Surgical Education, Simulation, and Simulators-Updating the Concept of Validity

Competency-based medical education (CBME) is rooted in the use of iterative assessments. We must ensure that the assessments used in CBME are valid, to make acceptable and accurate decisions regarding the competency of a trainee. Until recently, much of the educational and assessment literature in urology have used a now-outdated method of determining validity, based on theory and recommendations from over 50 years ago. We describe a contemporary approach to gathering construct validity evidence for the assessment of urologic trainees, for use in both clinical and simulation environments.

Five sources of evidence make up Messick's contemporary framework of validity: test content, response process, internal structure, relationship to other variables, and consequences. These are all components of construct validation and concern the accuracy, quality, reproducibility, generalizability, and wider impact of the scores generated by an assessment, respectively. When deciding the competency of a trainee, program directors and educators must have a clear understanding of how the validity is established and is determined in each assessment context. The contextual specificity of validity means that stakeholders must be prepared to defend the outcome of an assessment, particularly when making high-stake or summative decisions.