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Improving self-assessment: Identifying and resolving tensions.

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Mann K, Sargeant J. — Dalhousie University, Halifax, Nova Scotia

Armson H, Lockyer J. — University of Calgary, Alberta

Chesluk B, Holmboe ES. — American Board of Internal Medicine

Dornan T. — University of Manchester, England

Eva K. — McMaster University, Hamilton, Ontario

Loney E. — Bedford, Nova Scotia

van der Vleuten C. — Maastricht University, The Netherlands

Presented: Association of Medical Education in Europe Conference, September 2010

Background: Developing and supporting self-assessment abilities remains educationally challenging. Earlier work revealed a dynamic model of informed self-assessment with five interactive components; one component was tensions. This study's purpose was to explore the tensions described by learners and professionals in informing their self-assessments.

Summary of Work: This qualitative study was based in grounded theory. We purposively sampled eight programs in five countries across undergraduate, postgraduate and continuing medical education, and conducted 17 focus groups. Detailed analyses were conducted iteratively to understand themes and relationships.

Summary of Results: Participants experienced multiple tensions in self-assessment. Three categories of tensions emerged: between people (e.g., giving honest feedback vs. maintaining relationships), within people (e.g., appearing competent vs. open to feedback), and in the learning/practice environment (e.g., credible, valued feedback vs. "playing the game"). Tensions were ongoing, contextual and dynamic; they prevailed across participant groups, infusing all other model components.

Conclusions: Multiple tensions, requiring ongoing negotiation and renegotiation, are inherent in self-assessment. Tensions are both individual and culturally situated, reflecting both professional and institutional influences.

Take-Home Messages: Our findings suggest that educational interventions should be directed at both individual and cultural levels. Sociocultural and social learning theories may inform this work.

For more information about this presentation, please contact Research@abim.org.