How do competence committees make decisions about resident progression? A qualitative study
Date
2021-10-15
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Abstract
Competence committees (CC) determine trainees’ progression through postgraduate competency-based medical education (CBME) programs. Models of how CC function identify that most programs take a problem-identification approach while others provide developmental feedback to every trainee. While CC are tasked with high stakes decisions, the process by which they discuss and make decisions about resident progression remains uncertain, with few publications addressing this question. The purpose of this qualitative study was to describe the factors affecting CC decision-making. This instrumental case study examined two CC at a Canadian institution, three years post-CBME launch. Over a six-month period, one researcher observed four CC meetings and conducted interviews with 10 CC members which were audio recorded and transcribed verbatim. Royal College documents, CC terms of reference, investigator reflections, and memos created throughout the study were also examined. Following a constructivist grounded theory approach with constant comparison, two investigators coded transcripts independently and jointly to refine a codebook and identify themes in the data. Our theory-informed analysis led to a theoretical framework of CC decision-making: a process beginning within a social decision schema model and evolving to a discussion invoking social influence theory, shared mental models, and social judgment scheme to clarify the points of contention. The committee mindset determined the likelihood of entering a discussion about trainees; triggers for discussion related to CC members’ uncertainty of the process or concerns with the adequacy of the data. Ensuing conversations considered the context of the individual resident and CC members’ experiences. We found that ongoing challenges with CC functioning persist three years post-CBME implementation. Despite Royal College recommendations and local terms of reference, CC provide limited developmental feedback to trainees who are doing well, and acknowledge that biases could affect the intended process. While this study only examined two CC, it identified important themes to address when considering a robust CC process.
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Keywords
competency-based medical education, programmatic assessment
Citation
Curtis, C. M. (2021). How do competence committees make decisions about resident progression? A qualitative study (Master's thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca.