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The Dangerous Pursuit of “Independence”—Reflections on Self-Assessment in the Health Professions

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By Dr. Glenn Regehr, Professor, Department of Surgery, and Associate Director, Research, Centre for Health Education Scholarship, University of British Columbia 

For all professions, it is expected that individual practitioners will maintain competence through a process of ongoing self-directed learning, and there has long been an assumption that the ability to self-assess undergirds this process. In fact, most health professions embed the ability to self-assess as a cornerstone of their competency frameworks. In recent years, however, the effectiveness of self-assessment has been called into doubt. Researchers have been asking questions such as: How good are individuals at assessing their own performance? How do self-assessments compare to assessments by others? Is self-assessment a generalized skill that can be employed in any context? Is self-assessment adequate to ensure safe practice? 

Guest Perspective, Glenn RegehrA substantial body of research now indicates that the value of an independently generated self-assessment for identifying personal or professional weaknesses is shaky at best. As counterintuitive as it may be, we all have a tendency to view our performance positively no matter how we perform on a given task. Particularly disquieting is the finding that, when the poorest performers have an opportunity to compare their performance with that of their better performing peers, they still believe their performance is above average. In other words, when people are not good at something, it is difficult for them to perceive their own deficiencies. It is not merely that they do not know how to perform well. They also appear not to know what a good performance should look like.

Viewed from a psychological perspective, this phenomenon may not be so surprising. All human beings have mechanisms in place to protect them from information that they might find threatening. This includes information that might damage their overall assessment of themselves, sometimes called their self-concept. Interestingly, it has been posited that this self-protective instinct may not necessarily be a bad thing. The literature regarding self-efficacy (our sense of what we are capable of) tells us that having a “rose-colored” view of ourselves may actually be useful—not just for our egos, but for our performance as well. Experiments have shown that equally capable individuals perform better in academic settings when their sense of self-efficacy is raised (by focusing on reasons they might succeed) than when it is lowered (by focusing on reasons they might fail). In other words, people who are most acutely aware that their performance is lacking have the greatest difficulty improving their performance. 

So where does all this leave us when it comes to self-assessment?

It suggests that we should move away from the goal of teaching our students to better self-assess in order to identify weaknesses upon which they can improve. Such a goal is simply not achievable, and if it were, it might not be desirable. For those who are performing poorly, more accurate self-assessment might actually impede learning rather than spur its improvement. To the extent that we want to encourage self-assessment activities, we should focus instead on the meaningful byproducts of this process. For example, when students compare their performance against an explicit rubric, they may gain a better understanding of the expectations for their performance.  

It also suggests that, rather than using self-assessment as a mechanism to make students more independent in their efforts toward practice improvement, we should be trying to help students learn to become more effectively reliant on those around them. We all hold strong opinions about our own performance, and our natural inclination is to be defensive when our views about ourselves are challenged. Furthermore, while people may be eager to learn on a conscious level, they do not want to appear incompetent. So how can educators help students learn to welcome corrective feedback from others and even seek it out? Ironically, self-assessment may provide a key.  

By giving educators an inside view of their students’ perspectives on their own performance, self-assessment activities can assist educators in framing their evaluations in ways that students will find easier to accept. They can also help educators devise challenges for students that are likely to produce failure. Since research shows that making mistakes induces the kind of knowledge-seeking and skill-building behavior that self-assessment is supposed to engender, these challenges can play an important role in achieving self-assessment’s goals. 

In the end, the place of self-assessment in the process of self-regulation and continuous quality improvement is not as straightforward as it might seem. Self-assessment may be an inevitable process (we all do it), but as a mechanism to confidently identify our own weaknesses, it is problematically flawed. Nevertheless, self-assessment can be a valuable part of the learning process if we see it for what it is. Its value lies not in its ability to make our students less reliant on others, but rather in its ability to help us gain insight into our students and guide them more effectively.  

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