Ensuring Resident Competence: A Narrative Review of the Literature on Group Decision Making to Inform the Work of Clinical Competency Committees

Hauer, Karen E.; Cate, Olle ten; Boscardin, Christy; Iobst, William; Holmboe, Eric S.; Chesluk, Benjamin; Baron, Robert B.; O’Sullivan, Patricia

doi:10.4300/jgme-d-15-00144.1

Cited by 108 publications

(118 citation statements)

References 66 publications

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“…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.…”

Section: Introductionmentioning

confidence: 99%

Exploring differences in individual and group judgements in standard setting

et al. 2019

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Context Standard setting is critically important to assessment decisions in medical education. Recent research has demonstrated variations between medical schools in the standards set for shared items. Despite the centrality of judgement to criterion‐referenced standard setting methods, little is known about the individual or group processes that underpin them. This study aimed to explore the operation and interaction of these processes in order to illuminate potential sources of variability. Methods Using qualitative research, we purposively sampled across UK medical schools that set a low, medium or high standard on nationally shared items, collecting data by observation of graduation‐level standard‐setting meetings and semi‐structured interviews with standard‐setting judges. Data were analysed using thematic analysis based on the principles of grounded theory. Results Standard setting occurred through the complex interaction of institutional context, judges’ individual perspectives and group interactions. Schools’ procedures, panel members and atmosphere produced unique contexts. Individual judges formed varied understandings of the clinical and technical features of each question, relating these to their differing (sometimes contradictory) conceptions of minimally competent students, by balancing information and making suppositions. Conceptions of minimal competence variously comprised: limited attendance; limited knowledge; poor knowledge application; emotional responses to questions; ‘test‐savviness’, or a strategic focus on safety. Judges experienced tensions trying to situate these abstract conceptions in reality, revealing uncertainty. Groups constructively revised scores through debate, sharing information and often constructing detailed clinical representations of cases. Groups frequently displayed conformity, illustrating a belief that outlying judges were likely to be incorrect. Less frequently, judges resisted change, using emphatic language, bargaining or, rarely, ‘polarisation’ to influence colleagues. Conclusions Despite careful conduct through well‐established procedures, standard setting is judgementally complex and involves uncertainty. Understanding whether or how these varied processes produce the previously observed variations in outcomes may offer routes to enhance equivalence of criterion‐referenced standards.

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Section: Introductionmentioning

confidence: 99%

Exploring differences in individual and group judgements in standard setting

et al. 2019

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“…W e enjoyed the informative review by Hauer et al 1 on group decision making and membership of Clinical Competency Committees (CCCs), and we would like to suggest a helpful innovation from our program's CCC that highlights several of the recommendations made in the review. Since our CCC's inception, we have designated a ''societal representative'' whose role is to remind the membership that ''the ultimate purpose (of the CCC) is to demonstrate our accountability as medical educators to the public,'' while ensuring the safety of patients under the care of residents during their training and in the future.…”

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confidence: 99%

“…Her role on the committee is to remind CCC members of our social contract with the public in order to ensure the safety of the patients cared for by our residents-in-training, as well as for those patients cared for by the graduates of our training program. As recommended by Hauer et al, 1 the CCC chair will often ask her first to express her view as the societal representative to offset any hierarchical influence by physician members or senior administrators on the committee. The presence of the societal representative for the CCC has been key in ensuring the accountability, public trust, and privilege that society has given the profession of medicine to self-regulate.…”

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confidence: 99%

Maintaining the Public Trust in Clinical Competency Committees—Societal Representatives

Loo

Lee

Acosta

2017

Journal of Graduate Medical Education

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“…A 2016 narrative review has highlighted the initial literature relevant to clinical competency committees [7]. Much of this review was devoted to important elements of clinical competency committees such as group membership and optimal number of participants.…”

Section: Introductionmentioning

confidence: 99%

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

Chahine¹,

Cristancho²,

Padgett³

et al. 2017

Perspect Med Educ

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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.

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Ensuring Resident Competence: A Narrative Review of the Literature on Group Decision Making to Inform the Work of Clinical Competency Committees

Cited by 108 publications

References 66 publications

Exploring differences in individual and group judgements in standard setting

Exploring differences in individual and group judgements in standard setting

Maintaining the Public Trust in Clinical Competency Committees—Societal Representatives

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

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