Modelling the Effect of Age, Semester of Study and Its Interaction on Self-Reflection of Competencies in Medical Students.

Objectives: Accurate self-assessment and -reflection of competencies are crucial skills for all health professions. The National Competence-Based Learning Objectives Catalogue (NKLM) guiding medical faculties in Germany points out reflection as a non-technical skill and competency-based medical education (CBME) as important approaches. In this context, the role and structure of curricula and skills labs evolved. Especially in peer-assisted trainings, reflection of competencies is important to improve self-regulated learning. Traditionally, we assume self-reflection skills to evolve automatically with learners' experience. This approach aims to find empirical evidence for this assumption and implements self-reflection of competencies in clinical skills education. Here, we quantify the influence of age and semester of study and its interaction on the concordant self-reflection of students' own competencies. Methods: Investigation was based on a retrospective analysis of evaluation data from peer-assisted "first aid" and "physical examination" courses in the skills labs of the medical faculty at the Ruhr-University Bochum, Germany. Participants were asked for self-assessed competencies before ( pre ) and after ( post ) the course. Additionally, they were asked to retrospectively re-rate their "before" competencies after completing the course ( post-pre ). Differences between pre and post-pre competencies were assessed as the concordant self-reflection in a moderated regression analysis. Group means and standard deviation were depicted using univariate analysis of variance (ANOVA) with post-hoc Tukey HSD testing in IBM SPSS Statistics V.28 . Moderated regression and simple slope analyses were conducted to calculate interaction effects of age and semester of study on the concordant self-reflection. Results: As expected, participants ( n = 168) showed significant progress in subjective self-assessment ( pre vs. post ) in all 18 assessed domains in the course (all p < 0.001). Additionally, participants self-assessed their previous competencies after the course ( post - pre ) differently than before the course ( pre) in 11 out of 18 domains. Hereby, the interaction of age and semester of study explained a significant part of variance in the first aid course (∆ R 2 = 0.008, ∆ F (1;1020) = 8.53, p < 0.005) and in the physical examination course (Δ R 2 = 0.03, Δ F (1;10,280) = 10.72, p < 0.001). Conclusions: We quantified that interaction of age and semester has a significant influence on concordant self-reflection skills using a moderated regression analysis. Assumed as an indicator, we conclude that advanced and older students show less differences in pre- vs. post-pre -ratings. This has implications for curriculum development, postulating that an exposure to self-reflection as a metacognitive process should be introduced early in order to train competencies in health professionals. Prospective studies with competency-based assessments are necessary to validate findings.