Inistitute of Health and Nursing Science, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Centre for Adaptive Rationality, Max Planck Institute for Human Development, Berlin, Germany.
Med Educ. 2020 Apr;54(4):320-327. doi: 10.1111/medu.14057. Epub 2020 Mar 2.
Accurate self-assessment of one's performace on a moment-by-moment basis (ie, accurate self-monitoring) is vital for the self-regulation of practising physicians and indeed for the effective regulation of self-directed learning during medical education. However, little is currently known about the functioning of self-monitoring and its co-development with medical knowledge across medical education. This study is the first to simultaneously investigate a number of relevant aspects and measures that have so far been studied separately: different measures of self-monitoring for a broad area of medical knowledge across 10 different performance levels.
This study assessed the self-monitoring accuracy of medical students (n = 3145) across 10 semesters. Data collected during the administration of the formative Berlin Progress Test Medicine (PTM) were analysed. The PTM comprises 200 multiple-choice questions covering all major medical disciplines and organ systems. A self-report indicator (ie, confidence) and two behavioural indicators of self-monitoring accuracy (ie, response time and the likelihood of changing an initial answer to a correct rather than an incorrect item) were examined for their development over semesters.
Analyses of more than 390 000 observations (of approximately 250 students per semester) showed that confidence was higher for correctly than for incorrectly answered items and that 86% of items answered with high confidence were indeed correct. Response time and the likelihood of the initial answer being changed were higher when the initial answer was incorrect than when it was correct. Contrary to expectations, no differences in self-monitoring accuracy were observed across semesters.
Convergent evidence from different measures of self-monitoring suggests that medical students self-monitor their knowledge on a question-by-question basis well, although not perfectly, and to the same degree as has been found in studies outside medicine. Despite large differences in performance, no variations in self-monitoring across semesters (with the exception of the first semester) were observed.
准确地自我评估（即准确的自我监测）在执业医师的自我调节中至关重要，实际上对于医学教育中的自我导向学习的有效调节也是如此。然而，目前对于自我监测的功能以及其在医学教育中与医学知识的共同发展知之甚少。这项研究首次同时调查了迄今为止分别研究的一些相关方面和措施：在 10 个不同的表现水平上，针对广泛的医学知识进行了不同的自我监测措施。
本研究评估了医学生（n=3145）在 10 个学期中的自我监测准确性。在进行形成性柏林进展测试医学（PTM）期间收集的数据进行了分析。PTM 包含 200 个多项选择题，涵盖了所有主要医学学科和器官系统。自我报告指标（即信心）和自我监测准确性的两个行为指标（即反应时间和初始答案更改为正确而不是错误项的可能性），对其在学期中的发展进行了研究。
对超过 390000 次观察（每个学期约有 250 名学生）的分析表明，正确回答的项目比错误回答的项目的信心更高，而以高置信度回答的 86%的项目确实是正确的。当初始答案错误时，反应时间和初始答案改变的可能性更高。与预期相反，在整个学期中没有观察到自我监测准确性的差异。
不同自我监测措施的一致性证据表明，医学生能够很好地（尽管不是完美地）自我监测他们对问题的知识，并且与医学以外的研究中发现的自我监测程度相同。尽管表现存在很大差异，但在整个学期中没有观察到自我监测的变化（除了第一学期）。
