Students` Self-Assessment in Pediatrics in Al-Qadisiah University School of Medicine

Objective: student self-evaluation is an important component of clinical education and also of a comprehensive clinical evaluation system. Our aim was to determine the reliability in the evaluation system in our college.Methods: The study included 72 final year medical students in the academic year 2010-2011. The students were asked to freely evaluate their selves in the final theory, traditional long case and OSCE in pediatrics by putting a score representing their performance in these exams. The students self-rating was compared with the actual scores these students obtained.Results: There was a significant correlation between students self-rating and the actual students scores in the final exam in pediatrics.Conclusion: In the presence of a consensus among departments on the level of knowledge and skills that need to be mastered by students during undergraduate medical education, and the implementation of active training program ; students self evaluation could be used as an additional method of students evaluation and assessment.


Introduction
Despite widespread use of selfassessment, teachers have doubts about the value and accuracy of the technique. The doubts center on the concern that students may have inflated perceptions of their accomplishments. Good students under-estimate their achievements while confused learners over-estimate their achievements.( 1)There is a persuasive evidence, across several grades, that self assessment Contributes to student learning. The strength of self assessment can be enhanced Through active student training. Self assessment when properly implemented ,Produces valid and reliable information about student achievement ( 2) The assessment of students' clinical competence is of paramount importance, there being several means of evaluating student performance in medical examinations (3,4). The objective structured clinical examination (OSCE) has been recognized not only as a useful evaluative tool but also as a valuable method of enhancing student learning (5). Student self assessment encourages the development of skills that are important for lifelong learning. Overestimation may lead to misdiagnosis, inadequate performance and premature closure. Underestimation usually leads to overuse of diagnostic tests, excessive uncertainty and unnecessary referrals.
The department of pediatrics in Al-Qadisiah university school of medicine assess the final (sixth year ) students at the end of their clerkship by 3 sets of tests: 1. The final theory exam: this consist of 4 parts: short essay questions(SEQ), single choice MCQ, multiple choice( true, false) MCQ, and clinical case files.
The aim of this study is to determine whether self assessment is a reliable and useful student assessment technique in our college by comparing student self rating and the corresponding students actual scores in these exams.

Materials and Methods
The study was conducted during June 2011, at the time of the final clinical examination in pediatrics, the exam consist of 2 parts: OSCE and TLC. The total number of students in the final year( 6 th year) was 72. The examination days were 4, 18 students were assessed in each day. The TLC exam was done from 7.00 -10.30 AM and the OSCE at 11.00 AM. At the end of the OSCE, a name free questionnaire was given to the students asking them to freely assess their selves and to put a score for themselves in the final theory exam, the TLC exam, and the OSCE. The marks or scores put by the students should closely reflect their performance in these exams. Each group of students had a briefing session before they assess their performance. Participation in the self-assessment was on a voluntary basis and students were assured that they would not be penalized for their response. The mean of the students self rating and the actual students scores in the 3 parts of the exam were compared and analyzed using basic statistical and regression analysis to find the correlation between self-reported rating and actual performance. A p-value of less than 0.05 was considered significant for the correlation coefficients. All students respond to the self assessment.

Results and Discussion
The mean of the students self-rating in the final theory, TLC and OSCE was: 49, 53, 57 respectively. The mean of the actual students scores in these exams was: 50,54,55 respectively ( Table 1). Core clinical skills that need to be mastered during undergraduate medical education are still not clearly defined (6). Medical schools are working to define a system of accredition, certification or comparable procedures including theoretical curriculum as well as clinical skills ( 7). Several authors agree that clinical evaluation is difficult and complex ( 8,9,10,11,12 ). Self evaluation allow students to take a more active role in their assessment and to improve the evaluation process(8).Self-evaluation help students to become more independent and able to accurately identify their own strengths and weaknesses(13).
There was a surprising result that our students appropriately self-evaluate their selves in all parts of the exam particularly in the OSCE (Table 1) ,this could be partly due to active motivation of students to participate in this study which is done for the 1 st time in this college and also to the active training program adapted by our department. A comparable studies in Jamaica, Croatia, and USA reveal a wide range of correlation between actual performance, self rating and teachers expectation ( 14,15,16). The reason for that could be the limited research into medical students` self-assessment (1,17). Students self evaluation could promote understanding of teaching objectives, development of confidence and competence and provision of useful skills for lifelong learning(14).
Conclusion: students self evaluation could be used as an additional method of students evaluation and assessment