title: Self versus external assessment for technical tasks in surgery: a narrative review.
abstract: BACKGROUND
  Self-assessment is an intricate component of continuing professional development and lifelong learning for health professionals. The agreement between self and external assessment for cognitive tasks in health professionals is reported to be poor; however, this topic has not been reviewed for technical tasks in surgery.
  
  
  OBJECTIVE
  To compare self and external assessment for technical tasks in surgery.
  
  
  METHODS
  MEDLINE, ERIC, and Google Scholar databases were searched for data from January 1960 to November 2011. Inclusion criteria were restricted to articles published in English in peer-reviewed journals, which reported on a comparison between self and external assessment for a technical task in a surgical specialty and involved medical students, surgical residents, surgical fellows, or practicing surgeons. Abstracts of identified articles were reviewed and pertinent full-text versions were retrieved. Manual searching of bibliographies for additional studies was performed. Data were extracted in a systematic manner.
  
  
  RESULTS
  From a total of 49 citations, 17 studies (35%) were selected for review. Eight of the 17 studies (47%) reported no agreement, whereas 9 studies (53%) reported an agreement between self and external assessment for technical tasks in surgery. Four studies (24%) reported higher self versus external assessment scores, whereas 3 studies (18%) reported lower self versus external assessment scores. Sixteen studies (94%) focused on retrospective self-assessment and 1 study (6%) focused on predictive self-assessment. Agreement improved with higher levels of participant training; with high-quality, timely, and relevant feedback; and with postprocedure video review.
  
  
  CONCLUSIONS
  This review demonstrated mixed results regarding an agreement between self and external assessment scores for technical tasks in surgery. Future investigations should attempt to improve the study design by accounting for differences between men and women, conducting paired and independent mean comparisons of self and external assessments, and ensuring that external assessments are valid and reliable.
authors.forename: Boris
authors.initials: B
authors.lastname: Zevin