Self-assessment in general practice trainees: insights into the profession and its postgraduate training (PhD reports)

Introduction: General practice has produced new definitions of its tasks and implemented specialised postgraduate curricula. We explored the results of these endeavours by examining the perceptions of the next generation of general practitioners (GPs). In order to frame our questions, we developed a model of self-assessment as a multilayered construct from the global notion of self-concept, to self-perceived competence, self-monitoring, and metacognitive regulation1. Research questions addressed three levels of self-assessment: 1. Professional identity: How do GP trainees envision their future role? 2. Self-perceived competence (SPC): Do GP trainees feel prepared to practice autonomously? What are the determinants of SPC? 3. Metacognitive regulation: Do trainees possess adequate levels of usable (i.e. certain) knowledge? Are they able to assess their knowledge appropriately? Methods: Study 1 (professional identity and SPC framed as self-efficacy beliefs): We conducted 5 focus groups in Belgium and France with 28 participants. Transcripts were analysed by immersion crystallisation. Study 2 (SPC and metacognitive regulation): We conducted a cross-sectional study of 127 postgraduate trainees in Belgium. Trainees assessed their competence in four clinical domains using ordinal scales and sat a written test on these domains. Confidence judgements were elicited for each test item. Results: Study 1: Trainees’ descriptions were consistent with new definitions. Initially low self-efficacy beliefs usually increased through experiences of success, positive feedback and sharing anxieties with peers. A few trainees developed avoidance strategies, continued to display low self-efficacy beliefs and envisaged leaving the profession. Study 2: Depending on the domain, 20.5-76.4% of trainees described their competence as good or very good. Number of patient contacts and on-call duties were not linked to higher SPC, nor was postgraduate year. Men were more likely to feel competent (OR 1.2-6.1). SPC was not correlated to test scores. The average proportion of knowledge that was usable (i.e. assigned a high degree of certainty) was 36.6%. The average proportion of ignorance that was hazardous (i.e. assigned a high degree of certainty) was 14.3%. These were not linked to test performance. Discussion and conclusion: New definitions are being embodied by future GPs. Most trainees feel confident enough to practice autonomously. There are however concerns about those who do not. Volume of practice does not seem influential. The impact of low SPC on future practice requires longitudinal studies. Self-assessment ability is low even at the specific level of test response confidence judgement. Teachers should be aware of the partial nature of much knowledge and of the significant amount of misconceptions.