title: Reviewing residents' competence: a qualitative study of the role of clinical competency committees in performance assessment.
abstract: OBJECTIVE
  Clinical competency committees (CCCs) are now required in graduate medical education. This study examined how residency programs understand and operationalize this mandate for resident performance review.
  
  
  METHODS
  In 2013, the investigators conducted semistructured interviews with 34 residency program directors at five public institutions in California, asking about each institution's CCCs and resident performance review processes. They used conventional content analysis to identify major themes from the verbatim interview transcripts.
  
  
  RESULTS
  The purpose of resident performance review at all institutions was oriented toward one of two paradigms: a problem identification model, which predominated; or a developmental model. The problem identification model, which focused on identifying and addressing performance concerns, used performance data such as red-flag alerts and informal information shared with program directors to identify struggling residents.In the developmental model, the timely acquisition and synthesis of data to inform each resident's developmental trajectory was challenging. Participants highly valued CCC members' expertise as educators to corroborate the identification of struggling residents and to enhance credibility of the committee's outcomes. Training in applying the milestones to the CCC's work was minimal.Participants were highly committed to performance review and perceived the current process as adequate for struggling residents but potentially not for others.
  
  
  CONCLUSIONS
  Institutions orient resident performance review toward problem identification; a developmental approach is uncommon. Clarifying the purpose of resident performance review and employing efficient information systems that synthesize performance data and engage residents and faculty in purposeful feedback discussions could enable the meaningful implementation of milestones-based assessment.
authors.affiliation: K.E. Hauer is professor, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California. B. Chesluk is clinical research associate, Evaluation, Research, and Development, American Board of Internal Medicine, Philadelphia, Pennsylvania. W. Iobst is vice president for academic and clinical affairs and vice dean, Commonwealth Medical College, Scranton, Pennsylvania. E. Holmboe is senior vice president, Accreditation Council for Graduate Medical Education, Chicago, Illinois, and adjunct professor of medicine, Yale School of Medicine, New Haven, Connecticut. R.B. Baron is professor of medicine and associate dean for graduate and continuing medical education, Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California. C.K. Boscardin is associate professor, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California. O. ten Cate is professor of medical education and director, Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands. P.S. O'Sullivan is professor of medicine and director of research and development in medical education, Office of Medical Education, University of California, San Francisco, School of Medicine, San Francisco, California.
authors.forename: Karen E
authors.initials: KE
authors.lastname: Hauer
authors.forename: Benjamin
authors.initials: B
authors.lastname: Chesluk
authors.forename: William
authors.initials: W
authors.lastname: Iobst
authors.forename: Eric
authors.initials: E
authors.lastname: Holmboe
authors.forename: Robert B
authors.initials: RB
authors.lastname: Baron
authors.forename: Christy K
authors.initials: CK
authors.lastname: Boscardin
authors.forename: Olle Ten
authors.initials: OT
authors.lastname: Cate
authors.forename: Patricia S
authors.initials: PS
authors.lastname: O'Sullivan
mesh_terms: D000328:Adult; D000368:Aged; D002140:California; D002983:Clinical Competence; D032802:Committee Membership; D004503:Education, Medical, Graduate; D004521:Educational Measurement; D004650:Employee Performance Appraisal; D005260:Female; D006801:Humans; D007396:Internship and Residency; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D018024:Peer Review, Health Care; D036301:Qualitative Research