Review Medical students’ self-assessment of performance: Results from three meta-analyses Danielle Blanch-Hartigan * Department of Psychology, Northeastern University, Boston, MA, USA 1. Introduction Accurate self-assessment of performance allows physicians to understand their own strengths and weaknesses and know which areas to focus on in their lifelong medical education [1,2]. Because of the importance of this ability throughout their careers, self- assessment is considered a component of establishing clinical competence in medical school [3,4]. The present article presents three meta-analyses of published research on medical students’ self-assessment accuracy, one for each of the three different ways self-assessment accuracy is typically reported, and examines potential moderators of self- assessment accuracy. The relationship between medical student self-assessment and performance criteria is often in the low to moderate range [5], indicating that self-assessment is not an easy or perfect ability. However, formal meta-analysis has not been conducted and we know very little about the direction of inaccuracy; do students typically over- or underestimate their performance? In addition, moderator analyses of characteristics that may influence self-assessment have not been conducted, leaving open the question of whether there are systematic differences in self-assessment ability and direction of inaccuracy across studies. 1.1. Different ways to measure self-assessment accuracy The most commonly reported accuracy measure is the correlation between self-assessment and criterion scores [6]. This covariation between self-assessment and criterion indicates how well criterion scores can be predicted from self-assessment scores. This measure provides no indication of direction of inaccuracy in an absolute sense (i.e., either over- or underestimation) because correlation coefficients standardize variables. Therefore, with a correlation coefficient one does not know how far apart the self- assessment and the criterion are or which is higher than the other, only whether they covary across self-assessors. However, this is the most frequently reported self-assessment accuracy score, perhaps because criterion and self-assessment do not have to be on the same scale. For example, a self-evaluation on a rating scale could be correlated with end of year grade point average. Patient Education and Counseling xxx (2010) xxx–xxx * Correspondence address. Department of Psychology, Northeastern University, 125 Nightingale Hall, 360 Huntington Ave., Boston, MA 02115, USA. Tel.: +1 617 373 3079; fax: +1 617 373 8714. E-mail address: Blanch.d@husky.neu.edu. ARTICLE INFO Article history: Received 18 January 2010 Received in revised form 23 June 2010 Accepted 24 June 2010 Keywords: Self-assessment Medical students Medical education Self-evaluation Gender Competence ABSTRACT Objective: Self-assessment is an important component of medical education. Meta-analyses were conducted to better understand accuracy of self-assessment and direction of inaccuracy. Methods: Three meta-analyses were conducted on results from 35 published articles on medical student self-assessment, one for each of the theoretically distinct ways of measuring accuracy of self-reported ability (correlational, paired comparison, and independent means comparison). Characteristics that potentially influence self-assessment accuracy, including gender, year in medical school, and type of self-assessment, were examined. Results: Students are moderately able to self-assess performance and are more accurate later in medical school. Students as a whole do not significantly over- or underestimate, but are more likely to overestimate on communication-based, standardized patient encounters than objective, knowledge- based performance measures. Female students underestimate their performance more than male students, but gender analyses are often unreported. Conclusion: A deeper understanding of the causes and consequences of over- and underestimation is impossible without measurement and reporting of the direction of inaccuracy. Practice implications: To improve our understanding of self-assessment and increase its effectiveness as a teaching tool, research should report self-assessment as both a correlation and a paired comparison, and conduct analyses of important moderators that can influence self-assessment accuracy. ß 2010 Elsevier Ireland Ltd. All rights reserved. G Model PEC-3764; No. of Pages 7 Please cite this article in press as: Blanch-Hartigan D. Medical students’ self-assessment of performance: Results from three meta- analyses. Patient Educ Couns (2010), doi:10.1016/j.pec.2010.06.037 Contents lists available at ScienceDirect Patient Education and Counseling journal homepage: www.elsevier.com/locate/pateducou 0738-3991/$ – see front matter ß 2010 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.pec.2010.06.037