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Challenges in measuring ACGME competencies: considerations for milestones.
Prathiba Natesan1, Nicholas J Batley2, Rinad Bakhti3
1Department of Educational Psychology, University of North Texas, 1155 Union Circle #311335, Denton, TX, 76203, USA.
International Journal of Emergency Medicine
|June 11, 2019
Summary
Accreditation Council for Graduate Medical Education (ACGME) competency evaluations show severe multicollinearity, indicating poor validity. Current tools may not accurately assess resident performance, suggesting a need for improved evaluation strategies.
Area of Science:
- Medical Education Research
- Graduate Medical Training Assessment
- Competency-Based Education
Background:
- Ensuring resident competency is crucial for Accreditation Council for Graduate Medical Education (ACGME) standards.
- Previous research indicates physicians often use global ratings, relying on single criteria for evaluations.
- This study examines the validity of ACGME International competency measures in an international context.
Purpose of the Study:
- To validate Accreditation Council for Graduate Medical Education (ACGME) International competency measures in emergency medicine (EM) and neurology.
- To analyze the performance of these measures across different evaluators and specialties.
- To identify potential issues with current competency assessment tools used in resident training.
Main Methods:
- Advanced statistical analysis, including Confirmatory Factor Analysis (CFA), was applied to EM and neurology data.
- CFA models were tested and modified based on fit indices to assess construct validity.
- Measurement invariance tests were conducted to examine differences in competency perception among EM physicians.
Main Results:
- High reliability coefficients and factor loadings (>.93) indicated significant multicollinearity among evaluated items.
- This multicollinearity suggests that most items were redundant and measured the same underlying construct.
- The findings were consistent across both EM and neurology datasets and all six EM faculty evaluators.
Conclusions:
- Evaluation forms for the six core ACGME competencies lack adequate validity due to severe multicollinearity.
- The upcoming ACGME milestones with numerous sub-competencies may exacerbate existing assessment flaws if tool weaknesses are ignored.
- A more effective evaluation process should acknowledge and incorporate physician subjectivity for more meaningful feedback.
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