Background Trust is a critical component of competency committees given their high-stakes decisions. Research from outside of medicine on group trust has not focused on trust in group decisions, and “group trust” has not been clearly defined. The purpose was twofold: to examine the definition of trust in the context of group decisions and to explore what factors may influence trust from the perspective of those who rely on competency committees through a proposed group trust model. Methods The authors conducted a literature search of four online databases, seeking articles published on trust in group settings. Reviewers extracted, coded, and analyzed key data including definitions of trust and factors pertaining to group trust. Results The authors selected 42 articles for full text review. Although reviewers found multiple general definitions of trust, they were unable to find a clear definition of group trust and propose the following: a group-directed willingness to accept vulnerability to actions of the members based on the expectation that members will perform a particular action important to the group, encompassing social exchange, collective perceptions, and interpersonal trust. Additionally, the authors propose a model encompassing individual level factors (trustor and trustee), interpersonal interactions, group level factors (structure and processes), and environmental factors. Conclusions Higher degrees of trust at the individual and group levels have been associated with attitudinal and performance outcomes, such as quality of group decisions. Developing a deeper understanding of trust in competency committees may help these committees implement more effective and meaningful processes to make collective decisions. Electronic supplementary material The online version of this article (10.1186/s12909-019-1726-4) contains supplementary material, which is available to authorized users.

Introduction: Trust is an important foundational component of a competency committee. Little work has been done in health professions education to look at trust and group decisions. A recent scoping review defined "group trust," examined factors that may influence group trust, and proposed a model to illustrate the relationship between trust at the individual and group levels. The purpose of this study was to test this model in the context of competency committee decisions and assignment of the ACGME Milestones. Methods: The authors conducted structured observations of competency committee meetings in internal medicine and pediatrics residency and subspecialty programs within the National Capital Consortium. Data were analyzed using a constant comparison method. Results: The authors observed six meetings from May to June 2018 (15 hours) reaching thematic saturation by the final meeting. The proposed model served as an organizing framework for reporting findings into the following categories: individual and group level factors, interpersonal interactions, and environmental factors. Results suggest that diversity of opinion promotes a more complete understanding of trainee competence. Varied faculty experiences, interactions, and actions by committee chairs helped to build a shared group mental model, which was identified as one of the most important aspects of making collective decisions and assigning Milestones. Meetings generally had similar structure based upon the size of the training program, and groupthink was more of a risk for larger training programs, especially when assigning individual Milestones. An important environmental factor identified was decision making fatigue, which was most prevalent towards the end of committee meetings. Conclusions: As training programs develop policies, procedures, and determine the membership of competency committees, utilizing these findings may help improve the design and execution of these groups, enhancing the translation of evaluation data and individual opinions into Milestone and competency decisions.

Spontaneous pneumomediastinum is a fairly uncommon complication of diabetic ketoacidosis. Knowledge of the clinical and radiographic manifestation is important for the proper management of patients since the disease usually follows a benign evolution. We report a case of a 20-year-old soldier who presented with a pneumomediastinum that was initially falsely attributed to a motor vehicular crash.