Validity in competency-based health professions education.

INTRODUCTION: Validity is a term that carries significant weight within health professions education (HPE), particularly with regard to learner assessment. Validity theory has changed significantly over the last century, transforming in concert with education, measurement and assessment practices. Most recently, HPE has adopted the conceptualisation of validity as an argument supporting the interpretation (and sometimes uses) of assessment data. The spread of competency-based education and programmatic assessment has introduced new tensions and opportunities for operationalising argument-based approaches to validity. METHODS: The authors used a selective interpretive synthesis of the literature to explore how current argument-based validity frameworks can be extended to support the complexity of programmatic assessment and to meet the social imperative of public protection that is core to competency-based education. RESULTS: The authors advocate that argument-based frameworks, such as those of Messick or Kane, are useful in applying validity theory to competency-based education, particularly when navigating the complexity of programmatic assessment and the increasing emphasis on consequences of assessment decisions. The authors propose three ways that can help with validity and validation in competency-based systems: argumentation theory, integration of qualitative principles in validation and evidence-centred design. DISCUSSION: Argument-based validity conceptualisations provide flexibility to accommodate competency-based assessment systems and allow for the foregrounding of consequences of assessment decisions during validation.