The Assessment Rationale of Postgraduate Medical Trainees With Incongruent Self and Faculty Assigned Entrustment Scores.

Background Self-assessment is a central skill in competency-based medical education (CBME) and should be fostered in order to promote life-long learning. One measure that will guide the development of self-assessment is the alignment between it and external expert assessment. In this study, we explored the qualitative themes in the self-assessment rationale among trainees with incongruent self and faculty-assigned entrustment scores. Methods A total of 40 postgraduate medical trainees completed a four-scenario summative objective structured clinical examination (OSCE) as part of a simulation-based resuscitation curriculum in December 2017. After each scenario, an assessment involving an entrustment score and narrative rationale was completed by both trainee (self) and faculty. The differences between the trainee and faculty scores were calculated for each scenario and summed to give a single "incongruence score". Trainees who consistently scored themselves higher than the faculty were said to have a "positive-incongruence score" and those scoring below the faculty were said to have a "negative-incongruence" score. Through this method, 10 trainees with the highest and lowest scores were assigned to each group and their narrative rationales were coded and thematically analyzed. Results The content of the self-assessment narrative rationale differed between the two groups. Trainees in the positive-incongruence group focused on the concepts of speed and situational management, while trainees in the negative-incongruence group commented on lack of support, and a need to improve communication, diagnosis, and code blue management. The quality of the self-assessment rationale also differed between groups. Trainees in the negative-incongruence group provided higher-quality comments that were more detailed and granular. Conclusion We found differences in the content and quality of the self-assessment rationale between trainees whose self and faculty-assigned assessment is incongruent. This provides insight into how these groups differ and has valuable implications for the development of curricula targeting self-assessment skills.