Abstract
BackgroundPrevious studies report various degrees of agreement between self-perceived competence and objectively measured competence in medical students. There is still a paucity of evidence on how the two correlate in the field of Evidence Based Medicine (EBM). We undertook a cross-sectional study to evaluate the self-perceived competence in EBM of senior medical students in Malaysia, and assessed its correlation to their objectively measured competence in EBM.MethodsWe recruited a group of medical students in their final six months of training between March and August 2006. The students were receiving a clinically-integrated EBM training program within their curriculum. We evaluated the students' self-perceived competence in two EBM domains ("searching for evidence" and "appraising the evidence") by piloting a questionnaire containing 16 relevant items, and objectively assessed their competence in EBM using an adapted version of the Fresno test, a validated tool. We correlated the matching components between our questionnaire and the Fresno test using Pearson's product-moment correlation.ResultsForty-five out of 72 students in the cohort (62.5%) participated by completing the questionnaire and the adapted Fresno test concurrently. In general, our students perceived themselves as moderately competent in most items of the questionnaire. They rated themselves on average 6.34 out of 10 (63.4%) in "searching" and 44.41 out of 57 (77.9%) in "appraising". They scored on average 26.15 out of 60 (43.6%) in the "searching" domain and 57.02 out of 116 (49.2%) in the "appraising" domain in the Fresno test. The correlations between the students' self-rating and their performance in the Fresno test were poor in both the "searching" domain (r = 0.13, p = 0.4) and the "appraising" domain (r = 0.24, p = 0.1).ConclusionsThis study provides supporting evidence that at the undergraduate level, self-perceived competence in EBM, as measured using our questionnaire, does not correlate well with objectively assessed EBM competence measured using the adapted Fresno test.Study registrationInternational Medical University, Malaysia, research ID: IMU 110/06
Highlights
Previous studies report various degrees of agreement between self-perceived competence and objectively measured competence in medical students
Objective assessment tools are often regarded as the gold standards in measuring competence, and studies on physicians found that their self-assessment of clinical skills did not correlate well with external assessment of the same skills, and the most inaccurate self-assessments were observed in the physicians who expressed the highest confidence or those who were externally-rated to be the lowest [5]
One similar study has been conducted on the undergraduates, using a web-based assessment tool to assess self-reported competence and actual competence through a series of multiple choice questions that evaluated understanding and application of certain key concepts in Evidence Based Medicine (EBM) [14]
Summary
Previous studies report various degrees of agreement between self-perceived competence and objectively measured competence in medical students. We undertook a cross-sectional study to evaluate the selfperceived competence in EBM of senior medical students in Malaysia, and assessed its correlation to their objectively measured competence in EBM. Studies conducted on either medical students or junior doctors showed more variable results in terms of correlation between self-perceived and objectively measured or observed competence, with poorer correlations in practical clinical skills, and comparatively better correlations in the “soft” skills like communication skills [6,7,8,9,10,11]. One similar study has been conducted on the undergraduates, using a web-based assessment tool to assess self-reported competence and actual competence through a series of multiple choice questions that evaluated understanding and application of certain key concepts in EBM [14]. The aforementioned three studies used assessment instruments that focused on one specific area in EBM, either in literature appraisal [13] or in the understanding on the EBM terms [12,14], and they were conducted before the introduction of validated instruments that assess a wide range of EBM related skills, which have only been developed relatively recently [2]
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