ABSTRACT

Background

Since 2013, US residency programs have used the competency-based framework of the Milestones to report resident progress and to provide feedback to residents. The implementation of Milestones-based assessments, clinical competency committee (CCC) meetings, and processes for providing feedback varies among programs and warrants systematic examination across specialties.

Objective

We sought to determine how varying assessment, CCC, and feedback implementation strategies result in different outcomes in resource expenditure and stakeholder engagement, and to explore the contextual forces that moderate these outcomes.

Methods

From 2017 to 2018, interviews were conducted of program directors, CCC chairs, and residents in emergency medicine (EM), internal medicine (IM), pediatrics, and family medicine (FM), querying their experiences with Milestone processes in their respective programs. Interview transcripts were coded using template analysis, with the initial template derived from previous research. The research team conducted iterative consensus meetings to ensure that the evolving template accurately represented phenomena described by interviewees.

Results

Forty-four individuals were interviewed across 16 programs (5 EM, 4 IM, 5 pediatrics, 3 FM). We identified 3 stages of Milestone-process implementation, including a resource-intensive early stage, an increasingly efficient transition stage, and a final stage for fine-tuning.

Conclusions

Residency program leaders can use these findings to place their programs along an implementation continuum and gain an understanding of the strategies that have enabled their peers to progress to improved efficiency and increased resident and faculty engagement.

ABSTRACT

Background

Shared mental models (SMMs) help groups make better decisions. Clinical competency committees (CCCs) can benefit from the development and use of SMMs in their decision-making as a way to optimize the quality and consistency of their decisions.

Objective

We reviewed the use of SMMs for decision making in graduate medical education, particularly their use in CCCs.

Methods

In May 2020, the authors conducted a narrative review of the literature related to SMMs. This review included the SMM related to teams, team functioning, CCCs, and graduate medical education.

Results

The literature identified the general use of SMMs, SMMs in graduate medical education, and strategies for building SMMs into the work of the CCC. Through the use of clear communication and guidelines, and a shared understanding of goals and expectations, CCCs can make better decisions. SMMs can be applied to Milestones, resident performance, assessment, and feedback.

Conclusions

To ensure fair and robust decision-making, the CCC must develop and maintain SMMs through excellent communication and understanding of expectations among members.

Competency-based medical education (CBME) entails the assessment of learner development and a systematic approach to decision-making about learner progress. Decision-making by groups charged with generating valid judgments of progress can ensure learner readiness for advancement and inform feedback to learners. Programmatic assessment, which supports CBME, requires collecting and synthesizing multiple data points about learner performance to generate progress decisions.¹

The study of group process and decision-making dates to the 1930s² and includes theories and approaches that can inform educators' work in a CBME program. The importance of group decision-making in graduate medical education (GME) is highlighted by

Physicians-in-training are educated through the paradigm of competency-based medical education (CBME), which promotes progressive development of expertise. To better support CBME, the Accreditation Council for Graduate Medical Education (ACGME) introduced the Milestones assessment framework across all ACGME-accredited graduate medical education (GME) training programs.^1,2 Milestones are behavioral descriptions of the developmental trajectory of trainees in the GME environment, which provide longitudinal and trajectory-based metrics along domains of physician competency. These metrics aim to promote lifelong learning and ensure residents and fellows are “ready for autonomous practice” at graduation. Yet, such “readiness for autonomous practice” at the completion