A multispecialty ethnographic study of clinical competency committees (CCCs)

Abstract

Purpose

Clinical competency committees (CCCs) assess residents’ performance on their specialty specific milestones, however there is no ‘one-size fits all’ blueprint for accomplishing this. Thus, CCCs have had to develop their own procedures. The goal of this study was to examine these efforts to assist new programs embarking on this venture and established programs looking to improve their CCC practices and processes.

Methods

We purposefully sampled CCCs across multiple specialties and institutions. Data from three sources were triangulated: (1) online demographic survey, (2) ethnographic observations of CCC meetings and (3) post-observation semi-structured interviews with the program director and/or CCC chairperson. Template analysis was used to build the coding structure.

Results

Sixteen observations were completed with 15 different CCCs at 9 institutions. Three main thematic categories that impact the operations of CCCs emerged: (1) Membership structure and members roles, (2) Roles of the CCC in residency and 3) CCC processes, including trainee presentation to the committee and decision-making. While effective practices were observed, substantial variation existed in all three thematic areas.

Conclusions

While CCCs used some known effective practices, substantial variation in structure and processes was notable across CCCs. Future work should explore the impact of this variation on educational outcomes.

Keywords:

• Clinical competency committee
• ethnography
• faculty development
• milestones
• assessment

Acknowledgments

DIOs, PDs, CCC Chairs and Members of participating institutions

Ben Chesluk

Nick Yaghmour

Lisa Conforti

Disclosure statement

Laura Edgar is an employee of ACGME.

ES Holmboe is an employee of ACGME and receives royalties from Elsevier Publishing for a textbook on assessment.

Author contributions/roles

AE and LE designed the study, observation and interview templates, performed observations and interviews, determined themes, and coded all data together.

LW conducted observations and interviews and served as an auditor for coding by completing a final check of the data.

EH - provided guidance on the study design, observation and interview templates, and regular secondary coding and manuscript revisions.

Additional information

Notes on contributors

Andem Ekpenyong

Dr. Andem Ekpenyong, MD, MHPE has been a general internist at Rush University Medical Center in Chicago since 2000. She completed all her medical training at Rush and subsequently joined the faculty there. She was an associate program director for approximately 10 years with a focus on curriculum and assessment. During that time she was an active member of various professional organizations, including Society of General Internal Medicine (SGIM), the Association of Program Directors in Internal Medicine (APDIM), and was elected to the position of co-chair for the clinical competency committee (CCC) collaborative for the Alliance of Academic Internal Medicine. She has provided faculty development at Rush to assist in implementing a milestones-based curriculum. Dr. Ekpenyong completed a masters of health professions education (MHPE) in 2016. She has conducted research on CCCs with the Accreditation Council for Graduate Medical Education (ACGME) and serves as faculty for their course titled ‘Developing Faculty Competencies in Assessment.’

Laura Edgar

Laura Edgar, EdD Accreditation Council for Graduate Medical Education, Chicago, IL. He is the Vice President for Milestone Development. In her current role, she serves as an organizational and department leader. She leads volunteers and staff members through the development of Milestones and related materials for all ACGME accredited specialties. Dr. Edgar creates and manages the Milestones resources that aid program directors, learners, and Clinical Competency Committees. She serves as a liaison to the medical education community and is a frequent speaker on topics related to the Milestones, Clinical Competency Committees, assessment, education, and accreditation. She previously served as the Executive Director for Milestones Development and the Review Committees for Medical Genetics and Genomics, Pathology, and Radiation Oncology. Prior to working at ACGME, Dr. Edgar worked in the clinical laboratory for 10 years and then directed several domestic and international certification, accreditation, and scientific organizations. Dr. Edgar earned her doctorate in education, focusing on organizational leadership after obtaining a Bachelor’s degree in medical laboratory sciences and a Master’s degree in business administration. She is a certified medical technologist and a certified association executive.

LuAnn Wilkerson

LuAnn Wilkerson, EdD oversees the assessment processes for medical student education at Dell Medical School and serves as a consultant to the residency program directors for issues in assessment and evaluation. She is an active researcher in medical education with special interests in program evaluation, assessment, and faculty development. Prior to joining Dell Med in 2016 to help with the development of this new school, she served as senior associate dean for medical education at the David Geffen School of Medicine at UCLA.

Eric S. Holmboe

Eric S Holmboe, MD, Chief, Research, Milestones Development and Evaluation, Accreditation Council for Graduate Medical Education, Chicago, Illinois. He is currently the Chief, Research, Milestones Development and Evaluation Officer at the Accreditation Council for Graduate Medical Education.