Why Self-Assessment and Life-Long Learning Go Hand-in-Hand

By Brie Holmes, PharmD, PGY1 Pharmacy Practice Resident, Magnolia Regional Health Center

 

Healthcare is advancing and expanding at an astounding rate. Now, more than ever, healthcare professionals must take the initiative to learn about new technology, diagnoses, and treatment options to provide the best care to patients.¹ Healthcare practice is rooted in trusting patient/provider relationships, and healthcare professions are expected to continually expand their knowledge. It is simply not adequate to rely on one’s initial education and training or the required continuing education hours to stay well informed about the latest developments.² Instead, healthcare professionals must take responsibility and be self-directed learners to remain competent throughout their career.

Self-assessment methods and the utility of those methods has been well studied. Research has shown that those who regularly engage in a self-assessment process have increased academic achievement and workplace performance.¹ Andrade defines self-assessment as “…a process of formative assessment during which students reflect on and evaluate the quality of their work and learning, judge the degree to which they reflect explicitly stated goals or criteria, identify strengths or weaknesses in their work and revise accordingly.”³ There are other definitions of self-assessment, but all sources agree that it is a process with the goal of continuous improvement involving an intrinsic evaluation of one’s knowledge and performance, recognizing one’s own deficits, and implementing a plan to correct identified deficits. Because there is a clear expectation for healthcare professionals to stay up-to-date on new research, there is also an expectation that healthcare professionals skillfully use self-assessment techniques to accomplish this. Despite what’s known about effective self-assessment methods and their benefits, there are numerous studies showing the general inability of students and healthcare providers alike to accurately assess their knowledge and skills and, therefore, effectively address deficits. In fact, only 45% of the studies included in a systematic review of the physician literature showed a positive relationship between self- and external assessments.³ Not only is this a disservice to oneself as a professional, but it is also a disservice to our patients who have trusted us to provide the best care possible.

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Multiple studies have suggested students and some providers are not able to correctly assess their learning needs.  One possible explanation is that students have grown accustomed to dependent learning. Historically, evaluation of knowledge has largely been done using exams. This external form of evaluation often creates dependent learners who have very little intrinsic consideration or responsibility. Dependent learning can quickly dissolve motivation to gain knowledge outside of what will be on an exam and instead encourages memorization, resulting in a reliance on external motivation and validation.³ This process does not adequately equip students with the necessary skills required for work after graduation as they are not prepared to take the initiative to identify their learning needs or to address perceived deficits. After graduation, there will no longer be someone who will identify the student’s learning needs or direct them to appropriate learning activities.¹ Thus, educators can and should incorporate self-assessments early in the curriculum to teach students this important skill so that they can apply it in the real world.⁵

Developing good self-assessment skills can also improve the learner’s willingness to accept feedback as well as develop their self-confidence.³ It is well-accepted that self-assessment is a learned skill.  It not something that most people “just naturally” know how to do. Because of this, the Accreditation Council on Pharmacy Education has stated that self-assessment should be integrated into the pharmacy curriculum early and continued throughout the curriculum.³ Additionally, the American Medical Association considers self-assessments to be a vital professional skill and has suggested guided self-assessments be incorporated at the earliest possible stage in medical training.⁴ The key to guiding self-assessments is ensuring the student receives quality external feedback. Some examples of activities educators could incorporate that would provide an opportunity for self-assessment coupled with external feedback is an Objective Structured Clinical Examination (OSCE), particularly if they are videotaped and reviewed by the student.  Problem-based learning cases and independent learning projects can also be used, whereby students compare their self-assessment of their performance to external evaluations using rubrics.^1,3

If educators want their students to be competent and successful healthcare professionals who embrace the notion of continuous professional development, they must instill the importance and benefits of self-assessments and stimulate increased motivation to engage in the process.³ As research continues to show the clear benefits of self-assessment, accrediting bodies require health professional programs to include self-assessments.  Self-assessment techniques should be introduced early in curriculums alongside external assessments.  This will help students learn the vital skill of identifying deficits and critically evaluating their work.  In this way, students will be better prepared for post-graduation work and lifelong learning. Furthermore, self-assessments should prompt students to consider their personal and professional goals while equipping them with the tools necessary to achieve those goals. Without effective self-assessment strategies, healthcare professionals will not be adequately prepared for lifelong learning in a field that is constantly expanding and changing.

References

1.    Guglielmino LM. The case of promoting self-directed learning in formal educational institutions. South African Education Journal. 2013;10(2):1-18.

2.    Asadoorian J, Batty, H. An evidence-based model of effective self-assessment for directing professional learning. Journal of Dental Education. 2005;69(12):1315-1322.

3.    Motycka CA, Rose RL, Ried LD, Brazeau G. Self-assessment in pharmacy and health science education and professional practice. Am J Pharm Educ 2010;74(5) Article 85.

4.    Duffy FD, Holmboe ES. Self-assessment in lifelong learning and improving performance in practice. JAMA 2006;296(9):1137-1139. doi: 10.1001/jama.296.9.1137

5.    Adachi C, Tai JH-M, Dawson P. Academics’ perceptions of the benefits and challenges of self and peer assessment in higher education. Assessment & Evaluation in Higher Education. 2017;43(2):294-306. doi:10.1080/02602938.2017.1339775.