Elsevier

Journal of Surgical Education

Volume 71, Issue 6, November–December 2014, Pages e22-e27
Journal of Surgical Education

2014 APDS SPRING MEETING
A Systematic Approach Toward Building a Fully Operational Clinical Competency Committee

https://doi.org/10.1016/j.jsurg.2014.04.005Get rights and content

Background

The Accreditation Council for Graduate Medical Education has offered minimal guidelines for the creation and implementation of clinical competency committees (CCCs). As surgical residency programs may differ greatly in terms of size and structure, requirements that are too specific throughout the process could place some programs at a great disadvantage.

Objective

The purpose of this article is to address some of the common considerations all surgery residency programs will face. The creation of standard operating procedures for the CCCs will allow each committee to develop internal consistency, improve productivity, maintain efficiency and quality control, facilitate training of new committee members, and cross-train other faculty and residents on the key processes to provide transparency.

Methods

This article offers recommendations on the 3 key areas of CCC implementation: the prereview, resident milestone review, and the postreview processes. Specific components related to shifting culture, committee membership and terms, assessing available evidence, and review dissemination are outlined, and example scenarios are provided throughout the article.

Conclusion

With the implementation of CCCs and the milestones project, residency programs have an opportunity to improve the overall quality of decision making regarding residents’ promotion to the next training level or independent practice. CCCs will undoubtedly be confronted with numerous challenges, as they implement the milestones project and are faced with the need to make multiple changes. Therefore, implementing milestones should be viewed as a goal to be accomplished over the long term.

Introduction

The Accreditation Council for Graduate Medical Education (ACGME) has offered minimal guidelines for the creation and implementation of clinical competency committees (CCCs) (Fig. 1).1, 2 As surgical residency programs may differ greatly in terms of size and structure, requirements that are too specific throughout the process could place some programs at a disadvantage. Minimal guidelines enable each program to find a process that will work for them. However, programs large and small will encounter similar issues and basic time points when certain decisions will need to be made. Those programs in phase 1 of the Next Accreditation System3 report that developing a step-by-step process increases the likelihood that programs will benefit from implementing milestones.4, 5 The purpose of this article is to address some of the common considerations all surgery residency programs will face.

For most residency programs, the implementation of the Next Accreditation System represents a significant culture shift from conventional practice in the conduct of assessment activities. This shift affects structures and practices on multiple levels. First, residency programs will begin to use milestones to measure resident performance at key developmental points. Second, recommendations pertaining to resident progress, promotion, and remediation will be made by specially trained and formally designated teams. Third, members of CCCs, often of differing status or even profession, will need to develop working relationships in which all perspectives are considered important and respected, and where differences of opinion are viewed as data to be processed for purposes of making better decisions. In implementing milestones, CCCs will confront multiple challenges that may require action beyond the scope of the committee. Yet to be effective, they will need to advocate for change. Committee members will undoubtedly discover that evidence needed for decision making is frequently lacking, assessment quality suffers because faculty have not made the transition from Likert scales to milestones, and curricular changes or additional assessment methods are needed. Setting the stage for a clear understanding of the mission and function of the CCC—anticipating these challenges—has the potential to enhance the curriculum and assessment processes, as well as focus more attention on supporting the professional growth of the resident. The first step, however, requires careful attention to setting up the committee and establishing a review process.

Section snippets

Committee Membership

The ACGME defines minimum CCC size1 as 3 members, giving larger programs leeway for increased membership. Regardless of size, a committee chair should be identified early in the process. Specific guidelines for the committee chair are listed in Figure 2 and roles and responsibilities for all members in Figure 3. The role of the program director in the committee is undefined and must be considered on a case-by-case basis. In certain situations, inclusion of the program director as a CCC member

Resident Assignment

The ACGME has not stipulated how resident reviews are to occur. Thus, there is no “right way” to assign resident reviews to members. The size of the residency program will greatly influence the way in which residents are assigned for review. Smaller programs may be able to assign multiple members to provide in-depth reviews on each resident. Larger programs may have to assign only 1 committee member for each in-depth resident review with CCC members, who can then report their findings to the

Dissemination of Evaluations to Program Director and Residents

If the program director is a member of the CCC or sits in on meetings as an observer (or even recorder of minutes), the notification of recommendations by the committee can be handled quickly. If the program director is not present for meetings, a more formal notification process will be required. The dissemination of milestone evaluations to the residents will be the larger issue. According to the ACGME common program requirements,1 the committee is required to prepare and report milestone

Conclusion

With the implementation of CCCs and the milestones project, residency programs have an opportunity to improve the overall quality of decision making regarding residents’ promotion to the next training level or independent practice. The milestones project will theoretically allow faculty on CCCs to take a step back and reevaluate the quality of the information being used in these decisions and then potentially enhance assessment efforts. A byproduct of this should be enhanced feedback to

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