title: Low performing students have insightfulness when they reflect-in-action.
abstract: BACKGROUND
  Measuring appropriateness of certainty of responses in a progress test using descriptors authentic to practice as reflection-in-action builds on existing theories of self-monitoring. Clinicians making decisions require the ability to accurately self-monitor, including certainty of being correct. Inappropriate certainty could lead to medical error. Self-assessment and certainty of assessment performance have been measured in a variety of ways. Previous work has shown that those with less experience are less accurate in self-assessment, but such studies looked at self-assessment using methods less authentic to clinical practice. This study investigates how correctness varies with certainty, allowing for experience and performance.
  
  
  METHODS
  Students in Years 2-5 were certain of their responses to two iterations of a progress test during one calendar year. Analyses compared correctness for certainty of response, test number, student year cohort and performance level, defined by criterion scores.
  
  
  RESULTS
  The odds of a correct response increased with student certainty for all subsets allowing for year group and ability, including student subsets with less experience and subsets in lower-performance groups.
  
  
  CONCLUSIONS
  Unlike previous work showing poorer accuracy of self-assessment for those with less experience or ability, we postulate that our finding of similar increases in correctness with increasing certainty even in the less experienced and lower performance groups, relates to certainty descriptors being worded in a way that is authentic to clinical practice, and in turn related to reflection-in-action.
authors.affiliation: School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand.
authors.forename: Mike
authors.initials: M
authors.lastname: Tweed
authors.affiliation: School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand.
authors.forename: Gordon
authors.initials: G
authors.lastname: Purdie
authors.affiliation: School of Medicine and Health Sciences, University of Otago, Christchurch, New Zealand.
authors.forename: Tim
authors.initials: T
authors.lastname: Wilkinson
mesh_terms: D002983:Clinical Competence / Q000706:statistics & numerical data*; D004504:Education, Medical, Undergraduate; D006801:Humans; D012647:Self-Assessment; D013337:Students, Medical / Q000523:psychology*; D013850:Thinking