Exploring the alignment between medical school outcomes with residency competencies: a modified Delphi study

Facilitation of competency-based medical education adoption would benefit from alignment between medical school (undergraduate medical education [UME]) and residency (graduate medical education [GME]) assessments. This study explores the strength of an a priori alignment of medical school assessments with residency competency domains to guide programmatic assessment and research.

In fall 2023, the authors (US faculty with UME and GME expertise) used a 2-phase Delphi consensus approach (9 participants in phase 1 and 16 in phase 2) to independently map medical school assessments to the Accreditation Council for Graduate Medical Education competency domains (0, no association; 1, some or moderate association; and 2, strong association). The mean responses were used to create a heatmap of the strength of associations, with a score of 1.5 or higher indicating a meaningful association. Consensus discussion was used to develop a final heatmap of associations.

Strong a priori associations emerged for the patient care domain and metrics of clerkship grading, professionalism concerns, clinical skills, and failure to match. Medical knowledge was closely associated with the United States Medical Licensing Examination Step scores and preclinical metrics. Communication and professionalism were associated with professionalism concerns, Gold Humanism Honor Society membership, clerkship grades and rank, clinical skills, Step 2 Clinical Skills failure, and failure to match or Supplemental Offer and Acceptance Program participation. Practice-based learning and improvement and systems-based practice had weaker associations, suggesting these competencies may be less reflected in traditional medical school metrics. However, subcomponents of practice-based learning related to reflection revealed associations with professionalism concerns and match outcomes.

Experts perceived associations between UME and GME assessments in multiple domains, with weaker associations in practice-based learning and systems-based practice. These results offer perspective on how UME outcomes could be associated with GME performance and might be used in programmatic assessment.