Article Text

Download PDFPDF
Primary care
Validity and reliability of the Spanish version of the ACE tool for assessing competencies in evidence-based medicine in medical students
  1. Nadia Sgarbossa1,
  2. Sofia Marino1,
  3. Lucas Aletta1,
  4. Fernando Ramón Vázquez Peña2,
  5. Juan Victor Ariel Franco3,4
  1. 1 Health Department, Universidad Nacional de La Matanza, San Justo, Buenos Aires Province, Argentina
  2. 2 Family and Community Medicine Division, Hospital Italiano de Buenos Aires, Buenos Aires, Federal District, Argentina
  3. 3 Research Department, Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, Buenos Aires, Argentina
  4. 4 Institute of General Practice, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
  1. Correspondence to Dr Juan Victor Ariel Franco, Institute of General Practice, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; juan.franco{at}


Objective To translate and culturally adapt the tool ‘Assessing Competency in evidence-based medicine (EBM)’ (ACE) to Spanish and to implement it in a cohort of medical students for the evaluation of the instrument’s psychometric properties.

Design Bilingual translators produced a translation and backtranslation of the original instrument, with interim consensus in each stage with oversight and input by a group of experts. We then performed cognitive interviews to adapt the wording of the tool culturally. Finally, we implemented the final version in a cohort of medical students on a virtual general practice course with EBM modules.

Setting Medical School in Buenos Aires, Argentina. Due to restrictions to in-person teaching during the COVID-19 pandemic, we conducted this study in the context of virtual learning.

Participants We included 125 fourth and fifth-year medical students.

Main outcome measures We measured internal consistency with the Kuder-Richardson coefficient (>0.6 as a threshold for reliability) and construct validity through a Pearson’s correlation between the examinations carried out with the translated instrument and the results of the regular examinations of EBM in the same students (expected values of at least 0.3 to 0.7). We also compared the total score of the instrument of fifth-year students to fourth-year students.

Results As for measurements for internal consistency, the coefficient Kuder-Richardson resulted in a value of 0.268, below our prespecified threshold. For construct validity, the Pearson correlation between the sum of the items and regular examinations was 0.139, also below our prespecified threshold. However, fifth-year students averaged 0.94 points more than fourth-year students (95% CI 0.24 more to 1.65 more).

Conclusion The translated and cross-culturally adapted version of the ACE tool into Spanish had low reliability and validity in an MBE course taught and evaluated in a virtual environment.

Trial registration Not applicable.

  • Medical education & training
  • General medicine
  • primary care

Data availability statement

Data are available upon request. The individual assessments of the students are available upon request.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

Data are available upon request. The individual assessments of the students are available upon request.

View Full Text


  • Twitter @juan_francomd

  • Contributors JVAF designed the study and supervised the methods and is the guarantor of this study. FRVP conducted the statistical analysis. NG, SM, LA conducted and coordinated the steps of the research and performed the field evaluations. All authors wrote the manuscript and approved the final version.

  • Funding CYTMA-2 programme of the Universidad Nacional de La Matanza (Project code: C2SAL-041, Resolution 269/2020) and Scientific Research Grants (Resolution 482/2020).

  • Competing interests JVAF is the Editor-in-Chief of BMJ Evidence-Based Medicine but was not involved in the editorial process of this manuscript, which an independent editor carried out.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.