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Discordance between global versus reductionist approach in competency-based assessment for medical students in a transition to residency course.

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Title: Discordance between global versus reductionist approach in competency-based assessment for medical students in a transition to residency course.
Authors: Caretta-Weyer, Holly A.1 (AUTHOR) hcweyer@stanford.edu, Yarris, Lalena M.2 (AUTHOR)
Source: Medical Teacher. Mar2026, Vol. 48 Issue 3, p506-515. 10p.
Subject Terms: *Medical education, *Internship programs, *Universities & colleges, *Educational tests & measurements, *Simulation methods in education, *Clinical competence, *Achievement tests, *Outcome-based education, *Psychology of medical students, *Medical preceptorship, Descriptive statistics, Chi-squared test
Abstract: Introduction: The advent of competency-based education has led to concerns regarding reductionism in the assessment of clinical competence. This apprehension stems from using the assessment of isolated subunit competencies to build a complete picture of clinical competence. Some argue that the entrustable professional activity (EPA) framework complements the construct of competencies, as EPAs describe units of work and require a global approach to their assessment. To that end, we aimed to discern whether the assessment of separate subunit competencies subsequently aggregated is equivalent to the global assessment of EPAs. Methods: We designed a simulation-based workshop and assessed each student using the subunit competencies mapped to the core EPAs (the bottom-up approach) compared to the assessment of the global EPAs (the top-down approach) using 1) a supervision scale, 2) a global statement regarding entrustment and 3) a statement regarding readiness for residency. We aimed to determine whether the global assessment of EPAs was equivalent to aggregating the corresponding subunit competency assessments. The subunit competency assessments were additionally compared to aggregate workplace-based assessment data on the various subunit competencies from core clerkships. Results: All eligible students participated (136/136). Assessment data obtained using the subunit competencies mapped to the EPAs were highly correlated with the assessment of subunit competencies obtained in the workplace during core clerkships. However, these subunit competency assessments obtained during the TTR course did not correlate with EPA-based global supervision scale ratings, entrustment decisions, or perceived readiness for residency. Discussion: Global assessment of EPAs and the judgment of entrustment appear to be separate processes from aggregating the assessment of subunit competencies. This may reflect variations in the approach to global assessment when compared to the assessment of subunit competencies and the need to consider the construct of trustworthiness in addition to the learner's ability to perform each activity. [ABSTRACT FROM AUTHOR]
Copyright of Medical Teacher is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Discordance between global versus reductionist approach in competency-based assessment for medical students in a transition to residency course.
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  Data: <searchLink fieldCode="AR" term="%22Caretta-Weyer%2C+Holly+A%2E%22">Caretta-Weyer, Holly A.</searchLink><relatesTo>1</relatesTo> (AUTHOR)<i> hcweyer@stanford.edu</i><br /><searchLink fieldCode="AR" term="%22Yarris%2C+Lalena+M%2E%22">Yarris, Lalena M.</searchLink><relatesTo>2</relatesTo> (AUTHOR)
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  Data: <searchLink fieldCode="JN" term="%22Medical+Teacher%22">Medical Teacher</searchLink>. Mar2026, Vol. 48 Issue 3, p506-515. 10p.
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  Data: *<searchLink fieldCode="DE" term="%22Medical+education%22">Medical education</searchLink><br />*<searchLink fieldCode="DE" term="%22Internship+programs%22">Internship programs</searchLink><br />*<searchLink fieldCode="DE" term="%22Universities+%26+colleges%22">Universities & colleges</searchLink><br />*<searchLink fieldCode="DE" term="%22Educational+tests+%26+measurements%22">Educational tests & measurements</searchLink><br />*<searchLink fieldCode="DE" term="%22Simulation+methods+in+education%22">Simulation methods in education</searchLink><br />*<searchLink fieldCode="DE" term="%22Clinical+competence%22">Clinical competence</searchLink><br />*<searchLink fieldCode="DE" term="%22Achievement+tests%22">Achievement tests</searchLink><br />*<searchLink fieldCode="DE" term="%22Outcome-based+education%22">Outcome-based education</searchLink><br />*<searchLink fieldCode="DE" term="%22Psychology+of+medical+students%22">Psychology of medical students</searchLink><br />*<searchLink fieldCode="DE" term="%22Medical+preceptorship%22">Medical preceptorship</searchLink><br /><searchLink fieldCode="DE" term="%22Descriptive+statistics%22">Descriptive statistics</searchLink><br /><searchLink fieldCode="DE" term="%22Chi-squared+test%22">Chi-squared test</searchLink>
– Name: Abstract
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  Data: Introduction: The advent of competency-based education has led to concerns regarding reductionism in the assessment of clinical competence. This apprehension stems from using the assessment of isolated subunit competencies to build a complete picture of clinical competence. Some argue that the entrustable professional activity (EPA) framework complements the construct of competencies, as EPAs describe units of work and require a global approach to their assessment. To that end, we aimed to discern whether the assessment of separate subunit competencies subsequently aggregated is equivalent to the global assessment of EPAs. Methods: We designed a simulation-based workshop and assessed each student using the subunit competencies mapped to the core EPAs (the bottom-up approach) compared to the assessment of the global EPAs (the top-down approach) using 1) a supervision scale, 2) a global statement regarding entrustment and 3) a statement regarding readiness for residency. We aimed to determine whether the global assessment of EPAs was equivalent to aggregating the corresponding subunit competency assessments. The subunit competency assessments were additionally compared to aggregate workplace-based assessment data on the various subunit competencies from core clerkships. Results: All eligible students participated (136/136). Assessment data obtained using the subunit competencies mapped to the EPAs were highly correlated with the assessment of subunit competencies obtained in the workplace during core clerkships. However, these subunit competency assessments obtained during the TTR course did not correlate with EPA-based global supervision scale ratings, entrustment decisions, or perceived readiness for residency. Discussion: Global assessment of EPAs and the judgment of entrustment appear to be separate processes from aggregating the assessment of subunit competencies. This may reflect variations in the approach to global assessment when compared to the assessment of subunit competencies and the need to consider the construct of trustworthiness in addition to the learner's ability to perform each activity. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of Medical Teacher is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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RecordInfo BibRecord:
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        Value: 10.1080/0142159X.2025.2566967
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      – Code: eng
        Text: English
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        PageCount: 10
        StartPage: 506
    Subjects:
      – SubjectFull: Medical education
        Type: general
      – SubjectFull: Internship programs
        Type: general
      – SubjectFull: Universities & colleges
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      – SubjectFull: Educational tests & measurements
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      – SubjectFull: Simulation methods in education
        Type: general
      – SubjectFull: Clinical competence
        Type: general
      – SubjectFull: Achievement tests
        Type: general
      – SubjectFull: Outcome-based education
        Type: general
      – SubjectFull: Psychology of medical students
        Type: general
      – SubjectFull: Medical preceptorship
        Type: general
      – SubjectFull: Descriptive statistics
        Type: general
      – SubjectFull: Chi-squared test
        Type: general
    Titles:
      – TitleFull: Discordance between global versus reductionist approach in competency-based assessment for medical students in a transition to residency course.
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            NameFull: Caretta-Weyer, Holly A.
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              Text: Mar2026
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              Y: 2026
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