Better Decision-Making: Shared Mental Models and the Clinical Competency Committee

Abstract

Background Shared mental models (SMMs) help groups make better decisions. Clinical competency committees (CCCs) can benefit from the development and use of SMMs in their decision-making as a way to optimize the quality and consistency of their decisions. Objective We reviewed the use of SMMs for decision making in graduate medical education, particularly their use in CCCs. Methods In May 2020, the authors conducted a narrative review of the literature related to SMMs. This review included the SMM related to teams, team functioning, CCCs, and graduate medical education. Results The literature identified the general use of SMMs, SMMs in graduate medical education, and strategies for building SMMs into the work of the CCC. Through the use of clear communication and guidelines, and a shared understanding of goals and expectations, CCCs can make better decisions. SMMs can be applied to Milestones, resident performance, assessment, and feedback. Conclusions To ensure fair and robust decision-making, the CCC must develop and maintain SMMs through excellent communication and understanding of expectations among members.

Positive Patient Postoperative Outcomes with Pharmacotherapy: A Narrative Review including Perioperative-Specialty Pharmacist Interviews

“…Another programmatic systems approach to medication management endeavors to create a shared mental model using drug stewardship as a platform of organizational change [ 104 , 105 , 106 , 107 ]. While most stewardship programs have concentrated on rational antimicrobial use [ 108 ], recent developments have focused attention on medication classes that are frequently used in perioperative care and are high-risk for the patient, including opioids [ 109 , 110 , 111 , 112 , 113 ], anticoagulants [ 114 , 115 , 116 , 117 , 118 , 119 , 120 ], anemia management [ 121 , 122 , 123 , 124 , 125 ], and glycemic control with insulin [ 126 , 127 ], among others [ 4 ].…”

Reimagining the Clinical Competency Committee to Enhance Education and Prepare for Competency-Based Time-Variable Advancement

“…Focus Area #1: Assess and promote the development of competency in all trainees, not just outliers, through a shared model of assessment and competency-based advancement 50 , 56…”

“… 52 , 61 This is compounded when CCCs lack a shared model on CCC process and function; these norms of outlier identification and straight-line scoring become established, and then are hard to break. 50 In order to discern and describe the developmental status of each resident for the purpose of optimizing their education, the CCC must first establish a shared model and commitment to reviewing each individual resident and providing summative feedback that can be used by trainees to co-produce an ILP with program leadership. 5 , 24 , 50 , 55 , 56 , 58 , 60 , 62 Faculty development for CCC members is essential to mitigate biases that could potentially influence CCC ratings, including bias regarding gender, race, ethnicity, and other forms of cognitive bias.…”

“… 50 In order to discern and describe the developmental status of each resident for the purpose of optimizing their education, the CCC must first establish a shared model and commitment to reviewing each individual resident and providing summative feedback that can be used by trainees to co-produce an ILP with program leadership. 5 , 24 , 50 , 55 , 56 , 58 , 60 , 62 Faculty development for CCC members is essential to mitigate biases that could potentially influence CCC ratings, including bias regarding gender, race, ethnicity, and other forms of cognitive bias. 53 , 63 , 64 CCCs are encouraged to think deliberately about the diversity of their membership and incorporate the science of effective group processes to ensure fair, unbiased committee discussions and decisions.…”

The Purpose, Structure, and Process of Clinical Competency Committees: Guidance for Members and Program Directors

“…7 Edgar and colleagues elaborate on the development of a shared mental model in decision-making. 26 Faculty development is a foundational element of establishing CCC process and decision-making. 27 CCCs have traditionally been oriented toward a problem identification model, focused on identifying those trainees who are struggling; however, many CCCs now strive for a developmental model that reviews all trainees in the spirit of the Next Accreditation System and focuses on multiple domains of performance for the purpose of driving feedback and learning.…”