Sargeant Joan, Mann Karen, van der Vleuten Cees, Metsemakers Job
Office of Continuing Medical Education, Dalhousie University Faculty of Medicine, Dalhousie University, Halifax, Canada.
J Contin Educ Health Prof. 2008 Winter;28(1):47-54. doi: 10.1002/chp.155.
Accurate self-assessment appears to be difficult and, some would propose, even impossible. Recent reviews suggest that peer assessment may be more accurate and that multisource feedback (MSF) may inform self-assessment. We had conducted a series of studies of family physicians in an MSF program including assessments from patients, medical colleagues, and coworkers and self-assessment. Using this body of research, this article explores self-assessment within the social context of multisource feedback and investigates the influence of feedback from peers and others upon self-assessment.
This is a review article in which we synthesized findings of the series of studies with respect to self-assessment, used conclusions to propose a model for self-assessment within a social context, and suggest practical and research implications.
Physicians compared peers' and others' assessment feedback with global self-perceptions of performance. Negative feedback, especially from medical colleagues, that was inconsistent with self-perceptions was not readily reconciled with self-assessments. Multiple internal and environmental factors influenced reconciliation and assimilation of negative feedback. Reflection upon feedback and self-perceptions appeared to be instrumental to reconciliation, and reflection could be facilitated.
We propose a model of "directed" self-assessment to facilitate the integration of external feedback, especially negative feedback, with self-perceptions and enable its use for practice improvement. Implications for education and research include increasing understanding of ways physicians assimilate external feedback and of the role of educators as facilitators of "directed" self-assessment and self-learning to assist physicians in integrating external feedback.
准确的自我评估似乎很难，有些人甚至认为这是不可能的。最近的综述表明，同行评估可能更准确，多源反馈（MSF）可能有助于自我评估。我们对参与多源反馈项目的家庭医生进行了一系列研究，包括患者、医学同事、同事的评估以及自我评估。本文利用这一系列研究成果，探讨多源反馈社会背景下的自我评估，并研究同行和他人的反馈对自我评估的影响。
这是一篇综述文章，我们综合了关于自我评估的系列研究结果，利用这些结论提出了一个社会背景下自我评估的模型，并提出了实际和研究意义。
医生将同行和他人的评估反馈与对自身表现的整体自我认知进行比较。与自我认知不一致的负面反馈，尤其是来自医学同事的，很难与自我评估相协调。多种内部和环境因素影响了负面反馈的协调和吸收。对反馈和自我认知的反思似乎有助于协调，并且可以促进反思。
我们提出了一个“定向”自我评估模型，以促进外部反馈，尤其是负面反馈与自我认知的整合，并使其用于实践改进。对教育和研究的启示包括，加深对医生吸收外部反馈方式的理解，以及教育工作者作为“定向”自我评估和自我学习促进者的作用，以帮助医生整合外部反馈。
