Components of postgraduate competence: analyses of thirty years of longitudinal data

The conceptualisation and measurement of competence in patient care are critical to the design of medical education programmes and outcome assessment.

We aimed to examine the major components and correlates of postgraduate competence in patient care.

A 24-item rating form with additional questions about resident doctors' performance and future residency offers was used. Study participants comprised 4560 subjects who graduated from Jefferson Medical College between 1975 and 2004. They pursued their graduate medical education in 508 hospitals. We used a longitudinal study design in which the rating form was completed by programme directors to evaluate residents at the end of the first postgraduate year. Factor analysis was used to identify the underlying components of postgraduate ratings. Multiple regression, t-test and correlational analyses were used to study the validity of the components that emerged.

Two major components emerged, which we labelled 'Knowledge and Clinical Capabilities' and 'Professionalism', and which addressed the science and art of medicine, respectively. Performance measures during medical school, scores on medical licensing examinations, and global assessment of Medical Knowledge, Clinical Judgement and Data-gathering Skills showed higher correlations with scores on the Knowledge and Clinical Capabilities component. Global assessments of Professional Attitudes and ratings of Empathic Behaviour showed higher correlations with scores on the Professionalism component. Offers of continued residency and evaluations of desirable qualities were associated with both components.

Psychometric support for measuring the components of Knowledge and Clinical Capabilities, and Professionalism provides an instrument to empirically evaluate educational outcomes to medical educators who are in search of such a tool.