Do students' self-reflections of performance align with their graded performance in objective structured clinical exams?

Angelina S. Lim, Sunanthiny Krishnan, George Tan, Derek Stewart, Tarik Al-Diery

Research output: Contribution to journalArticleResearchpeer-review


Introduction: Self-awareness of strengths and weaknesses through self-reflection are important for life-long learning and development. The aim of this study was to assess the alignment in third-year undergraduate pharmacy students' self-reflections of their objective structured clinical exam (OSCE) performance to their actual OSCE scores and explore the most common aspects students reflected on as markers of perceived performance. 

Methods: Students completed a three-station OSCE and a written self-reflection about their performance. These reflections were coded using a latent pattern content analysis, with categories defined as “doing well (≥ 50% on exam)” and “not doing well (< 50% on exam)” and compared to their actual OSCE exam scores, to determine the degree of alignment. 

Results: Two hundred sixty-nine students completed the OSCE and reflection. Students had a low degree of alignment between their self-reflections and actual OSCE performance. Low alignment was overwhelmingly prevalent and significant in high-achieving students with OSCE scores of ≥90%. Most common aspects students reflected on as indicators of performance were finishing on time and communicating effectively. High-achieving students reflected on aspects such as empathy, systematic questioning, and patient teach-back as aspects of their performance. 

Conclusions: Student reflections on exam performance do not align with their actual performance, particularly amongst the high-achieving students. High-achieving students were more aware of the different aspects that affected their performance. To ensure that high-achieving students are aware of their strengths, educators should provide more targeted feedback mechanisms and positive reassurances to help these students become more confident in their decision-making skills.

Original languageEnglish
Article number102097
Number of pages10
JournalCurrents in Pharmacy Teaching and Learning
Issue number8
Publication statusPublished - Aug 2024


  • Competency development
  • Metacognition
  • Objective structured clinical exam
  • Self-awareness
  • Self-reflection

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