victoria is an enthusiast in the social media and #FOAMed world (@SocraticEM). She is co-producer of Simulcast and she hosts the Harvard Macy Institute podcast. She also serves as a faculty member with the Harvard Macy Institute.