Accuracy of Self-Assessment in Medical Student Communication Performance

Effective communication is a core competency in medical practice, supporting patient relationships, treatment adherence, and clinical outcomes. Developing both skills and confidence is a central goal of medical education. Self-assessment, guided reflection, and exemplar-based feedback are promising strategies to enhance competence and self-regulation. Yet, evidence on medical students' accuracy in self-evaluating communication remains limited. This study examined calibration of self-assessed communication performance, potential gender differences, impact of feedback strategies, and changes over time.

We analyzed data from 78 students in a larger study who completed self-evaluation of their communication with a virtual patient. Participants engaged with eight video-based clinical vignettes targeting two communication competencies: providing clear, relevant information and responding to patient emotions. For each vignette, students recorded an initial response, reviewed exemplar feedback, completed a self-evaluation (with or without reflection prompts), and re-recorded their response. Communication behaviors were scored using an AI-based system validated against expert ratings. Mixed-effects regression models tested linear and quadratic effects of actual performance on self-assessed behaviors. Gender, experimental condition, and time (T1 vs. T2) were included as moderators to examine differences and changes in calibration.

Students consistently overestimated their performance at low actual ability levels (intercept significantly greater than zero: t(154) = 13.48, p < .001, d = 1.53) and underestimated at higher levels (slope significantly less than one: t(148) = -9.99, p < .001, d = -1.13). The quadratic term did not improve model fit. No significant gender differences or improvements in calibration over time or feedback condition were observed.

Medical students show systematic miscalibration in self-assessed communication, even when engaging in structured self-evaluation and exemplar-based reflection. These findings highlight the importance of instructional strategies that actively promote comparison with high-quality exemplars and guided reflection. Integrating these approaches may reduce miscalibration, strengthen communication skills, and better prepare students for the interpersonal demands of clinical practice.