Key Factors in Clinical Competency Committee Members’ Decisions Regarding Residents’ Readiness to Serve as Supervisors: A National Study

Abstract

Purpose Entrustment has become a popular assessment framework in recent years. Most research in this area has focused on how frontline assessors determine when a learner can be entrusted. However, less work has focused on how these entrustment decisions are made. The authors sought to understand the key factors that pediatric residency program clinical competency committee (CCC) members consider when recommending residents to a supervisory role. Method CCC members at 14 pediatric residency programs recommended residents to one of five progressive supervisory roles (from not serving as a supervisory resident to serving as a supervisory resident in all settings). They then responded to a free-text prompt, describing the key factors that led them to that decision. The authors analyzed these responses, by role recommendation, using a thematic analysis. Results Of the 155 CCC members at the participating programs, 84 completed 769 supervisory role recommendations during the 2015–2016 academic year. Four themes emerged from the thematic analysis: (1) Determining supervisory ability follows from demonstrated trustworthiness; (2) demonstrated performance matters, but so does experience; (3) ability to lead a team is considered; and (4) contextual considerations external to the resident are at play. Conclusions CCC members considered resident and environmental factors in their summative entrustment decision making. The interplay between these factors should be considered as CCC processes are optimized and studied further.

The Science of Effective Group Process: Lessons for Clinical Competency Committees

“…Recent evidence suggests that CCCs may conflate their own performance with experience, hallmarks of groupthink. 29,30 Directive leaders, high cohesion, poor decisionmaking methods, and time constraints all promote groupthink. 31,32 Groupthink draws focus to the desire or social pressure to achieve consensus, and contrasts with functional theory, which emphasizes the group's careful understanding and weighing of various alternatives.…”

“…33 Membership turnover or appointed ''devil's advocates'' may improve consideration of alternatives and enhance decision-making. 10,30 Frequent assessment of and reflection on the group's decisions encourage more thorough deliberations. 34…”

The role of previously undocumented data in the assessment of medical trainees in clinical competency committees

“…Thus, our participants raised doubts about whether documented data could ever create a complete picture of the trainee. Less tangible issues, such as professionalism [ 25 ] and environmental/contextual considerations [ 26 ], have been found to affect overall resident assessment, but may be more challenging to document comprehensively. In short, documented assessments might indeed be further enhanced; however, a brief review of the literature supports our participants’ assertion that preceptors will continue to resist such requests for a variety of reasons.…”

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

“…21 Decisions can include judgments about residents' and fellows' readiness for supervisory roles, performance on particular competencies and Milestones, or need for remediation. 22 In a CCC, member diversity can entail academic rank, gender, race/ethnicity, program role, professional focus, and health profession. 7 Other members may include a chief resident who is in an additional year of postgraduate training and can bring insights from the near-peer perspective, an interprofessional colleague who works with residents (eg, nurse, social worker) or a public member to represent patients' perspectives.…”