Self-assessment in Lifelong Learning and Improving Performance in Practice

Duffy, F. Daniel; Holmboe, Eric S.

doi:10.1001/jama.296.9.1137

Cited by 189 publications

(140 citation statements)

References 10 publications

(13 reference statements)

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“…24,25 Our finding that gender modified the association between knowledge and confidence is supported by previous findings that among undergraduate students, medical students, and residents, females tended to under-assess, and males tended to overassess their own competence. [26][27][28] Importantly, other studies have found that inaccurate self-assessment is most common among physicians with the least skills and greatest confidence, 25 raising concern that physicians and trainees who are newly adopting UDT may be ineffective at determining when they lack knowledge.…”

Section: Discussionsupporting

confidence: 83%

“…Additionally, studies have found that physician self-assessment of knowledge in other clinical areas is often inaccurate. 24,25 Therefore, as part of a needs assessment about internal medicine residents' management of CNMP, we sought to explore the relationship between residents' knowledge and confidence in interpreting UDT results. We hypothesized that residents' knowledge and confidence in UDT interpretation would be low, and that they would be positively associated with each other.…”

Section: Introductionmentioning

confidence: 99%

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They Don’t Know What They Don’t Know: Internal Medicine Residents’ Knowledge and Confidence in Urine Drug Test Interpretation for Patients with Chronic Pain

et al. 2012

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BACKGROUND: Urine drug testing (UDT) can help identify misuse or diversion of opioid medications among patients with chronic pain. However, misinterpreting results can lead to false reassurance or erroneous conclusions about drug use. OBJECTIVE: To examine the relationship between resident physicians' knowledge about UDT interpretation and confidence in their ability to interpret UDT results. DESIGN: Cross-sectional survey. PARTICIPANTS: Internal medicine residents in a university health system in the Bronx, from 2010 to 2011. MAIN MEASURES:We assessed knowledge using a 7-item scale (UDT knowledge score), and confidence in UDT interpretation using a single statement ("I feel confident in my ability to interpret the results of urine drug tests"). We conducted chi-square tests, t-tests, and logistic regression to determine the association between knowledge and confidence, and in exploratory analyses to examine whether resident characteristics (gender, training level, and UDT use) moderated the relationship between knowledge and confidence. KEY RESULTS: Among 99 residents, the mean UDT knowledge score was 3.0 out of 7 (SD 1.2). Although 55 (56 %) of residents felt confident in their ability to interpret UDT results, 40 (73 %) of confident residents had a knowledge score of 3 or lower. Knowledge score was not associated with confidence among the full sample or when stratified by training level or UDT use. The association between knowledge and confidence differed significantly by gender (interaction term p< 0.01). Adjusting for training level and UDT use, knowledge was positively associated with confidence among females (AOR 1.79, 95 % CI: 1.06, 3.30), and negatively associated with confidence among males (AOR 0.47, 95 % CI: 0.23, 0.98). CONCLUSIONS: Despite poor knowledge about UDT interpretation, most resident physicians felt confident in their ability to interpret UDT results. Gender differences warrant further exploration, but even confident physicians who use UDT should evaluate their proficiency in interpreting UDT results. Educational initiatives should emphasize the complexities of UDT interpretation.KEY WORDS: urine drug testing; chronic pain; opioid medications; physician self-assessment.

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Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

They Don’t Know What They Don’t Know: Internal Medicine Residents’ Knowledge and Confidence in Urine Drug Test Interpretation for Patients with Chronic Pain

et al. 2012

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“…Ideally, objective data would be used in conjunction with iterative feedback, possibly through a mentor or advisor, to guide trainees when performing self-assessment. 5 Future studies might include reflection on individual or group data and should be done on a continuous basis with ongoing formative feedback, for example using a structured learning portfolio. 1,3 Validating the accuracy of residents' selfassessments, either singularly or through a learning portfolio, will be an ongoing challenge.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5] In theory, self-assessment can serve as a mechanism for identifying one's strengths and weaknesses, and subsequently, identifying learning plans 1 and goals to improve patient care. 2 Reflective practice, which incorporates self-assessment, is a key component of professional development 6 and is being integrated into the evaluation of competency in residency training.…”

Section: Introductionmentioning

confidence: 99%

Resident Identification of Learning Objectives after Performing Self-assessment based upon the ACGME Core Competencies

2008

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BACKGROUND: Self-assessment is increasingly being incorporated into competency evaluation in residency training. Little research has investigated the characteristics of residents' learning objectives and action plans after self-assessment. OBJECTIVE:To explore the frequency and specificity of residents' learning objectives and action plans after completing either a highly or minimally structured selfassessment. DESIGN:Internal Medicine residents (N =90) were randomized to complete a highly or minimally structured self-assessment instrument based on the Accreditation Council for Graduate Medical Education Core Competencies. All residents then identified learning objectives and action plans. MEASUREMENTS:Learning objectives and action plans were analyzed for content. Differences in specificity and content related to form, gender, and training level were assessed.RESULTS: Seventy-six residents (84% response rate) identified 178 learning objectives. Objectives were general (79%), most often focused on medical knowledge (40%), and were not related to the type of form completed (p >0.01). "Reading more" was the most common action plan. CONCLUSIONS:Residents commonly identify general learning objectives focusing on medical knowledge regardless of the structure of the self-assessment form. Tools and processes that further facilitate self-assessment should be identified.

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“…12 A growing body of evidence demonstrates relationships between certification status and quality of care including outcomes following acute MI, [13][14][15] colorectal surgery, 16 diabetes care, 17 mammography screening, 17 and other preventive services. 18 Unfortunately, unrelenting time pressures in clinical practice have made it increasingly difficult for physicians to maintain habits of lifelong learning, 19,20 resulting in decrements in medical knowledge over time. 9,21,22 Traditional continuing medical education (CME) courses vary in effectiveness [23][24][25] and often do not provide the "just in time" learning needed at the point of care.…”

mentioning

confidence: 99%

Relationship of Electronic Medical Knowledge Resource Use and Practice Characteristics with Internal Medicine Maintenance of Certification Examination Scores

et al. 2012

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BACKGROUND: Maintenance of certification examination performance is associated with quality of care. We aimed to examine relationships between electronic medical knowledge resource use, practice characteristics and examination scores among physicians recertifying in internal medicine. METHODS: We conducted a cross-sectional study of 3,958 United States physicians who took the Internal Medicine Maintenance of Certification Examination (IM-MOCE) between January 1, 2006 and December 31, 2008, and who held individual licenses to one or both of two large electronic knowledge resource programs. We examined associations between physicians' IM-MOCE scores and their days of electronic resource use, practice type (private practice, residency teaching clinic, inpatient, nursing home), practice model (single or multispecialty), sex, age, and medical school location. RESULTS: In the 365 days prior to the IM-MOCE, physicians used electronic resources on a mean (SD, range) of 20.3 (36.5, 0-265) days. In multivariate analyses, the number of days of resource use was independently associated with increased IM-MOCE scores (0.07-point increase per day of use, p=0.02). Increased age was associated with decreased IM-MOCE scores (1.8-point decrease per year of age, p< 0.001). Relative to physicians working in private practice settings, physicians working in residency teaching clinics and hospital inpatient practices had higher IM-MOCE scores by 29.1 and 20.0 points, respectively (both p<0.001). CONCLUSIONS: Frequent use of electronic resources was associated with modestly enhanced IM-MOCE performance. Physicians involved in residency education clinics and hospital inpatient practices had higher IM-MOCE scores than physicians working in private practice settings.

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Self-assessment in Lifelong Learning and Improving Performance in Practice

Abstract: Blueprint for establishing effective postbaccalaureate medical school pre-entry program for educationally disadvantaged students.

Cited by 189 publications

References 10 publications

They Don’t Know What They Don’t Know: Internal Medicine Residents’ Knowledge and Confidence in Urine Drug Test Interpretation for Patients with Chronic Pain

They Don’t Know What They Don’t Know: Internal Medicine Residents’ Knowledge and Confidence in Urine Drug Test Interpretation for Patients with Chronic Pain

Resident Identification of Learning Objectives after Performing Self-assessment based upon the ACGME Core Competencies

Relationship of Electronic Medical Knowledge Resource Use and Practice Characteristics with Internal Medicine Maintenance of Certification Examination Scores

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