Variable trajectory: a systematic review, analytic synthesis and construct domain consolidation of international measures of competence in doctors and medical students

BACKGROUND: Competence is assessed throughout a doctor’s career. Failure to identify and manage impaired competence can have critical consequences. Consistent conceptualisation and accurate measurement of this construct is imperative. Therefore, the objective of this review was to identify and evaluate measures used to assess competence in doctors and medical students. METHODS: A systematic search of the published literature was undertaken between December 2019 and February 2020 for articles reporting on the measurement of competence in doctors and/or medical students. Searches were conducted in the PsychSOURCE, US National Library of Medicine National Institutes of Health, MEDLINE (PubMed), The Cochrane Central Register of Controlled Trials and Web of Science electronic databases. Citation screening and forward citation tracking of included studies were carried out to identify any further relevant papers for inclusion. One thousand one hundred and thirty-six potentially relevant articles were screened. An analytic synthesis approach was implemented to the identification, organisation and interpretation of homogenous study and measure characteristics. RESULTS: Twelve competence domains were identified from the 153 identified measures. Knowledge and procedural competence domains were the dominant focus of publications reporting current medical practice, but less so in research-based studies which more frequently assessed interpersonal, psychological, physiological and ethical competencies. In the 105 included articles, the reporting of measurement instrument quality was varied, with comprehensive reporting only present in 53.6% of measures; validation for some of the measures was particularly limited. DISCUSSION: While this review included a considerable number of publications reporting the measurement of competence in doctors and medical students, the heterogeneity of the measures and variation of findings limit the ability to evaluate their validity and generalisability. However, this review presents a resource for researchers and medical educators which may inform operational practice and future research. PROSPERO REGISTRATION NUMBER: CRD42020162156.