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This study examined medical residents’ (N = 91) self-assessment accuracy, and its relation with goal orientation, reflection and performance. Residents completed a case test derived from the Medical Knowledge Self Assessment Program (MKSAP) and rated their confidence in the accuracy of each response on the case test. Furthermore, they completed questionnaires about goal orientation and engagement in reflection activities. Measures of self-assessment accuracy show that residents are highly overconfident for incorrect responses. Residents with a higher level of mastery-goal orientation self-reported more reflective activities, but also showed lower self-assessment accuracy and lower case test performance. These contradictory findings indicate that it is important to triangulate data by combining self-report questionnaire data with more fine-grained measures of self-assessment accuracy.