Reframing Validity: How Values Shape Assessment in Postgraduate Medical Education.

Introduction: Values (value judgments, beliefs, etc.) have implications for clinician educators' conceptualization of postgraduate education, as well as their interpretation and application of assessment data. Seeking clarity around individual, program, and systems values within a competency based medical education (CBME) program, the authors sought evidence of distinct values reflected in the CBME assessment literature. Methods: The authors conducted an exploratory critical review study in two phases aligned with Kahlke's method. In phase one (from September 2020 to December 2022) the authors worked towards five interconnected goals: focus, generate data, appraise, sample, and analyze. In phase two (October 2022), the authors invited peer review of the process and findings. Results: Three values and related assessment goals were distilled from the literature on competency-based assessment: 1) Safety: Assessment protects patient safety, ensuring that only clinicians who demonstrate safe practice are advanced; 2) Development: Assessment supports the development of learners' competence, rather than ranking or differentiating between individuals; and 3) Agility: Assessment evolves in response to context and should be adapted to better support learners and faculty. The authors linked the values within assessment programs to practical consequences for measuring clinical competence. Discussion: The authors articulated how values within academic medicine directly shape the interpretation and judgement of competence. Deliberately balancing the values of patient safety, learner development, and systems agility can prevent harm when any single value dominates. Preparing faculty to recognize and navigate these value tensions is essential for fair, transparent, and defensible assessment decisions in CBME.