Physicians appear to have a limited ability to accurately self-assess their own continuing medical education needs as compared with external observations of their competence, according to a review article in the September 6 issue of JAMA, a theme issue on medical education.
"Self-assessment and self-directed, lifelong learning have long been mainstays of the medical profession – they are activities presumed to be linked closely to the quality of care provided to patients," the authors provide as background information in the article. "Physicians in the United States must demonstrate their engagement in lifelong learning by choosing and participating in continuing medical education (CME) activities and acquiring CME credit, which is mandated by the majority of state medical boards under the rubric [directions and rules] of states' medical practice acts."
David A. Davis, M.D., from the University of Toronto, and colleagues reviewed the medical literature to find studies that compared physicians' self-rated assessments with external observations. The search yielded 725 articles, of which 17 met all inclusion criteria as outlined in the JAMA study. "Of the 20 comparisons between self- and external assessment, 13 demonstrated little, no, or an inverse relationship and 7 demonstrated positive associations," the authors write. "A number of studies found the worst accuracy in self-assessment among physicians who were the least skilled and those who were the most confident. These results are consistent with those found in other professions."
In conclusion the authors write, "The processes currently used to undertake professional development and evaluate competence may need to focus more on external assessment." (JAMA. 2006; 296:1094-1102. Available pre-embargo to the media at www.jamamedia.org.)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Editorial: Physician Know Thyself
"The systematic review of physician self-assessment by Davis and colleagues in this issue of JAMA provokes rethinking of whether it is wise to rely on unguided physician self-assessment as a cornerstone of continuous professional development," writes F. Daniel Duffy, M.D. and Eric S. Holmboe, M.D., from the American Board of Internal Medicine, Philadelphia.
"As Davis et al recommend, the medical profession should shift CME and maintenance of certification and licensure to include processes of testing and educational methods that provide iterative feedback to supportively guide physicians in learning new concepts, as well as in changing work processes that lead to better patient care. This approach to continuous professional development combines the motivating energy provided by uncovering gaps in performance with CME, recertification, and relicensure. Physicians cannot be expected to do this in isolation; they require educational service from specialty societies and academic centers, and need the credible measurement tools and standards from certifying and licensing boards and organizations." (JAMA. 2006; 296:1137 – 1139. Available pre-embargo to the media at www.jamamedia.org.)
Editor's Note: Drs. Duffy and Holmboe are employees of the American Board of Internal Medicine, which uses self-assessment and self-audit in its maintenance of certification process. No other financial disclosures were reported.
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