The 'unskilled and unaware' effect is linear in a real-world setting

Area of Science:

• Medical Education
• Health Professions Education
• Metacognition

Background:

• Self-assessment is crucial for medical professionals' growth and academic success.
• Existing literature indicates a general deficit in self-assessment capabilities among medical practitioners and students.
• Accurate self-assessment in high-stakes, real-world medical examinations has not been extensively studied.

Purpose of the Study:

• To evaluate the accuracy of undergraduate medical students' self-assessment of their performance in a high-stakes anatomy practical examination.
• To investigate the relationship between predicted and actual exam grades among medical students.
• To explore demographic and learning factors influencing self-assessment accuracy.

Main Methods:

• A cohort of 74 first and second-year medical students predicted their anatomy practical exam grades online immediately post-exam.
• Pearson's correlation was used to analyze the relationship between predicted and attained grades.
• Independent t-tests were employed to analyze demographic data and self-assessment ability.

Main Results:

• A significant negative correlation was observed between predicted and actual exam grades (P < 0.0001).
• Students in the bottom, third, and top quartiles showed significant discrepancies between predicted and actual grades, unlike those in the second quartile.
• Self-assessment ability was not influenced by entry status or self-directed learning hours, but a relationship with gender was found in second-year students.

Conclusions:

• Medical students exhibit the 'unskilled and unaware' phenomenon, inaccurately self-assessing their performance in a real-world examination setting.
• Poor performers tend to overestimate their abilities, while high achievers underestimate theirs, with only mid-range students demonstrating accurate self-assessment.
• These findings underscore the need to re-evaluate current revalidation methods that rely heavily on self-assessment and inform targeted educational interventions.