‘I don’t know what I don’t know’: A qualitative study of medical students’ self-assessment in a Hong Kong context

Introduction: Self-assessment (SA), a crucial psychological process in education, involves learners judging whether they meet their own identified standards. SA is a multi-dimensional construct shaped by various factors, including individual, contextual, and cultural influences. This cross-sectional study aims to explore how medical students develop and enact SA across training stages within an East Asian educational context, with particular attention to multilevel influences. Methods: Conducted at a Hong Kong medical school, this study involved one-on-one semi-structured interviews with medical students at different stages of training. Interview focused on students’ SA practices and the factors influencing their development across different stages of training. Data were analyzed using thematic analysis, informed by the social ecological model, through iterative coding and interpretation. Results: Interviews with 26 medical students across preclinical and clinical training stages revealed four interrelated levels influencing SA practices: individual level—perceived value, emotional, motivational factors, professional identity, and subconscious reflection; interpersonal level—teacher feedback, peer interaction, and patient feedback; institutional level—curriculum structure, frequency and format of assessments, a supportive environment, and alignment of teaching and learning objectives; and societal level—collectivist cultural norms, humility, and local academic expectations. Additionally, students recognized SA as both a cognitive and emotional regulatory process, shaped by culturally mediated norms around self-evaluation, feedback interpretation, and performance comparison. Discussion: This study demonstrates that medical students’ SA practices are shaped by interacting influences across individual, interpersonal, institutional, and societal levels, with cultural norms playing a structuring role rather than a peripheral one. By highlighting how commonly described SA processes operate differently in an East Asian context, these findings extend existing SA and SRL literature and underscore the importance of culturally responsive educational and assessment practices to support students’ development of SA and lifelong learning.