Informing factors and outcomes of self-assessment practices in medical education: a systematic review

Self-assessment (SA) is increasingly recognized not only as an assessment method but also as a vital learning activity that enables learners to identify their strengths and limitations, fostering a crucial skill for lifelong learning. Despite its acknowledged significance, there remains a gap in understanding SA for and as learning, rather than merely of learning. This review, therefore, explores two primary questions: (1) What factors inform the implementation of medical students' SA practices? (2) How does SA practices contribute to various educational outcomes?

A systematic review was conducted across five databases, employing a combination of keywords pertinent to SA and medical education. Our selection criteria deliberately excluded articles that solely focused on the accuracy of SA or used SA exclusively as a measure for other outcome variables. As a result, 39 studies met our inclusion criteria and were analyzed for this review. Qualitative narrative synthesis was used to summarize the informing factors. Furthermore, Kirkpatrick's model was employed to categorize and summarize the effects of SA activities across various educational outcome levels, including reactions, learning, and behavioral changes.

Our review reveals that key factors influencing students' SA includes feedback from various stakeholders, peer assessment, the format of SA, and both learner and teacher training. Among the 39 studies examined, the majority demonstrated positive effects of SA on aspects such as attitudes and skills. However, a minority found no significant associations, with these outcomes frequently linked to contextual variables and how SA was implemented.

Our review does not focus on SA accuracy or its role as an assessment method; instead it delves into the role of SA as an integral learning practice. We explored its influencing factors and its impact across various outcomes. The findings indicate that for SA to effectively enhance student learning outcomes, it must be implemented with ample support, clear guidelines, and within contexts that encourage feedback and reflection.