title: A systematic approach toward building a fully operational clinical competency committee.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of General Surgery, Cleveland Clinic, Cleveland, Ohio. Electronic address: frenchj2@ccf.org.
authors.forename: Judith C
authors.initials: JC
authors.lastname: French
authors.affiliation: Cleveland Clinic and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio.
authors.forename: Elaine F
authors.initials: EF
authors.lastname: Dannefer
authors.affiliation: Cleveland Clinic and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio; Texas A&M Health Science Center College of Medicine, Bryan, Texas.
authors.forename: Colleen Y
authors.initials: CY
authors.lastname: Colbert
mesh_terms: D002983:Clinical Competence; D003479:Curriculum; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration* / Q000592:standards
keywords: Interpersonal and Communication Skills; Medical Knowledge; Patient Care; Practice-Based Learning and Improvement; Professionalism; Systems-Based Practice; assessment; clinical competency committee; milestones; next accreditation system; resident education