Medical students' clinical self-assessments: comparisons with external measures of performance and the students' self-assessments of overall performance and effort.

PURPOSE

To find predictors of students' initial self-assessments of their clinical performances, the predictive value of their self-assessments, and factors that relate to their final self-assessments.

METHOD

Of the 142 third-year students at the University of Michigan Hospital in 1988-89, 137 (96%) completed a self-assessment questionnaire on the first day of their internal medicine clerkship and a slightly expanded questionnaire on the last day. The questionnaires asked the students to use Likert-type scales to rate their abilities regarding clinical skills, use of knowledge in the clinical setting, and discharge of patient care responsibilities. Also collected were data on the students' performances as measured externally: college grade-point averages; standardized examinations taken before, during, and after the clerkship; and ratings given the students by the faculty and residents with whom they worked in the clerkship. Pearson product-moment correlations were then calculated between the students' self-assessment ratings and their scores on the external measures of performance.

RESULTS

Weak to absent correlations were found between prior-performance measures and initial self-assessments. The lower-performing students, as measured by college grade-point averages and Medical College Admission Test scores, tended to rate their performances higher than did their peers at initial self-assessment. IN contrast, the higher-performing students rated themselves lower than would be warranted given their prior performances. There were significant increases in the initial self-assessments as the year progressed and the students entered the clerkship after having had more experience. The correlations between the students' final self-assessments and the ratings by faculty and residents were generally weak. The strongest (.267, p < or = .001) concerned the students' medical knowledge. In addition, there was a moderate correlation (.413, p < or = .001) between the students' self-assessments of how hard they had worked and their self-assessments of overall performance.

CONCLUSION

The findings in this study were similar to those of previous studies in that they showed relatively poor agreement between external measures of students' performances and students' self-assessments of their performances.