title: Resident self-other assessor agreement: influence of assessor, competency, and performance level.
abstract: OBJECTIVE
  To review the literature on self-assessment in the context of resident performance and to determine the correlation between self-assessment across competencies in high- and low-performing residents and assessments performed by raters from a variety of professional roles (peers, nurses, and faculty).
  
  
  METHODS
  Retrospective analysis of prospectively collected anonymous self-assessment and multiprofessional (360) performance assessments by competency and overall.
  
  
  METHODS
  University-based academic general surgical program.
  
  
  METHODS
  Sixty-two residents rotating in general surgery.
  
  
  METHODS
  Mean difference for each self-assessment dyad (self-peer, self-nurse, and self-attending physician) by resident performance quartile, adjusted for measurement error, correlation coefficients, and summed differences across all competencies.
  
  
  RESULTS
  Irrespective of self-other dyad, residents asked to rate their global performance overestimated their skills. Residents in the upper quartile underestimated their specific skills while those in the lowest-performing quartile overestimated their abilities when compared with faculty, peers, and especially nurse raters. Moreover, overestimation was greatest in competencies related to interpersonal skills, communication, teamwork, and professionalism.
  
  
  CONCLUSIONS
  Rater, level of performance, and the competency being assessed all influence the comparison of the resident's self-assessment and those of other raters. Self-assessment of competencies related to behavior may be inaccurate when compared with raters from various professions. Residents in the lowest-performing quartile are least able to identify their weakness. These data have important implications for residents, program directors, and the public and suggest that strategies that help the lowest-performing residents recognize areas in need of improvement are needed.
authors.affiliation: MHPE, The Johns Hopkins Hospital, Baltimore, MD 21287, USA. plipsett@jhmi.edu
authors.forename: Pamela A
authors.initials: PA
authors.lastname: Lipsett
authors.forename: Ilene
authors.initials: I
authors.lastname: Harris
authors.forename: Steven
authors.initials: S
authors.lastname: Downing
mesh_terms: D002983:Clinical Competence; D004521:Educational Measurement; D005180:Faculty, Medical; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D009726:Nurses; D010379:Peer Group; D012189:Retrospective Studies; D012647:Self-Assessment; D013647:Task Performance and Analysis