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Academic Medicine:
doi: 10.1097/ACM.0b013e3182951efc
Research Reports

A Multisite, Multistakeholder Validation of the Accreditation Council for Graduate Medical Education Competencies

Smith, C. Scott MD; Morris, Magdalena RN, MSN; Francovich, Chris EdD; Tivis, Rick MPH; Bush, Roger MD; Sanders, Shelley Schoepflin MD; Graham, Jeremy DO; Niven, Alex MD; Kai, Mari MD; Knight, Christopher MD; Hardman, Joseph MD; Caverzagie, Kelly MD; Iobst, William MD; for the Pacific Northwest Consortium for Outcomes in Residency Education

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Abstract

Purpose: The Accreditation Council for Graduate Medical Education’s (ACGME’s) six-competency framework has not been validated across multiple stakeholders and sites. The objective of this study was to perform a multisite validation with five stakeholder groups.

Method: This was a cross-sectional, observational study carried out from October to December, 2011, in the internal medicine residency continuity clinics of eight internal medicine residency programs in the Pacific Northwest, including a VA, two academic medical centers, a military medical center, and four private hospitals. The authors performed a cultural consensus analysis (CCA) and a convergent-discriminant analysis using previously developed statements based on internal medicine milestones related to the six competencies. Ten participants were included from each of five stakeholder groups: patients, nurses, residents, faculty members, and administrators from each training site (total: 400 participants).

Results: Moderate to high agreement and coherence for all groups were observed (CCA eigenvalue ratios ranging from 2.16 to 3.20); however, high differences in ranking order were seen between groups in four of the CCA statements, which may suggest between-group tension in these areas. Analyses revealed excellent construct validity (Zcontrast score of 5.323, P < .0001) for the six-competency framework. Average Spearman correlation between same-node statements was 0.012, and between different-node statements it was –0.096.

Conclusions: The ACGME’s six-competency framework has reasonable face and construct validity across multiple stakeholders and sites. Stakeholders appear to share a single mental model of competence in this learning environment. Data patterns suggest possible improvements to the competency-milestone framework.

© 2013 by the Association of American Medical Colleges

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