Sometimes it doesn't matter whether you can accurately judge your skills--if you think you're a good dancer but you're not, the worst you can do is step on your partner's toes. But for physicians, incorrectly assessing a situation can be much more serious. If a doctor gives a patient the wrong prescription, for example, the error can cause life-threatening side effects.
Psychologist Larry Gruppen, PhD, of the University of Michigan Medical School, has been studying this important aspect of medical practice in medical students, and he hopes to apply his findings to medical training and continuing education.
"There's good evidence that once physicians leave their residency, the currency of their information starts to decline fairly steadily," he says. "If we understand the process by which students or physicians accurately assess themselves and their problems, we can start to provide relevant feedback and help them identify places where they need further education." Medical certifying bodies have acknowledged this reality and are now requiring new physicians to recertify every few years, depending on their specialty, he notes.
In his research with medical students, Gruppen has indeed found that some students don't gauge their abilities very well. In a study reported in Academic Medicine (Vol. 72, No. 10, Supplement 1), for instance, Gruppen and University of Michigan colleagues Casey White and Tom Fitzgerald, PhD, showed that on average, medical students thought they performed better on a required clinical exercise than their supervisors thought they did. In a related study in Academic Medicine (Vol. 75, No. 5), Gruppen's team also found that even when medical students correctly perceived they'd done poorly on a task, they didn't necessarily take steps to correct it.
Now, Gruppen is adding an important new piece by longitudinally examining the accuracy of individual students' assessment of their abilities. By gathering between 12 and 20 pieces of self-assessment data every year for three years on each of 337 medical school students, Gruppen's team has demonstrated that individual students' self-assessments are stable over time, regardless of performance. The study, in press at Medical Education, also revealed an overall drop in self-assessment accuracy in the third year, when students switched from classroom-based exams to more complex clinical interactions with patients.
"Some people are highly competent but are unaware of it," Gruppen says. "I am less concerned with those individuals than with the students who are poor self-assessors and are doing poorly. They are the ones most at risk for making dangerous mistakes out of overconfidence."
Next his team will try to identify shared characteristics of these students, while other researchers test possible educational remedies.
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