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      Faculty Versus Resident Self-Assessment Using Pathology Milestones: How Aligned Are We?

      research-article
      , BA 1 , , MD, MEd 2 , , MA, MPH 3 , , CTAGME 4 , , PhD, MA 5
      Academic Pathology
      SAGE Publications
      Clinical Competency Committee, faculty, Milestones, pathology, residents

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          Abstract

          Competent physicians must be able to self-assess skill level; however, previous studies suggest that medical trainees may not accurately self-assess. We utilized Pathology Milestones (PM) data to determine whether there were discrepancies in self- versus Clinical Competency Committee (CCC) ratings by sex, program year (PGY), time of evaluation, and question category (Patient Care, Medical Knowledge, Systems-Based Practice [SBP], Practice-Based Learning and Improvement [PBL], Professionalism [PRO], and Interpersonal and Communication Skills) and Residency In-Service Examination (RISE) score. We completed retrospective analyses of PM evaluation scores from 2016 to 2019 (n = 23 residents) 2 times per year. Discrepancies in evaluation scores were calculated by subtracting CCC scores from resident self-evaluation scores. There was no significant difference in discrepancy scores between male versus female residents (P = .94). Discrepancy scores among all PGYs were significantly different (P < .0001), with PGY1 tending to overrate the most, followed by PGY2. PGY3 and PGY4 underrated themselves on average compared to CCC ratings, with PGY4 having significantly lower self-ratings than CCC compared to any other PGY. In January, residents underscored themselves and in July residents overscored themselves compared to CCC (P < .0001 for both). Question types resulted in variable discrepancy scores, with SBP significantly lower than and PRO significantly higher than all other categories (P < .05 for both). Increases in RISE score correlated to increases in self- and CCC-scoring. These discrepancies can help trainees improve self-assessment. Discrepancies indicate potential areas for amelioration, such as curriculum adjustments or Milestone’s verbiage.

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          Most cited references22

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          Unskilled and unaware of it: how difficulties in recognizing one's own incompetence lead to inflated self-assessments.

          People tend to hold overly favorable views of their abilities in many social and intellectual domains. The authors suggest that this overestimation occurs, in part, because people who are unskilled in these domains suffer a dual burden: Not only do these people reach erroneous conclusions and make unfortunate choices, but their incompetence robs them of the metacognitive ability to realize it. Across 4 studies, the authors found that participants scoring in the bottom quartile on tests of humor, grammar, and logic grossly overestimated their test performance and ability. Although their test scores put them in the 12th percentile, they estimated themselves to be in the 62nd. Several analyses linked this miscalibration to deficits in metacognitive skill, or the capacity to distinguish accuracy from error. Paradoxically, improving the skills of participants, and thus increasing their metacognitive competence, helped them recognize the limitations of their abilities.
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            Clinical skills in junior medical officers: a comparison of self-reported confidence and observed competence.

            The intern year is a key time for the acquisition of clinical skills, both procedural and cognitive. We have previously described self-reported confidence and experience for a number of clinical skills, finding high levels of confidence among Australian junior doctors. This has never been correlated with an objective measure of competence. We aimed to determine the relationship between self-reported confidence and observed competence for a number of routine, procedural clinical skills. A group of 30 junior medical officers in their first postgraduate year (PGY1) was studied. All subjects completed a questionnaire concerning their confidence and experience in the performance of clinical skills. A competency-based assessment instrument concerning 7 common, practical, clinical skills was developed, piloted and refined. All 30 PGY1s then completed an assessment using this instrument. Comparisons were then made between the PGY1s' self-reported levels of confidence and tutors' assessments of their competence. A broad range of competence levels was revealed by the clinical skills assessments. There was no correlation between the PGY1s' self-ratings of confidence and their measured competencies. Junior medical officers in PGY1 demonstrate a broad range of competence levels for several common, practical, clinical skills, with some performing at an inadequate level. There is no relationship between their self-reported level of confidence and their formally assessed performance. This observation raises important caveats about the use of self-assessment in this group.
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              Comparison of Male vs Female Resident Milestone Evaluations by Faculty During Emergency Medicine Residency Training.

              Although implicit bias in medical training has long been suspected, it has been difficult to study using objective measures, and the influence of sex and gender in the evaluation of medical trainees is unknown. The emergency medicine (EM) milestones provide a standardized framework for longitudinal resident assessment, allowing for analysis of resident performance across all years and programs at a scope and level of detail never previously possible.
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                Author and article information

                Journal
                Acad Pathol
                Acad Pathol
                APC
                spapc
                Academic Pathology
                SAGE Publications (Sage CA: Los Angeles, CA )
                2374-2895
                13 December 2021
                Jan-Dec 2021
                : 8
                : 23742895211060526
                Affiliations
                [1 ]Department of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
                [2 ]Department of Pathology and Microbiology and Associate Dean for Medical Education, University of Nebraska Medical Center, Omaha, NE, USA
                [3 ]Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA
                [4 ]Department of Pathology and Microbiology, Omaha, NE, USA
                [5 ]Department of Surgery and Graduate Medical Education Research and Education Program Manager, University of Nebraska Medical Center, Omaha, NE, USA
                Author notes
                [*]Kari Nelson, University of Nebraska Medical Center, 985524 Nebraska Medical Center, Omaha, NE 68198, USA. Email: kari.nelson@ 123456unmc.edu
                Article
                10.1177_23742895211060526
                10.1177/23742895211060526
                8679011
                34926794
                760b2e64-a379-4746-94df-b1e4195b680f
                © The Author(s) 2021

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License ( https://creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                : 14 June 2021
                : 23 August 2021
                : 15 October 2021
                Categories
                Regular Article
                Custom metadata
                January-December 2021
                ts3

                clinical competency committee,faculty,milestones,pathology,residents

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