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Construct Validity Evidence for ACGME Milestones in Surgical Specialties: A Systematic Review
Ting Sun1, Stanley J Hamstra2, Kenji Yamazaki3
1is an Assistant Professor, Office of Surgical Education, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA.
Journal of Graduate Medical Education
|May 26, 2025
Summary
This systematic review examined validity evidence for Accreditation Council for Graduate Medical Education (ACGME) Milestones in surgical education. Most evidence focused on relations to other variables and response processes, with limited internal structure data, highlighting research needs for competency-based medical education.
Area of Science:
- Medical Education Research
- Graduate Medical Education
- Surgical Training
Background:
- Accreditation Council for Graduate Medical Education (ACGME) Milestones are transitioning from low-stakes to higher-stakes applications in competency-based medical education (CBME).
- Extensive validity evidence is crucial for this transition, particularly in surgical specialties due to their unique skill requirements.
- This review synthesizes existing validity evidence for ACGME Milestones within surgical disciplines.
Purpose of the Study:
- To systematically review and synthesize studies reporting validity evidence for the ACGME Milestones in surgical specialties.
- To identify the types and extent of validity evidence available for ACGME Milestones in this critical educational context.
Main Methods:
- Systematic literature review adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
- Comprehensive search across 8 databases and reference lists for studies on ACGME Milestones validity in surgical specialties.
- Literature screening, coding based on Messick's framework, and quality assessment using the Medical Education Research Study Quality Instrument.
Main Results:
- 114 studies published between 2013 and 2023 were included.
- The most frequent sources of validity evidence were relations to other variables (39.5%) and response processes (33.3%).
- Evidence regarding internal structure was limited (10.5%), and areas like consequences and specific response process elements require further investigation.
Conclusions:
- This review clarifies the landscape of validity evidence for ACGME Milestones in surgical specialties.
- Significant gaps exist, particularly in internal structure evidence, which are essential for supporting higher-stakes CBME.
- Further research is recommended to strengthen the validity argument for ACGME Milestones in surgical graduate medical education.
