The competent physician pursues lifelong learning through the recognition of deficiencies and the formulation of appropriate learning goals. Despite the accepted theoretical value of self-assessment, studies have consistently shown that the accuracy of self-assessment is poor. This paper examines the methodological issues that plague the measurement of self-assessment ability and presents several strategies that address these methodological problems within the current paradigm. In addition, the article proposes an alternative conceptualization of self-assessment and describes its associated methods. The conclusions of prior research in this domain must be re-examined in light of the common pitfalls encountered in the design of the studies and the analyses of the data. Future efforts to elucidate self-assessment phenomena need to consider the implications of this review.