title: A multisite, multistakeholder validation of the Accreditation Council for Graduate Medical Education competencies.
abstract: OBJECTIVE
  The Accreditation Council for Graduate Medical Education's (ACGME's) six-competency framework has not been validated across multiple stakeholders and sites. The objective of this study was to perform a multisite validation with five stakeholder groups.
  
  
  METHODS
  This was a cross-sectional, observational study carried out from October to December, 2011, in the internal medicine residency continuity clinics of eight internal medicine residency programs in the Pacific Northwest, including a VA, two academic medical centers, a military medical center, and four private hospitals. The authors performed a cultural consensus analysis (CCA) and a convergent-discriminant analysis using previously developed statements based on internal medicine milestones related to the six competencies. Ten participants were included from each of five stakeholder groups: patients, nurses, residents, faculty members, and administrators from each training site (total: 400 participants).
  
  
  RESULTS
  Moderate to high agreement and coherence for all groups were observed (CCA eigenvalue ratios ranging from 2.16 to 3.20); however, high differences in ranking order were seen between groups in four of the CCA statements, which may suggest between-group tension in these areas. Analyses revealed excellent construct validity (Zcontrast score of 5.323, P < .0001) for the six-competency framework. Average Spearman correlation between same-node statements was 0.012, and between different-node statements it was -0.096.
  
  
  CONCLUSIONS
  The ACGME's six-competency framework has reasonable face and construct validity across multiple stakeholders and sites. Stakeholders appear to share a single mental model of competence in this learning environment. Data patterns suggest possible improvements to the competency-milestone framework.
authors.affiliation: Boise VA Center of Excellence in Primary Care Education, Boise, ID 83702, USA. scott.smith2@va.gov
authors.forename: C Scott
authors.initials: CS
authors.lastname: Smith
authors.forename: Magdalena
authors.initials: M
authors.lastname: Morris
authors.forename: Chris
authors.initials: C
authors.lastname: Francovich
authors.forename: Rick
authors.initials: R
authors.lastname: Tivis
authors.forename: Roger
authors.initials: R
authors.lastname: Bush
authors.forename: Shelley Schoepflin
authors.initials: SS
authors.lastname: Sanders
authors.forename: Jeremy
authors.initials: J
authors.lastname: Graham
authors.forename: Alex
authors.initials: A
authors.lastname: Niven
authors.forename: Mari
authors.initials: M
authors.lastname: Kai
authors.forename: Christopher
authors.initials: C
authors.lastname: Knight
authors.forename: Joseph
authors.initials: J
authors.lastname: Hardman
authors.forename: Kelly
authors.initials: K
authors.lastname: Caverzagie
authors.forename: William
authors.initials: W
authors.lastname: Iobst
mesh_terms: D000068:Accreditation / Q000592:standards*; D002983:Clinical Competence / Q000592:standards*; D016002:Discriminant Analysis; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency / Q000592:standards*