A multisite, multistakeholder validation of the accreditation council for graduate medical education competencies

C. Scott Smith, Magdalena Morris, Chris Francovich, Rick Tivis, Roger Bush, Shelley Schoepflin Sanders, Jeremy Graham, Alex Niven, Mari Kai, Christopher Knight, Joseph Hardman, Kelly Caverzagie, William Iobst

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)997-1001
Number of pages5
JournalAcademic Medicine
Issue number7
StatePublished - Jul 2013

ASJC Scopus subject areas

  • Education


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