Abstract

The evolution of longitudinal self-assessment by third-year medical students

Author(s): Marina MacNamara, Paul George, Jamie Gainor, Nilay Patel, Richard Dollase, Julie Taylor

Background: Self-assessment is an essential component of the lifelong learning expected of physicians. There are limited data on the relationship between medical students’ self-assessments and their self-directed learning goals.

Objective: To longitudinally evaluate third-year medical students’ self-assessment of both clinical and professional competencies as well as self-directed learning goals over time: at the beginning and the end of a three-week non-specialty specific Clinical Skills Clerkship (CSC) that is offered at the start of the third year of medical school and again, 12 weeks into clinical clerkships.

Design: A single cohort of medical students was evaluated three times over 15 weeks with a confidential 22-question written survey including both quantitative and open-ended questions.

Setting: A new class of third-year medical students at one US university (n = 98).

Outcome Measures: Based on an extensive literature review and iterative process, medical education faculty and senior medical students developed and refined a self-assessment survey with 16 Likert-style questions which asked new third-year medical students to assess their own competencies in 12 clinical and four professional skills. An additional six open-ended questions addressed student learning goals for the three-week CSC and the subsequent clinical clerkships.

Results: Overall, the mean Likert score for 15 of 16 clinical and professional competencies in the survey were significantly higher at the end of the three-week CSC as compared to the start. In the first survey at the start of the course, means ranged from 1.08 to 2.83 (1 very incompetent, 4 very competent); in the second survey at the end of the course, they ranged from 2.10 to 3.24. Twelve weeks later, the mean for nine of the 16 competencies had significantly decreased compared to the end of the CSC, especially among clinical skills. Open-ended qualitative learning goals also mirrored this pattern, though without statistical significance.

Conclusion: Our study’s findings indicate a positive effect of the transition course on new third-year medical students’ self-reported preparedness level for clinical clerkships. The decrease in students’ self-assessment scores for certain clinical skills after three months of clinical experience may indicate the impact of experiential learning on self-assessments. The corresponding increase in citations of these same skills as learning goals provides evidence for the close relationship between the processes of self-assessment and the setting of learning goals.