Subjects are assessed using both internal and external assessments, and courses finish with an externally assessed series of examinations, usually consisting of two or three timed written examinations.
While there is a growing literature showing that learners are not necessarily accurate at self-assessing performance when compared with external assessments, social cognitive theory suggests how self-assessment is important.
Further research should investigate ways of promoting the effectiveness of external assessments as well as ways of assessing practice performance in both loops that provide external information to confirm trainees' self-confidence or in any other way scaffold their competence.
As the ability to self-assess has shown to be limited, there is a need for external assessments [ 1].
When internal assessments are out of step with external assessments, something is wrong.
All assessors achieved 85% inter-rater reliability before performing external assessments.
