Competence committees: The steep climb from concept to implementation

Abstract

Introduction Competence committees (CCs) are groups of educators tasked with reviewing resident progress throughout their training, making decisions regarding the achievement of Entrustable Professional Activities and recommendations regarding promotion and remediation. CCs have been mandated as part of competency‐based medical education programmes worldwide; however, there has yet to be a thorough examination of the implementation challenges they face and how this impacts their functioning and decision‐making processes. This study examined CC implementation at a Canadian institution, documenting the shared and unique challenges that CCs faced and overcame over a 3‐year period. Methods This study consisted of three phases, which were conceptually and analytically linked using Moran‐Ellis and colleagues’ notion of ‘following a thread.’ Phase 1 examined the early perceptions and experiences of 30 key informants using a survey and semi‐structured interviews. Phase 2 provided insight into CCs’ operations through a survey sent to 35 CC chairs 1‐year post‐implementation. Phase 3 invited 20 CC members to participate in semi‐structured interviews to follow up on initial themes 2 years post‐implementation. Detailed observation notes from 16 CC meetings across nine disciplines were used to corroborate the findings from each phase. Results Response rates in each phase were 83% (n = 25), 43% (n = 15) and 60% (n = 12), respectively. Despite the high degree of support for CCs among faculty and resident members, several ongoing challenges were highlighted: adapting to programme size, optimising membership, engaging residents, maintaining capacity among members, sharing and aggregating data and developing a clear mandate. Discussion Findings of this study reinforce the importance of resident engagement and information sharing between disciplines. Challenges faced by CCs are discussed in relation to the existing literature to inform a better understanding of group decision‐making processes in medical education. Future research could compare implementation practices across sites and explore which adaptations lead to better or worse decision‐making outcomes.

The role of groups in assessing learners with specific learning difficulties

“…Botan and colleagues 1 pointed to a critical equity issue within HPE; however, the implications of their work were primarily oriented towards individual medical educators as opposed to groups . As part of the global shift towards competency‐based medical education, there has been a movement towards having groups, rather than individuals, make decisions about learner competence 2 . In postgraduate medical education, competence committees (CCs) are groups of educators and sometimes learners who work together to review resident progress throughout their training, make decisions regarding the achievement of Entrustable Professional Activities, and develop recommendations regarding promotion and remediation 2,3 .…”

“…As part of the global shift towards competency‐based medical education, there has been a movement towards having groups, rather than individuals, make decisions about learner competence 2 . In postgraduate medical education, competence committees (CCs) are groups of educators and sometimes learners who work together to review resident progress throughout their training, make decisions regarding the achievement of Entrustable Professional Activities, and develop recommendations regarding promotion and remediation 2,3 . Key features of CCs include regular reviews of resident performance (e.g.…”

“…Key features of CCs include regular reviews of resident performance (e.g. quarterly), reliance on multiple data sources to assess performance holistically, and a focus on the early identification of learners who may be in difficulty so that early intervention can occur 2,3 . Thus, when considering the issue of physician learners who may have SpLDs (or other challenges that may affect their performance, whether these be acute or chronic illnesses or mental or physical disabilities), it is also important to consider the implications for group‐based forms of assessment, such as CCs.…”

“…CCs may have an important role to play in recommending accommodations for learners because their intended function is not only to make decisions about competence, but also to inform the development of training plans that can help learners at all levels succeed 2 . The early implementation of such plans can help address more serious issues before they arise.…”

Automated Assessment of Medical Students’ Competency-Based Performance Using Natural Language Processing (NLP)

“…However, this large volume of data makes summative competency assessment both time and resource intensive, limiting its frequency. 2…”