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Defining Trainee Competence

Value is in the Eye of the Stakeholder

Yarris, Lalena M., MD, MCR

doi: 10.1097/ACM.0000000000002643
Invited Commentary: PDF Only

In this issue of Academic Medicine, Lundsgaard and colleagues present “Embracing Multiple Stakeholder Perspectives in Defining Trainee Competence,” a qualitative exploration of how various stakeholders contribute to the understanding of trainee competence. Drawing on stakeholder theory from business management, the authors of that report explore how the perceptions of key stakeholders (leaders/administrators, nurses/nurse practitioners, trainees, and patients) either confirm, enhance, or complicate the picture of competence that emerges from the perspectives of senior physician supervisors.

In this Invited Commentary, the author considers the potential effects of applying stakeholder theory to educational assessment and elaborates on Lundsgaard and colleagues’ findings that additional stakeholder perceptions may be redundant in some instances and present conflicting understandings of competence in others. She also emphasizes the importance of a process of defining competence, and ultimately developing assessment programs, that includes measuring and illuminating conflicting perceptions of what constitutes competence. Finally, the author considers potential applications of Lundsgaard and colleagues’ results for educators and assessors with comprehensive assessment programs already in place.

There are limitations and risks to applying a conceptual framework that aims to increase value for a company to the training of physicians. However, with thoughtful application, incorporating multiple stakeholders into instrument development and workplace-based assessment may provide educators with a more nuanced picture of competence that incorporates the values of those ultimately impacted by trainee performance.

L.M. Yarris is professor and residency program director, Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon.

Editor’s Note: This is an Invited Commentary on Lundsgaard KS, Tolsgaard MG, Mortensen OS, Mylopoulos M, Østergaard D. Embracing multiple stakeholder perspectives in defining trainee competence. Acad Med. 2019;94:XX-XX.

Acknowledgements: The author would like to thank her colleagues Amy Miller Juve, EdD, and Anthony R. Artino, Jr, PhD, for their critical feedback on this commentary.

Funding/Support: None reported.

Other disclosures: None reported.

Ethical approval: Reported as not applicable.

Correspondence should be addressed to Lalena M. Yarris, 3181 SW Sam Jackson Park Road, Mailcode CDW-EM, Oregon Health & Science University, Portland, OR 97239; telephone: (503) 494-2962; e-mail:; Twitter: @lainieyarris.

© 2019 by the Association of American Medical Colleges