A discrepancy in objective and subjective measures of knowledge: do some medical students with learning problems delude themselves?

In general, the rankings of first-year medical students on a written test of long-term neuroscience retention (RET) correlated strongly with how many of three neuroscience research presentations given within the following 2 days the students reported understanding. The lowest-ranking sixth of the class on RET, however, reported understanding almost every lecture, even more than the highest-ranking RET students did. Some of these low-ranking students were aware that they had areas of weakness, but simply tolerated more of them without reporting overall lack of understanding. Other low-ranking students, however, seemed genuinely unaware that they had any areas of weakness. This interpretation was further supported by data on small-group problem-solving performance during the first-year neuroscience course, on use of human resources during the final first-year neuroscience take-home examination, and on performance during the third-year clinical clerkships. Persistence of the problem, even after 5 months of instruction specifically designed to improve such information-processing skills, suggests that correction may be difficult to achieve. The need for specific valid evaluative instruments and effective correctional techniques is noted.