Accuracy of Self-Assessment in Medical Student Communication Performance.

Introduction: Effective communication is a core competency in medical practice, supporting patient relationships, treatment adherence, and clinical outcomes. Developing both skills and confidence is a central goal of medical education. Self-assessment, guided reflection, and exemplar-based feedback are promising strategies to enhance competence and self-regulation. Yet, evidence on medical students' accuracy in self-evaluating communication remains limited. This study examined calibration of self-assessed communication performance, potential gender differences, impact of feedback strategies, and changes over time. Method: We analyzed data from 78 students in a larger study who completed self-evaluation of their communication with a virtual patient. Participants engaged with eight video-based clinical vignettes targeting two communication competencies: providing clear, relevant information and responding to patient emotions. For each vignette, students recorded an initial response, reviewed exemplar feedback, completed a self-evaluation (with or without reflection prompts), and re-recorded their response. Communication behaviors were scored using an AI-based system validated against expert ratings. Mixed-effects regression models tested linear and quadratic effects of actual performance on self-assessed behaviors. Gender, experimental condition, and time (T1 vs. T2) were included as moderators to examine differences and changes in calibration. Results: Students consistently overestimated their performance at low actual ability levels (intercept significantly greater than zero: t(154) = 13.48, p < .001, d = 1.53) and underestimated at higher levels (slope significantly less than one: t(148) = -9.99, p < .001, d = -1.13). The quadratic term did not improve model fit. No significant gender differences or improvements in calibration over time or feedback condition were observed. Conclusion: Medical students show systematic miscalibration in self-assessed communication, even when engaging in structured self-evaluation and exemplar-based reflection. These findings highlight the importance of instructional strategies that actively promote comparison with high-quality exemplars and guided reflection. Integrating these approaches may reduce miscalibration, strengthen communication skills, and better prepare students for the interpersonal demands of clinical practice.