Self-Assessment in Medical Practice

Although assessment of performance will be central to revalidation, to clinical governance and to maintenance of quality in the National Health Service, formal appraisal by a third party will be no more than an annual event for most medical staff.To be fully effective doctors should assess their own clinical performance more frequently, but many lack training in how to do this.Self-assessment is also a valuable exercise in its own right.Benefits include increased morale and motivation as well as improvements in knowledge, communication and performance 1 .This paper sets out the case for devoting more time to the teaching of self-assessment skills. WHAT IS SELF-ASSESSMENT?According to Antonelli 2 , 'self-assessment of knowledge and accuracy of skill performance is essential to the practice of medicine and self-directed life-long learning'.The emphasis on life-long learning is important.In medicine, as in many other professions, individuals are now responsible for determining their own continuing professional development (CPD); and a successful CPD programme demands awareness of remediable weaknesses through continual self-appraisal.Boud 3 defines self-assessment as 'the act of judging ourselves and making decisions about the next step.'An important principle is that assessment must be followed by action (i.e.assessment is not an end in itself).Equally important is Boud's 3 assertion that assessment can be conducted only against benchmarks or criteria.Brown, Bull and Pendlebury 4 make a further distinction between different forms of self-assessment.On the one hand the process may be linked to competency and formal appraisal, with relevance to public issues of accountability, surveillance and control.On the other hand, the emphasis may be on personal development through reflection.Brown and coworkers suggest that these different emphases produce tensions and confusion both in the published work and in practice.The competency approach is useful for demonstrating particular skills, whereas the developmental approach aids understanding and knowledge and encourages personal and professional growth.