How do small groups make decisions?: A theoretical framework to inform the implementation and study of clinical competency committees

Abstract

In the competency-based medical education (CBME) approach, clinical competency committees are responsible for making decisions about trainees’ competence. However, we currently lack a theoretical model for group decision-making to inform this emerging assessment phenomenon. This paper proposes an organizing framework to study and guide the decision-making processes of clinical competency committees.This is an explanatory, non-exhaustive review, tailored to identify relevant theoretical and evidence-based papers related to small group decision-making. The search was conducted using Google Scholar, Web of Science, MEDLINE, ERIC, and PsycINFO for relevant literature. Using a thematic analysis, two researchers (SC & JP) met four times between April–June 2016 to consolidate the literature included in this review.Three theoretical orientations towards group decision-making emerged from the review: schema, constructivist, and social influence. Schema orientations focus on how groups use algorithms for decision-making. Constructivist orientations focus on how groups construct their shared understanding. Social influence orientations focus on how individual members influence the group’s perspective on a decision. Moderators of decision-making relevant to all orientations include: guidelines, stressors, authority, and leadership.Clinical competency committees are the mechanisms by which groups of clinicians will be in charge of interpreting multiple assessment data points and coming to a shared decision about trainee competence. The way in which these committees make decisions can have huge implications for trainee progression and, ultimately, patient care. Therefore, there is a pressing need to build the science of how such group decision-making works in practice. This synthesis suggests a preliminary organizing framework that can be used in the implementation and study of clinical competency committees.

Exploring differences in individual and group judgements in standard setting

“…Group members who are unfamiliar expend effort on developing social roles and norms, which reduces their productivity . Two recent reviews in medical education have considered these theories in relation to the function of clinical competence committees . Amidst a variety of potential implications, they both caution against ‘group‐think’ in which important information is ignored by members of a group in an attempt to maintain harmony.…”

Rising to the Challenge: Residency Programs' Experience With Implementing Milestones-Based Assessment

“…2,[14][15][16][17] The ACGME has now published guidebooks for CCCs as well as milestones, and much work has been done to understand and optimize CCC efforts. 3,[18][19][20][21][22][23][24][25][26] However, these resources may not provide sufficient guidance and have only recently become available. Indeed, early efforts in the shift to milestones have been likened to ''building a plane in flight.''…”

Beyond summative decision making: Illuminating the broader roles of competence committees

“…In the literature, these small groups are most often defined as summative decision‐making bodies, responsible for the review, collation and evaluation of trainee assessment data 1‐4 . To date, this body of literature has been organised around two themes: (a) developing best practices and forwarding practical advice for the assemblage and operation of CCs, 5‐9 and (b) understanding how the decision‐making work of the CC unfolds 1,10‐14 . The latter literature has a strong emphasis on summative decision making, explicating how these small groups collate and interpret aggregate assessment data to inform decisions about progression and entrustment 1,13,15,16 .…”