title: A construct validity study of clinical competence: a multitrait multimethod matrix approach.
abstract: BACKGROUND
  The purpose of the study was to adduce evidence for estimating the construct validity of clinical competence measured through assessment instruments used for high-stakes examinations.
  
  
  METHODS
  Thirty-nine international physicians (mean age = 41 + 6.5 y) participated in high-stakes examination and 3-month supervised clinical practice to determine the practice readiness of physicians. Three traits-doctor-patient relationship, clinical competence, and communication skills-were assessed with objective structured clinical examinations, in-training evaluation reports, and clinical assessments. These traits were intercorrelated in a multitrait multimethod matrix (MTMM).
  
  
  RESULTS
  The reliability of assessments ranged from moderate to high (Cronbach's alpha: 0.58-0.98; Ep(2) = 0.79). There is evidence for both convergent and divergent validity for clinical competence, followed by doctor-patient relationships, and communications (validity coefficients = 0.12-0.85). The correlations between the same methods but different traits indicate that there is substantial method specificity in the assessment accounting for nearly one-quarter of the variance (23.7%).
  
  
  CONCLUSIONS
  There is evidence for the construct validity of all 3 traits across 3 methods. The MTMM approach, currently underutilized, could be used to estimate the degree of evidence for validating complex constructs, such as clinical competence.
authors.affiliation: Alberta International Medical Graduate Program, Health Sciences Centre, University of Calgary, Canada. lbaig@ucalgary.ca
authors.forename: Lubna
authors.initials: L
authors.lastname: Baig
authors.forename: Claudio
authors.initials: C
authors.lastname: Violato
authors.forename: Rodney
authors.initials: R
authors.lastname: Crutcher
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003142:Communication; D004521:Educational Measurement / Q000379:methods / Q000592:standards*; D005069:Evaluation Studies as Topic; D006801:Humans; D008875:Middle Aged; D010817:Physician-Patient Relations; D010820:Physicians / Q000592:standards*; D036301:Qualitative Research; D015203:Reproducibility of Results