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Embracing Multiple Stakeholder Perspectives in Defining Trainee Competence

Lundsgaard, Kristine Sarauw, MD, MPG; Tolsgaard, Martin G., MD, PhD, DMSc; Mortensen, Ole Steen, MD, PhD; Mylopoulos, Maria, PhD; Østergaard, Doris, MD, DMSc

doi: 10.1097/ACM.0000000000002642
Research Reports

Purpose To explore how multiple stakeholder groups contribute to the understanding of trainee competence.

Method The authors conducted a constructivist qualitative study in 2015 using focus group discussions to explore the perceptions of different stakeholder groups (patients, nurses/nurse practitioners, supervisors/senior physicians, leaders/administrators, trainees) regarding trainee competence in the emergency department. The authors used a conventional content analysis, a comparative analysis of supervisors’/senior physicians’ versus other stakeholders’ perspectives, and a directed analysis informed by stakeholder theory to analyze the focus group transcripts.

Results Forty-six individuals participated in nine focus groups. Four categories of competence were identified: Core Clinical Activities, Patient Centeredness, Aligning Resources, and Code of Conduct. Stakeholders generally agreed in their overall expectations regarding trainee competence. Within individual categories, each stakeholder group identified new considerations, details, and conflicts, which were a replication, elaboration, or complication of a previously identified theme. All stakeholders stressed those aspects of trainee competence that were relevant to their work or values. Trainees were less aware of the patient perspective than that of the other stakeholder groups.

Conclusions Considering multiple stakeholder perspectives enriched the description and conceptualization of trainee competence. It also can inform the development of curricula and assessment tools and guide learning about inter- and intradisciplinary conflicts. Further research should explore how trainees’ perceptions of value are influenced by their organizational context and, in particular, how trainees adapt their learning goals in response to the divergent demands of key stakeholders.

K.S. Lundsgaard is a PhD student, University of Copenhagen, Department of Occupational and Social Medicine, Copenhagen University Hospital Holbæk, Holbæk, Denmark; ORCID:

M.G. Tolsgaard is associate professor, University of Copenhagen and Copenhagen Academy of Medical Education and Simulation, Capital Region, Denmark; ORCID:

O.S. Mortensen is professor, Department of Public Health, Section of Social Medicine, University of Copenhagen, and Department of Occupational and Social Medicine, Copenhagen University Hospital Holbæk, Holbæk, Denmark; ORCID:

M. Mylopoulos is associate professor, Department of Paediatrics, scientist, MD Program, and associate director, Wilson Centre, University of Toronto, Toronto, Ontario, Canada; ORCID:

D. Østergaard is director, Copenhagen Academy of Medical Education and Simulation, and professor, University of Copenhagen, Capital Region, Denmark; ORCID:

Editor’s Note: An Invited Commentary by L.M. Yarris appears on pages 760–762.

Funding/Support: This study was partly funded by Region Zealand.

Other disclosures: None reported.

Ethical approval: This study complied with the Helsinki Declaration. The Regional Ethics Committee Zealand, Denmark, deemed this research exempt from ethical review (protocol number: DRVK-49212).

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Correspondence should be addressed to Kristine Sarauw Lundsgaard, Department of Occupational and Social Medicine, Copenhagen University Hospital Holbæk, Gl. Ringstedvej 4a, Holbæk Sygehus, 4300 Holbæk, Denmark; e-mail:

© 2019 by the Association of American Medical Colleges