Purpose: Informed self-assessment describes the set of processes through which individuals use external and internal data to generate an appraisal of their own abilities. The purpose of this project was to explore the tensions described by learners and professionals when informing their self-assessments of clinical performance.
Method: This 2008 qualitative study was guided by principles of grounded theory. Eight programs in five countries across undergraduate, postgraduate, and continuing medical education were purposively sampled. Seventeen focus groups were held (134 participants). Detailed analyses were conducted iteratively to understand themes and relationships.
Results: Participants experienced multiple tensions in informed self-assessment. Three categories of tensions emerged: within people (e.g., wanting feedback, yet fearing disconfirming feedback), between people (e.g., providing genuine feedback yet wanting to preserve relationships), and in the learning/practice environment (e.g., engaging in authentic self-assessment activities versus “playing the evaluation game”). Tensions were ongoing, contextual, and dynamic; they prevailed across participant groups, infusing all components of informed self-assessment. They also were present in varied contexts and at all levels of learners and practicing physicians.
Conclusions: Multiple tensions, requiring ongoing negotiation and renegotiation, are inherent in informed self-assessment. Tensions are both intraindividual and interindividual and they are culturally situated, reflecting both professional and institutional influences. Social learning theories (social cognitive theory) and sociocultural theories of learning (situated learning and communities of practice) may inform our understanding and interpretation of the study findings. The findings suggest that educational interventions should be directed at individual, collective, and institutional cultural levels. Implications for practice are presented.
Dr. Mann is professor emeritus, Division of Medical Education, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada, and professor, University of Manchester, Manchester, United Kingdom.
Dr. van der Vleuten is professor of education and chair, Department of Educational Development and Research, University of Maastricht, Maastricht, The Netherlands, and honorary professor, King Saud University, Riyadh, Saudi Arabia, and University of Copenhagen, Copenhagen, Denmark.
Dr. Eva is senior scientist, Centre for Health Education Scholarship, and associate professor and director of educational research and scholarship, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Dr. Armson is associate professor, Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada, and director, Enduring PBSG/Facilitator Training, Foundation for Medical Practice Education, McMaster University, Hamilton, Ontario, Canada.
Dr. Chesluk is clinical research associate in quality research, American Board of Internal Medicine, Philadelphia, Pennsylvania.
Dr. Dornan is professor, University of Maastricht, Maastricht, The Netherlands, and honorary professor, University of Manchester, Manchester, United Kingdom.
Dr. Holmboe is senior vice president for quality research and academic affairs, American Board of Internal Medicine, Philadelphia, Pennsylvania.
Dr. Lockyer is professor, Department of Community Health Sciences, and associate dean, Continuing Medical Education and Professional Development, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.
Ms. Loney is research associate and qualitative consultant, Bedford, Nova Scotia, Canada.
Dr. Sargeant is professor, Division of Medical Education, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
Please see the end of this article for information about the authors.
Correspondence should be addressed to Dr. Mann, Division of Medical Education, Faculty of Medicine, Dalhousie University, 5849 University Avenue, Halifax, NS, B3H 4H7; telephone: (902) 494-1884; fax: (902) 494-2278; e-mail: Karen.Mann@Dal.Ca.
First published online July 21, 2011