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

Area of Science:

• Medical Education Research
• Competency-Based Medical Education
• Assessment Alignment

Background:

• Alignment between undergraduate medical education (UME) and graduate medical education (GME) assessments is crucial for effective competency-based medical education (CBME).
• Current assessment strategies in UME may not fully reflect the competencies required for GME.
• Understanding the association between UME and GME assessments can inform programmatic assessment and research.

Purpose of the Study:

• To explore the strength of a priori alignment between UME assessments and GME competency domains.
• To guide programmatic assessment and research in CBME by identifying assessment linkages.
• To provide a framework for evaluating the congruence of medical school assessments with residency requirements.

Main Methods:

• A 2-phase Delphi consensus approach was employed with US faculty possessing UME and GME expertise.
• Participants mapped UME assessments to Accreditation Council for Graduate Medical Education (ACGME) competency domains using a scoring system (0, 1, or 2).
• A heatmap was generated based on mean association scores (≥1.5 indicating meaningful association) to visualize alignment strength.

Main Results:

• Strong associations were found between UME metrics and GME competencies in patient care, medical knowledge, communication, and professionalism.
• Medical knowledge demonstrated strong links with USMLE Step scores and preclinical metrics.
• Weaker associations were observed for practice-based learning and improvement and systems-based practice, although reflection subcompetencies showed some linkage.

Conclusions:

• Experts perceive significant associations between UME and GME assessments across multiple competency domains.
• The study highlights potential gaps in assessing practice-based learning and systems-based practice within traditional UME metrics.
• Findings offer insights into how UME outcomes can inform GME performance and support programmatic assessment strategies.