The primary aim of higher education has been debatable. However, one of the many goals that higher education strives for is to equip students with competencies that will enable them to succeed in their future professions. This goal is achieved through a structured academic curriculum that is embedded with competencies, and the competencies are ascertained through assessments. This study focused on developing a practical measurement approach that offers evidence for the structural validity of an undergraduate competency-based medical curriculum. Competency-based education (CBE) is the 21st century trend for delivering health professions curricula, and defensible assessment systems ascertain these competencies. Therefore, the ability to define and defend the assessment system by producing evidence for structural fidelity ensures curricula efficacy. Structural fidelity indicates the extent to which the inter-relationships among assessment tasks reflect the internal structure of a construct domain. This study sought evidence of structural validity for the pre-clinical curriculum through exploratory and confirmatory factor analysis to evaluate the efficacy of the curriculum. The EFA showed that the assessments in the pre-clinical curriculum primarily reflected three constructs. These were medical knowledge, patient care and osteopathic philosophy and practices. The constructs represented three of the seven competencies for the osteopathic medical curriculum. These constructs explained 47 percent of the variance. Through CFA a measurement model with moderate fit was generated: CMIN = 5.7, RMSEA = 0.09. SRMR = 0.07, AGFI = 0.81. This model was cross-validated establishing configural invariance CMIN = 4.52, CFI = 0.87, RMSEA = 0.06, SRMR = 0.07 and measurement invariance, CMIN = 4.55, change in CFI = 0.009, RMSEA = 0.06. The outcome of the study provided evidence to support the efficacy of the pre-clinical undergraduate medical curriculum. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://bibliotheek.ehb.be:2222/en-US/products/dissertations/individuals.shtml.]