Flawed Self-Assessment

Perceived Self-Efficacy and Risky Driving Behaviors

Les recherches dans le domaine de la santé, et notamment en matière de conduite automobile, attestent que le jugement subjectif du risque (comparatif et absolu) et l’auto-efficacité perçue sont impliqués dans les comportements à risque. Cette étude avait pour objectif d’étudier l’influence de l’auto-efficacité perçue sur le jugement subjectif du risque, évalué au moyen d’une mesure indirecte, et de tester le rôle médiateur de ce facteur entre l’auto-efficacité perçue et les comportements auto-déclarés. Les participants, 90 hommes, lisaient deux scénarii décrivant les deux comportements les plus impliqués dans l’accidentologie: la vitesse et l’alcool au volant. Les résultats ne montrent pas de lien significatif entre l’auto-efficacité perçue et le score de jugement comparatif mais une relation significative avec les deux évaluations absolues du risque (autrui et soi). De plus, le jugement absolu du risque pour soi médiatise partiellement la relation entre auto-efficacité perçue et comportements auto-déclarés relatifs aux deux risques routiers étudiés.

Cognitive Therapy Trainees’ Self-Reflections on their Professional Learning

Background: The widening scope of cognitive therapy models and strategies poses a challenge for designing cognitive therapy training. What are the core skills to be learned? What do learners view as important to learn and what are the skills and knowledge they focus on? Aims: The present study describes the perceptions of CT trainees of both what is important and what is difficult to learn. We also analyse what the trainees focus on when evaluating their professional learning. In addition, we report on changes in self-assessed skills during the training. Method: Quantitative and qualitative data were collected after 2 years of training (n = 39) in three programmes and after the entire 4-year training in four programmes (n = 53). Results: Significant progress was reported in all domains of therapist skills, most clearly in cognitive and constructivist strategies. The trainees practised most those skills they considered important to be learned and, consequently, they also attained a higher level of mastery in these skills. The trainees’ learning orientation and foci of self-reflections remained relatively unchanged. They focused on technical and conceptual skills and knowledge, whereas interpersonal skills were peripheral in their self-reflection. Conclusions: Pedagogical and theoretical implications of the findings are discussed.

How numeracy influences risk comprehension and medical decision making

We review the growing literature on health numeracy, the ability to understand and use numerical information, and its relation to cognition, health behaviors, and medical outcomes. Despite the surfeit of health information from commercial and noncommercial sources, national and international surveys show that many people lack basic numerical skills that are essential to maintain their health and make informed medical decisions. Low numeracy distorts perceptions of risks and benefits of screening, reduces medication compliance, impedes access to treatments, impairs risk communication (limiting prevention efforts among the most vulnerable), and, based on the scant research conducted on outcomes, appears to adversely affect medical outcomes. Low numeracy is also associated with greater susceptibility to extraneous factors (i.e., factors that do not change the objective numerical information). That is, low numeracy increases susceptibility to effects of mood or how information is presented (e.g., as frequencies vs. percentages) and to biases in judgment and decision making (e.g., framing and ratio bias effects). Much of this research is not grounded in empirically supported theories of numeracy or mathematical cognition, which are crucial for designing evidence-based policies and interventions that are effective in reducing risk and improving medical decision making. To address this gap, we outline four theoretical approaches (psychophysical, computational, standard dual-process, and fuzzy trace theory), review their implications for numeracy, and point to avenues for future research.

Self-affirmation enhances attentional bias toward threatening components of a persuasive message

We explored whether self-affirmation enhances attentional bias toward threatening elements of a persuasive message. Female alcohol consumers read an article linking alcohol to breast cancer and were then exposed supraliminally to threat and nonthreat words from the article (as well as threat and nonthreat words that did not appear in the article). Among moderately heavy drinkers who were not self-affirmed, there emerged an attentional bias away from the threatening words in the article-a result suggesting an avoidant response. However, among moderately heavy drinkers who were self-affirmed, there was a bias toward the threatening words. No attentional biases appeared for threat words not in the message, which suggested that the effect was threat specific. Moreover, no attentional biases were found among the heaviest drinkers. Self-affirmation may facilitate targeted implicit processing of threatening messages, although the effects could attenuate among individuals engaging in high levels of the behavior featured in the message.

Neonatologist training to guide family decision making for critically ill infants

OBJECTIVES

To assess neonatology fellow training in guiding family decision making for high-risk newborns and in several critical communication skills for physicians in these scenarios.

DESIGN

A Web-based national survey.

SETTING

Neonatal-perinatal training programs in the United States.

PARTICIPANTS

Graduating fellows in their final month of fellowship.

MAIN OUTCOME MEASURES

Fellows' perceived training and preparedness to communicate with families about decision making.

RESULTS

The response rate was 72%, representing 83% of accredited training programs. Fellows had a great deal of training in the medical management of extremely premature and dying infants. However, they reported much less training to communicate and make collaborative decisions with the families of these infants. More than 40% of fellows reported no communication training in the form of didactic sessions, role play, or simulated patient scenarios and no clinical communication skills training in the form of supervision and feedback of fellow-led family meetings. Fellows felt least trained to discuss palliative care, families' religious and spiritual needs, and managing conflicts of opinion between families and staff or among staff. Fellows perceived communication skills training to be of a higher priority to them than to faculty, and 93% of fellows feel that training in this area should be improved.

CONCLUSIONS

Graduating neonatology fellows are highly trained in the technical skills necessary to care for critically ill and dying neonates but are inadequately trained in the communication skills that families identify as critically important when facing end-of-life decisions.

Recognition of home injury risks by novice parents of toddlers

OBJECTIVE

Unintentional injury in the home is a leading cause of death for toddlers. The majority of injuries occur at home; parents play a significant role in injury prevention. Health-related behavior change theory suggests that behavior change is only possible if individuals (a) recognize the problem, and (b) believe they are vulnerable. This study examined these characteristics among novice parents of toddlers by investigating how well parents recognize hazards in the home and whether they believe their toddlers are vulnerable to those hazards.

METHODS

Three types of participants were recruited: novice parents of toddlers ages 12-36 months, daycare employees, and pediatric healthcare workers. All participants were examined three rooms simulating a typical toddler's bedroom, a living room, and a bathroom. Participants marked any hazards they recognized with stickers. Parents completed the hazard identification task twice, once identifying hazards for all toddlers and another time identifying hazards for their child.

RESULTS

Participants identified less than half the hazards present in the simulated rooms; parents identified more hazards than comparison groups. Parents identified significantly fewer hazards for their own child than they identified for other children.

DISCUSSION

Although parents identified more hazards than the professionals, they failed to identify a large portion of hazards and they perceived their own children to have less vulnerability than toddlers more broadly. Results indicate that education about toddler's vulnerability to injury in the home, as well as instructing parents about what situations are hazardous, might be considered during development of toddler home injury prevention programs.

Storytelling: its place in infection control education

It is generally accepted that hand hygiene is the single most effective measure to prevent health care associated infection. Similarly, education is thought to be the cornerstone of effective practice. While common sense supports the notion that hand hygiene compliance would be enhanced by producing a well informed health care worker, traditional didactic methods of teaching are often poor at invoking and sustaining behaviour change. Storytelling is gaining popularity as an educational activity as it is said to stimulate thought, reflection and enhance the learning experience. This paper, describes one way in which storytelling may be used within a hand hygiene improvement strategy.

English use among older bilingual immigrants in linguistically concentrated neighborhoods: social proficiency and internal speech as intracultural variation

This research focuses on patterns of English proficiency and use-of-English among older immigrants living in linguistically concentrated, ethnic neighborhoods. A sample (n = 60) of older Puerto Ricans, who moved from the island to the mainland in their twenties, were divided into English proficiency groups (fluent, high intermediate, low intermediate) via the Adult Language Assessment Scales. Participants then provided self-ratings of their English proficiency (understanding, speaking, reading, and writing), their use of English in social domains (language spoken with own-family, in-laws, spouse, children, neighbors, and workmates), and their use of English in private psychological domains (language of talking to oneself, counting, writing notes to oneself, thinking, dreaming, praying, and expressing feelings). Finally, all participants completed the Puerto Rican Bicultural Scale. Results show a cohort of immigrant elders whose first language is protected by their ethnic neighborhoods but whose domestic and private lives are increasingly permeated by English. In particular, children emerge as powerful forces of language socialization in English for their parents. Further, there are important individual differences by level of proficiency, with a lowest proficiency group that is less acculturated, lower in socioeconomic status, and even more linguistically isolated than groups with higher proficiency. In essence, level of second language proficiency is a potent source of intracultural variation. Methodologically, the paper makes the important point that self-rated patterns of language use are consistent with scores on formal measures of proficiency. The paper also provides empirical verification of the logic of dividing language use into external, social speech and internal, psychological speech.

Self-assessed driver competence among novice drivers--a comparison of driving test candidate assessments and examiner assessments in a Dutch and Finnish sample

PROBLEM

This study examined novice drivers' overconfidence by comparing their self-assessed driver competence with the assessments made by driving examiners.

METHOD

A Finnish (n=2,739) and a Dutch sample (n=239) of drivers license candidates assessed their driver competence in six areas and took the driving test.

RESULT AND DISCUSSION

In contrast to previous studies where drivers have assessed their skill in comparison to the average driver, a smaller proportion overestimated and a larger proportion made realistic self-assessments of their driver competence in the present study, where self-assessments were compared with examiner assessments. Between 40% and 50% of the candidates in both samples made realistic assessments and 30% to 40% overestimated their competence. The proportion of overestimation was greater in the Dutch than in the Finnish sample, which might be explained by greater possibilities for practicing self-assessment in the Finnish driver education system. Similar to other self-assessment studies that indicate that incompetence is related to overestimation, a larger proportion of candidates that failed the test overestimated their skill compared to those who passed. In contrast to other studies, males did not overestimate their skills more than females, and younger driver candidates were not more overconfident than older drivers.

IMPACT ON TRAFFIC SAFETY

Although a great proportion of the candidates made a realistic assessment of their own driver competence, overestimation is still a problem that needs to be dealt with. To improve the accuracy of novice drivers' self-assessment, methods for self-assessment training should be developed and implemented in the driver licensing process.

Assessing public health capabilities during emergency preparedness tabletop exercises: reliability and validity of a measurement tool

OBJECTIVES

Improving the ability of local public health agencies to respond to large-scale emergencies is an ongoing challenge. Tabletop exercises can provide an opportunity for individuals and groups to practice coordination of emergency response and evaluate performance. The purpose of this study was to develop a valid and reliable self-assessment performance measurement tool for tabletop exercise participants.

METHODS

The study population comprised 179 public officials who attended three tabletop exercises in Massachusetts and Maine between September 2005 and November 2006. A 42-item questionnaire was developed to assess five public health functional capabilities: (1) leadership and management, (2) mass casualty care, (3) communication, (4) disease control and prevention, and (5) surveillance and epidemiology. Analyses were undertaken to examine internal consistency, associations among scales, the empirical structure of the items, and inter-rater agreement.

RESULTS

Thirty-seven questions were retained in the final questionnaire and grouped according to the original five domains. Alpha coefficients were 0.81 or higher for all scales. The five-factor solution from the principal components analysis accounted for 60% of the total variance, and the factor structure was consistent with the five domains of the original conceptual model. Inter-rater agreement ranged from good to excellent.

CONCLUSIONS

The resulting 37-item performance measurement tool was found to reliably measure public health functional capabilities in a tabletop exercise setting, with preliminary evidence of a factor structure consistent with the original conceptualization and of criterion-related validity.

Exploring the hand hygiene competence of student nurses: a case of flawed self assessment

Hand hygiene remains the single most effective measure to prevent hospital acquired infection and yet poor compliance is reported repeatedly. Nurses represent the largest labour group and perform the greatest amount of direct patient care in the contemporary National Health Service. They receive their initial hand hygiene training in the pre-registration curriculum within a competence framework based on knowledge, skills and attitudes. The pre-eminent training method is one that delivers behavioural competence, making the tacit assumption that compliance will follow. In this study a mixed methods approach demonstrated that students overestimated their knowledge and skills, found it difficult to give an objective account of their performance, and reported an improbable level of compliance. The reasons why people can be self serving in their judgements may be due to information processing errors, exacerbated by the model of education and training. Flawed self assessments may present major barriers to improved performance if students view their compliance as better than it actually is. Conceptualising hand hygiene as a taxonomy of learning and introducing the cognitive strategies of reflection and self assessment would better enable students to problem solve, seek out new information, draw on past experience and gain greater and deeper understanding of the complex topic of hand hygiene behaviour.

Self-Image Goals and Compassionate Goals: Costs and Benefits

Two types of interpersonal goals-self-image goals and compassionate goals-reflect distinct motivational perspectives on the relationship between the self and others-egosystem and ecosystem perspectives, respectively. Research on the associations of self-image goals and compassionate goals with students' experiences in their first semester of college is described. Chronic self-image goals and compassionate goals predict changes in learning and achievement goals, self-regulation and goal progress, social support and friendships, emotions, and symptoms of anxiety and depression. Self-image goals have costs for belonging, and compassionate goals have benefits for belonging.

Beyond Oversights, Lies, and Pies in the Sky: Exaggeration as Goal Projection

The adaptiveness of overly positive self-evaluation is heavily debated. The present research emphasizes that costs and benefits of positive biases are contingent upon their underlying motives. Five studies explored psychological and performance correlates of the tendency to exaggerate academic performance. Students who exaggerated in a private reporting context showed greater achievement motivation and positive affect (Study 1), challenge and approach orientations (Study 2), and observer-rated composure during a stressful mock job interview (Study 3). Moreover, exaggeration predicted subsequent academic improvements. This form of exaggeration apparently reflects an adaptive tendency to project positive goals onto self-reports. In contrast, exaggeration in a more public context was associated with social desirability motives and not with positive affect, approach/challenge motives, or improvement (Study 4). Making actual performance salient (by highlighting that records would be checked) reduced exaggeration; students who exaggerated in this context did not improve over time, instead showing performance decrements (Study 5).

From sucker to saint: moralization in response to self-threat

When people's rationality and agency are implicitly called into question by the more expedient behavior of others, they sometimes respond by feeling morally superior; this is referred to as the sucker-to-saint effect. In Experiment 1, participants who completed a tedious task and then saw a confederate quit the same task elevated their own morality over that of the confederate, whereas participants who simply completed the task or simply saw the confederate quit did not. In Experiment 2, this effect was eliminated by having participants contemplate a valued personal quality before encountering the rebellious confederate, a result suggesting a role for self-threat in producing moralization. These studies demonstrate that moral judgments can be more deeply embedded in judges' immediate social contexts-and driven more by motivations to maintain self-image-than is typically appreciated in contemporary moral-psychology research. Rather than uphold abstract principles of justice, moral judgment may sometimes just help people feel a little less foolish.

When Focusing on Negative and Positive Attributes of the Self Elicits More Inductive Self-Judgment

Self-judgments can range from inductive (i.e., based on relevant characteristics, behaviors, and past experiences) to deductive (i.e., inferred from general beliefs about the self) depending on the situation. Previous work demonstrated that focusing on positive attributes—particularly under threat—can elicit less inductive self-judgment. In this article, the authors tested the hypothesis that priming negative attributes of the self would lead to more inductive self-judgment. The authors also tested whether focusing on positive attributes would lead to more inductive self-judgment in a context where one is constrained to think inductively. In three studies with disparate manipulations, the authors looked at how well participants' self-reported risk factors for health problems were related to their risk perceptions for these health problems. Both hypotheses were supported. The authors discuss implications of these findings for theoretical approaches to self-judgment and practical concerns about the reliability and validity of self-judgments.

Insight into neurocognitive dysfunction in schizophrenia

Insight into psychotic symptoms is typically poor in schizophrenia; however, it is not known whether insight into neurocognitive impairment is similarly impaired. Most people with schizophrenia experience cognitive dysfunction, and the deficits in attention, memory, and critical thinking have been associated with poor functional outcome. As new treatments are developed for the cognitive impairments, it will be important to know whether patients will be receptive to yet another therapy. Insight is an important factor in treatment compliance and treatment outcome; however, it is not known if patients have insight into their cognitive dysfunction. In order to assess insight into neuro cognitive dysfunction, 75 subjects were administered the Measure of Insight into Cognition-Clinician Rated, a newly created measure based on the Scale to Access the Unawareness of Mental Disorder, that assesses insight into cognitive impairment. Subjects were also administered the Brief Assessment of Cognition in Schizophrenia and Independent Living Scale-Problem Solving to objectively assess neuropsychological status and problem-solving skills needed for independent living. Results demonstrated that virtually all subjects had cognitive impairment, yet insight into their neuro cognitive symptoms was limited. This finding has potential implications for treatment programs seeking to improve cognitive functioning in schizophrenia.

Self-Assessment: The Disconnect between Research and Rhetoric

PURPOSE

Physical therapists are expected to engage in self-assessment in order to ensure competent practice and to identify appropriate professional development activities.

SUMMARY OF KEY POINTS

This paper reviews the current literature on the accuracy and role of self-assessment in physical therapy. Current literature indicating that self-assessment cannot be conducted with any degree of accuracy is discussed, and a proposed reformulation of the concept of self-assessment is presented.

RECOMMENDATIONS

Practical strategies are offered for clinicians to improve the potential for obtaining reliable and valid information about their own clinical performance to guide the selection of appropriate professional development activities and to promote the provision of competent patient care.

Clinical implications of numeracy: theory and practice

BACKGROUND

Low numeracy is pervasive and constrains informed patient choice, reduces medication compliance, limits access to treatments, impairs risk communication, and affects medical outcomes; therefore, it is incumbent upon providers to minimize its adverse effects.

PURPOSE

We provide an overview of research on health numeracy and discuss its implications in clinical contexts.

CONCLUSIONS

Low numeracy cannot be reliably inferred on the basis of patients' education, intelligence, or other observable characteristics. Objective and subjective assessments of numeracy are available in short forms and could be used to tailor health communication. Low scorers on these assessments are subject to cognitive biases, irrelevant cues (e.g., mood), and sharper temporal discounting. Because prevention of the leading causes of death (e.g., cancer and cardiovascular disease) depends on taking action now to prevent serious consequences later, those low in numeracy are likely to require more explanation of risk to engage in prevention behaviors. Visual displays can be used to make numerical relations more transparent, and different types of displays have different effects (e.g., greater risk avoidance). Ironically, superior quantitative processing seems to be achieved by focusing on qualitative gist and affective meaning, which has important implications for empowering patients to take advantage of the evidence in evidence-based medicine.

Compliance and infection control guidelines: a complex phenomenon

Healthcare-acquired infection has become a global health phenomenon affecting approximately 8.7% of the world's population. Despite a plethora of evidence-based guidelines, policies and procedures, knowledge of these can be poor, and when this is the case, sub-optimum care may follow. Historically, enhancement strategies have focused on the provision of education by making the tacit assumption that an increase in knowledge will result in an improvement in compliance. However, compliance is a multi-dimensional, abstract, complex concept that is difficult to define. Decision-making is rarely objective and the capacity of personal experience to outweigh scientific evidence is a hallmark of the post-modern times in which we live. It is well established in social psychology research that when faced with complex encounters, individuals turn to simple reasoning rules called 'heuristics', to make decisions. These heuristics are potentially dangerous as they can introduce flawed probability judgements in relation to compliance behaviour. If the raison-d'être of infection control nursing is to attain compliance with the best available evidence, organizations need to reject a reductionist, cause-and-effect view of compliance and acknowledge that compliance and infection control practice is a complex social construct.

The Impact of Anticipated Consequences, Respondent Group, and Strength of Affirmative Action Plan on Affirmative Action Attitudes

Two experiments found that affirmative action attitudes varied with the respondent's racioethnic group, strength of affirmative action plan (AAP), anticipated consequences of the AAP, and interactions of racioethnic group with the other variables. AAP strength had a monotonic negative effect on attitudes for some groups, but an inverse-U effect for others. Attitudes were most strongly associated with the anticipated impact of the AAP on company performance; they were also related to the expected effects on collective self-interest, target group representation, and target group stigmatization. The positive relation between the anticipated impact on company performance and support for the AAP was stronger among Whites than U.S.-born Hispanics; the negative relation between anticipated stigmatization and AAP support was stronger among Whites than African-Americans. The effect of AAP strength on attitudes was partially mediated by the anticipated consequences among Whites and African-Americans, but not among Hispanics and Asians.

Everyday Conceptions of Modesty: A Prototype Analysis

Good theoretical definitions of psychological phenomena not only are rigorously formulated but also provide ample conceptual coverage. To assess the latter, we empirically surveyed everyday conceptions of modesty in a combined U.S./U.K. sample. In Study 1, participants freely generated multiple exemplars of modesty that judges subsequently sorted into superordinate categories. Exemplar frequency and priority served, respectively, as primary and secondary indices of category prototypicality that enabled central, peripheral, and marginal clusters to be identified. Follow-up studies then confirmed the ordinal prototypicality of these clusters with the aid of both explicit (Studies 2 and 3) and implicit (Study 3) methodologies. Modest people emerged centrally as humble, shy, solicitous, and not boastful and peripherally as honest, likeable, not arrogant, attention-avoiding, plain, and gracious. Everyday conceptions of modesty also spanned both mind and behavior, emphasized agreeableness and introversion, and predictably incorporated an element of humility.

Self-Enhancement: Food for Thought

Self-enhancement denotes a class of psychological phenomena that involve taking a tendentiously positive view of oneself. We distinguish between four levels of self-enhancement—an observed effect, an ongoing process, a personality trait, and an underlying motive—and then use these distinctions to organize the wealth of relevant research. Furthermore, to render these distinctions intuitive, we draw an extended analogy between self-enhancement and the phenomenon of eating. Among the topics we address are (a) manifestations of self-enhancement, both obvious and subtle, and rival interpretations; (b) experimentally documented dynamics of affirming and threatening the ego; and (c) primacy of self-enhancement, considered alongside other intrapsychic phenomena, and across different cultures. Self-enhancement, like eating, is a fundamental part of human nature.

Praise for regret: People value regret above other negative emotions

What do people think about the emotion of regret? Recent demonstrations of the psychological benefits of regret have been framed against an assumption that most people find regret to be aversive, both when experienced but also when recalled later. Two studies explored lay evaluations of regret experiences, revealing them to be largely favorable rather than unfavorable. Study 1 demonstrated that regret, but not other negative emotions, was dominated by positive more than negative evaluations. In both studies 1 and 2, although participants saw a great deal of benefit from their negative emotions, regret stood out as particularly beneficial. Indeed, in study 2, regret was seen to be the most beneficial of 12 negative emotions on all five functions of: making sense of past experiences, facilitating approach behaviors, facilitating avoidance behaviors, gaining insights into the self, and in preserving social harmony. Moreover, in study 2, individuals made self-serving ascriptions of regret, reporting greater regret experiences for themselves than for others. In short, people value their regrets substantially more than they do other negative emotions.

Low Flu Shot Rates Puzzle—Some Plausible Behavioral Explanations

The paper presents an economic model to analyze an individual's decision about whether or not to be vaccinated against influenza. It shows that based upon objective parameters, the vaccination rate should be high. Yet, empirical findings indicate low vaccination rates. Therefore, we use the behavioral approach and subjective variables to explain the empirical findings. The subjective variables in the model include perceived infection probability, time preference, subjective costs of vaccination, perceived severity of illness and perceived vaccination effectiveness. A low vaccination rate has a negative externality on society. The paper discusses potential policies that can be applied to changing the situation.

Validity of the Inventory of Interpersonal Problems (IIP-64) for predicting assertiveness in role-play situations

The Inventory of Interpersonal Problems (IIP-64; Horowitz, Alden, Wiggins, & Pincus, 2000) is a self-report measure of maladaptive relationship behavior. Ninety-five adult female participants completed the IIP-64 and then interacted with a same-sex confederate in three diagnostic role plays, designed to evoke assertive responses. After each role play, both the participant and the confederate judged how assertive the participant had been, using two subscales from the Interpersonal Adjective Scales (IAS; Wiggins, 1995). The participants' general self-images, assessed with the IIP-64, were quite congruent with how they judged their own assertiveness in the role plays. But when role-play assertiveness was judged by the confederate, the match with the participants' general self-images was considerably lower. Our results indicate that self-reported interpersonal problems do not converge well with external judgments of interpersonal behavior.

A Mile in Moccasins: How Situational Experience Diminishes Dispositionism in Social Inference

In four studies, this article investigates the impact of situational experience on social inference. Participants without firsthand experience of a situation made more extreme and erroneous inferences about the personalities of people behaving in that situation than did participants with firsthand experience. Firsthand experience, thus, appears to diminish dispositionism in social inference because it informs people about the situational constraints that guide behavior. Across all studies, participants also displayed holier-than-thou biases, overpredicting how generously they would act relative to predictions about their peers and also relative to how they actually acted when the situation came.

Why the Unskilled Are Unaware: Further Explorations of (Absent) Self-Insight Among the Incompetent

People are typically overly optimistic when evaluating the quality of their performance on social and intellectual tasks. In particular, poor performers grossly overestimate their performances because their incompetence deprives them of the skills needed to recognize their deficits. Five studies demonstrated that poor performers lack insight into their shortcomings even in real world settings and when given incentives to be accurate. An additional meta-analysis showed that it was lack of insight into their own errors (and not mistaken assessments of their peers) that led to overly optimistic estimates among poor performers. Along the way, these studies ruled out recent alternative accounts that have been proposed to explain why poor performers hold such positive impressions of their performance.

"I'll never play professional football" and other fallacies of self-assessment

It is generally well accepted in health professional education that self-assessment is a key step in the continuing professional development cycle. While there has been increasing discussion in the community pertaining to whether or not professionals can indeed self-assess accurately, much of this discussion has been clouded by the fact that the term self-assessment has been used in an unfortunate and confusing variety of ways. In this article we will draw distinctions between self-assessment (an ability), self-directed assessment seeking and reflection (pedagogical strategies), and self-monitoring (immediate contextually relevant responses to environmental stimuli) in an attempt to clarify the rhetoric pertaining to each activity and provide some guidance regarding the implications that can be drawn from making these distinctions. We will further explore a source of persistence in the community's efforts to improve self-assessment despite clear findings from a large body of research that we as humans do not (and, in fact, perhaps cannot) self-assess well by describing what we call a "they not we" phenomenon. Finally, we will use this phenomenon and the distinctions previously described to advocate for a variety of research projects aimed at shedding further light on the complicated relationship between self-assessment and other forms of self-regulating professional development activities.

Making self-assessment more effective

Self-assessment has been held out as an important mechanism for lifelong learning and self-improvement for health care professionals. However, there is growing concern that individual learners often interpret the results inaccurately. This idea has led to skepticism that self-assessment in its current form can ever be truly useful for lifelong professional development. We examine the proposal that self-assessment can and should be made more effective. First, relevance should be improved. The process should be tied more explicitly to the individual's actual practice profile, rather than being loosely relevant to broader constructs around the permitted scope of practice (eg, certification or licensure). In addition, self-assessment should include not only knowledge and reasoning but also what is done every day in practice, thereby broadening from competence in simulated settings to performance in real settings. Second, the impact of self-assessment should be substantially strengthened by periodic external validation of self-assessment results, together with goals set as a result and plans for further improvement. This offers to the individual the very tangible benefit of satisfying external mandates (eg, licensure and certification). In addition, impact should be reinforced by linking the results of self-assessment to subsequent learning activities including Continuing Medical Education (CME). Although these enhancements individually may not cure all of what ails self-assessment, they might ensure greater effectiveness for the purposes of lifelong learning.

Maintaining competence in the field: learning about practice, through practice, in practice

Many of the assumptions about the "adult, self-directed learner" that form the basis of the current model of formal continuing education delivery are largely unsupported by the literature. Yet most practitioners maintain competence despite the apparent flaws in this model. After elaborating a set of problematic assumptions regarding the current construction of the self-regulating professional learner who uses formal continuing education to maintain competence, this paper explores another likely source for the learning that allows practitioners to engage in their own continuing professional development: the process of learning from their personal experiences of solving problems in their daily practice.

Self-assessment in CPD: lessons from the UK undergraduate and postgraduate education domains

UK continuing education is moving from credit-earning, taught continuing medical education (CME) to a continuing professional development (CPD) system that explicitly links education to change in practice, managed and monitored through mandatory peer appraisal. Alongside multisource feedback and consideration of issues of poor performance, satisfactory personal development planning will be required for relicensure and recertification. That system gives self-assessment, in the guise of reflection, a central place in personal development. This article uses instances of directed self-assessment drawn from undergraduate and early postgraduate medical education to consider how a positive system of self-assessment and professional self-regulation could be operationalized. It explores why medical students made avid use of an e-technology that presents the intended outcomes of their problem-based curriculum in a way that helps them seek out appropriate clinical opportunities and identify what they learned from them. It contrasts the experience of early postgraduate learners who, presented with a similar e-technology, found it hard to see links between their official curriculum and their day-by-day learning experiences, at least partly because the intended outcomes it offered were remote from what they were actually learning. Any extrapolation to CPD must be very tentative, but I advocate continued exploration of how best to use e-technology to support and structure (ie, direct) self-assessment. Direction could originate from consensus statements and other well-defined external standards when learners lack mastery of a domain. When learners must respond to institutional demands, direction could be provided by corporate goals. In areas of mastery, I propose learners themselves should define personal standards. In areas of difficulty, external assessment would take the place of self-assessment.

The link between post-qualification experience and self-confidence ratings in two problem-solving domains: a study of radiation therapists

Recognising one’s abilities and limits in clinical tasks is a valuable part of professionalism. This study investigated the self-ratings of problem-solving confidence of radiation therapists (RTs) in two domains: clinical scenarios and critical thinking items (CTIs). We divided the 60 participants into three groups based on post-qualification experience (PQE), and found that greater PQE was linked with higher self-rated confidence for clinical scenarios, but not for CTIs.