So perhaps this should have been part 20.

Assessing one’s own performance as a doctor is not taught at medical school.

The problem is of course that as a doctor there is a touch of the ‘God’-complex, not to mention a historical lack of scrutiny.

But on a more personal note it is actually very difficult to step-aside and assess your own performance objectively.

One way to do this is to focus on how you handled the difficult case. But in reality the difficult case was probably going to be difficult regardless of how brilliant a clinician you are and in many circumstances the reasons why the case is difficult is out of your control.

I think the real challenge is assessing overall performance. A little like assessing organisations you can assess processes and outcomes. Outcomes are the difficult measure because you don’t necessarily know how your peers perform and different doctors treat patients with different ‘degrees of difficulty’.

For both process and outcomes you can assess against benchmarks and guidelines but there will always be uncertainty about how these are set.

Finally one needs to have a personal reference point: do you aim for a consistent standard within a specific set of skills or do you have a reference of achieving both this, combined with progressive improvement & expansion of your skill-set.

I think the latter is the most important issue that needs to be addressed before the profession can embrace personal self-assessment. Do the practitioners know what their goals are? Do you graduate and coast or graduate and grow? Self-assessment needs concrete actions otherwise others will do it for us and no doubt in a way that won’t be helpful.