Competence Committees Adelle Atkinson The best health for

Competence Committees Adelle Atkinson The best health for

Competence Committees Adelle Atkinson The best health for all. The best care for all. Objectives By the end of this session, we will have: 1. Discussed: Why Competence Committees? 2. Reviewed the role of Competence Committees 3. Reviewed how to design a Competence Committee 4. Discussed how Competence Committees

make decisions Why Competence Committees? Assessment Systems Are Criticized: Too few observations

Too few data points Often not defensible Poor reliability Too subjective Not authentic Sometimes impractical (too much; n/a) Method reliability as a function of testing time Testing Time in Hours MCQ1 CaseBased Oral Long

Short Essay2 PMP1 Exam3 Case4 OSCE5 Mini CEX6 Practice Video InAssess- cognito ment7 SPs8 1

0.62 0.68 0.36 0.50 0.60 0.54 0.73

0.62 0.61 2 0.77 0.81 0.53 0.67 0.75

0.70 0.84 0.77 0.76 4 0.87 0.89

0.69 0.80 0.86 0.82 0.92 0.87 0.86 8

0.93 0.94 0.82 0.89 0.92 0.90 0.96

0.93 0.93 Norcini et al., 1985 2Stalenhoef-Halling et al., 1990 3Swanson, 1987 1 Wass et al., 2001 Van der Vleuten, 1988 6Norcini et al., 1999 4 7

5 8 Ram et al., 1999 Gorter, 2002 From CPM Van der Vleuten; ACGME 2016 4 What is the role of a Competence Committee?

What is the role of a Competence Committee? to review and make decisions on a learners achievement of EPAs and their progression through the stages of training toward the national standards as set by the discipline. provides guidance for training activities to help a resident progress within his/her current stage. Committee decisions and recommendations are made using highly integrative data from multiple EPA and milestone observations as well as feedback from clinical practice. What is the role of a Competence Committee?

Supervisors observe and record low stakes observation based on how the resident performed They dont have to make the final assessment The CC takes all the low stakes assessments and other assessment data and through the CC structure make promotion decisions What is the role of a Competence Committee? Empowered to make decisions on: Residents progressing from one stage to the next Reviewing and monitoring individual learning programs

Readiness for RCPSC exams Readiness for unsupervised practice Big decisions need to be ratified by the RPC Guided by a National Competency Framework How do you set up a Competence Committee? Competence Committee Resources - RCP SC website Guidelines put together by the RC and PG Deans Assessment Advisory Working Group These are guidelines only, local context is important in setting up your CC

TOR that can be used/modified for your Committee How do you set up a Competence Committee nuts and bolts Subcommittee of the RPC, or separate committee with members outside the RPC Membership:

Chair PD 1 faculty per 8 to 10 residents Primary reviewer Meet monthly/quarterly (depends on program size) each resident should be discussed a minimum of twice/ year What about an academic advisor? How do you set up a Competence Committee the nuts and bolts Set an agenda for every meeting, all members should know which of their residents (primary reviewer) are being discussed, so they can prepare

The agenda will state which stage they are currently at The primary reviewer will review the portfolio, benchmark against other learners, and provide a recommendation on learner status The committee will discuss the themes arising from the review and the learner status. A vote may be taken The committee will come up with a developmental plan for each resident Results should be shared with the learner with steps moving forward Primary Reviewer Opening statement: I reviewed Jane Doe who is currently in Foundations. I am going to recommend her for a modified learning plan

Proceed to present relevant and supportive data Like a clinic visit, what is relevant to this decision today. How does the Competence Committee report to the RTC? The Chair would be asked to report to the RPC The development of learning plans for each resident must be decided locally Learning plans should be developed for all residents, including those who are doing extremely well With time, these plans will be re-usable with residents in similar stages developmentally

Eric Warm: Cincinnati Basic Committee Principles Evidence-based versus verdict-based jury Start and review all evidence before a decision Do not start with a conclusion/decision Confirmation bias Be careful not to emphasize consensus over dissent Minority opinions, even if wrong, still helpful Be sure all voices are heard and watch carefully for negative effects of hierarchy

17 Theories Supporting Group Process Social decision scheme theory (Stasser) Social decision schemes are the methods used by a group to combine individual responses into a single group decision Conversation theory (Pask; Pangaro) Creating understanding and meaning through dialogue

Paradox of Group Life (Berg) Paradox an inherent part of group life 18 Committee Benefits Dr. Eric Holmboe Develop group goals and shared mental models Real-time faculty development Key for dealing with difficult trainees Share and calibrate strengths and weaknesses of multiple faculty assessments (observations) A place to synthesize the intrinsic roles 19 Wisdom of the Crowd

Hemmer (2001) Group conversations more likely to uncover deficiencies in professionalism among students Schwind, Acad. Med. (2004) 18% of resident deficiencies requiring active remediation became apparent only via group discussion. Average discussion 5 minutes/resident (range 1 30 minutes) 20 Keylime Podcast - Role of Competence Committees ePortfolio: Competence Committee Agenda

22 Resources Hauer, KE et. al. Reviewing residents' competence: a qualitative study of the role of clinical competency committees in performance assessment. Academic Medicine. 2015 Aug;90(8):1084-92 Keylime Podcast - Role of Competence Co mmittees Competence Committee Resources - RCP SC Thank you!

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