Self-assessment programs and their implications for health professions training.

Although expected of all health professionals, self-assessment skills are seldom addressed directly in training. A previous review by the author identified curricular criteria associated with improved accuracy and validity in self-assessments of knowledge and performance in curriculum studies published between January 1970 and February 1990. The present review analyzed 11 studies that meet those criteria. Eight studies were of implementations of self-assessment components within training programs in the health professions, and three involved other training environments. Most described initial disorientation or opposition on the part of learners, attributed to unfamiliar roles and to learners' distrust. The curricula that successfully negotiated the transition to self-assessment norms reported noncognitive benefits such as improvements in morale, motivation, and communications among learners and faculty. Reported cognitive benefits included improvements in knowledge, performance, and self-analysis of performance. The constellation of effects suggests that effective self-assessment programs may promote more mature, collegial, and productive learning environments, particularly suited to the training of health professionals. Most curricula fostering effective self-assessment did not require extraordinary resources, and none jeopardized traditional standards. No evidence was found to support or challenge the expectation that self-assessment training would transfer to later work settings.