Evaluation of perceived and actual competency in a family medicine objective structured clinical examination.

Objective: To examine the relationship between objective assessment of performance and self-rated competence immediately before and after participation in a required summative family medicine clerkship objective structured clinical examination (OSCE).

Design: Learners rated their competence (on a 7-point Likert scale) before and after an OSCE along 3 dimensions: general, specific, and professional competencies relevant to family medicine.

Setting: McGill University in Montreal, Que.

Participants: All 168 third-year clinical clerks completing their mandatory family medicine rotation in 2010 to 2011 were invited to participate.

Main Outcome Measures: Self-ratings of competence and objective performance scores were compared, and were examined to determine if OSCEs could be a "corrective" tool for self-rating perceived competence (ie, if the experience of undergoing an assessment might assist learners in recalibrating their understanding of their own performance).

Results: A total of 140 (83%) of the third-year clinical clerks participated. Participating in an OSCE decreased learners' ratings of perceived competence (pre-OSCE score = 4.9, post-OSCE score = 4.7; = 4.2;  < .05). Learners' mean self-rated competence for all categories of behaviour (before and after) showed no relationship to OSCE performance ( < 0.12 and > .08 for all), nor did ratings of station-relevant competence (before and after) ( < 0.19 and > .09 for all). Ratings of competence before and after the OSCE were correlated for individual students ( > 0.40 and < .001 for all).

Conclusion: After the OSCE, students' self-ratings of perceived competence had decreased, and these ratings had little relationship to actual performance, regardless of the specificity of the rated competency. Discordance between perceived and actual competence is neither novel nor unique to family medicine. However, this discordance is an important consideration for the development of competency-based curricula.