Elsevier

Journal of Surgical Education

Volume 71, Issue 1, January–February 2014, Pages 36-38
Journal of Surgical Education

INNOVATIONS
Competency Champions in the Clinical Competency Committee: A Successful Strategy to Implement Milestone Evaluations and Competency Coaching

https://doi.org/10.1016/j.jsurg.2013.09.012Get rights and content

Objectives

To create a clinical competency committee (CCC) that (1) centers on the competency-based milestones, (2) is simple to implement, (3) creates competency expertise, and (4) guides remediation and coaching of residents who are not progressing in milestone performance evaluations.

Design

We created a CCC that meets monthly and at each meeting reviews a resident class for milestone performance, a competency (by a faculty competency champion), a resident rotation service, and any other resident or issue of concern.

Setting

University surgical residency program.

Participants

The CCC members include the program director, associate program directors, director of surgical curriculum, competency champions, departmental chair, 2 at-large faculty members, and the administrative chief residents.

Results

Seven residents were placed on remediation (later renamed as coaching) during the academic year after falling behind on milestone progression in one or more competencies. An additional 4 residents voluntarily placed themselves on remediation for medical knowledge after receiving in-training examination scores that the residents (not the CCC membership) considered substandard. All but 2 of the remediated/coached residents successfully completed all area milestone performance but some chose to stay on the medical knowledge competency strategy.

Conclusions

Monthly meetings of the CCC make milestone evaluation less burdensome. In addition, the expectations of the residents are clearer and more tangible. “Competency champions” who are familiar with the milestones allow effective coaching strategies and documentation of clear performance improvements in competencies for successful completion of residency training. Residents who do not reach appropriate milestone performance can then be placed in remediation for more formal performance evaluation. The function of our CCC has also allowed us opportunity to evaluate the required rotations to ensure that they offer experiences that help residents achieve competency performance necessary to be safe and effective surgeons upon completion of training.

Section snippets

Background

In 1999, the Accreditation Council for Graduate Medical Education (ACGME) introduced the 6 domains of clinical competency: Medical Knowledge, Patient Care, Professionalism, Practice-Based Learning and Improvement, Systems-Based Practice, and Interpersonal and Communication Skills.1 Starting in 2009, the accreditation system underwent restructuring centered on these competencies.2 The Next Accreditation System will be implemented in for General Surgery in July 2014.

The ACGME and the American

Objectives

Our aim was to create a CCC that would meet the following 4 criteria: (1) be centered on the milestones, (2) be simple and efficient in assessment milestone achievement for semiannual resident review, (3) establish faculty expertise in each competency (“competency champions”), and (4) help coach and remediate residents who are not progressing appropriately based on their milestone performance evaluations.

Methods

Each of the 6 ACGME competencies was assigned a faculty competency champion. The competency champions were appointed by the program director based on experience, knowledge, expertise, and enthusiasm for a particular competency. The CCC is composed of these champions together with the program director, associate program directors, chair of the department, and 2 faculty members at large. Including the administrative and associate administrative chief residents as nonvoting members, a total of 12

Results

One year after restructuring our program for supervising and assessing the competencies of our residents and creating the CCC, several accomplishments became evident. First, there was increased awareness by both residents and faculty of the importance of the core competencies and the value of remediation in our surgical training program. Competency was defined by the CCC in its charter as “critical and foundational skills, knowledge, attitudes, and behaviors required for effective performance

Discussion

Although this is a work in process and we have only qualitative and descriptive data to report, we believe for the following reasons that the improvements to our program for assessing core competencies are real and can be readily adopted by other training programs.

First, although the task of assessing surgery residents by the CCC faculty involves frequent (monthly) meetings, it is not burdensome. The members of the CCC have learned in just 1 year how to review an entire class of residents in

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    (2009)
  • T.J. Nasca et al.

    The next GME accreditation system—rationale and benefits

    N Engl J Med

    (2012)
There are more references available in the full text version of this article.

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