Starting a Clinical Competency Committee

In the Next Accreditation System, the Accreditation Council for Graduate Medical Education requires training programs to develop a clinical competency committee (CCC) to monitor and record the progress of their residents on predefined Milestones. In many programs, the current practice is for the program director to weigh the evaluation data from multiple sources and make decisions about each trainee's progress with or without discussion with program faculty. Some programs, however, already use a committee for promotion decisions. The committee monitors resident growth and makes recommendations, such as specific educational or remediation plans. A few specialties such as anesthesiology have used competency committees. The challenge now is for each residency program to formally develop a CCC and leverage or discontinue existing processes as needed.Each program must create a document that describes the responsibilities and membership of the CCC. The CCC should be designed to triangulate the evaluation process; the CCC judges each resident's progress using the results from multiple assessment tools, taking into consideration tool reliability and validity. The CCC is expected to meet at least twice annually to assess each resident's progress in acquiring the relevant reporting Milestones for the resident's level of training. The CCC must make recommendations to the program director (PD) regarding resident progress, including promotion, remediation, and dismissal. Therefore, CCC recommendations will be part of an early warning system for residents who may not be progressing as expected.No single assessment can provide all the information necessary for a competency appraisal. Experts suggest that 8 to 10 samples provide enough information for a reliable assessment.1 Qualitative assessments using narratives, such as comments from direct observation or work-based assessments, have been found to provide important information on resident performance.2,3 Studies show that group input and committee discussions can provide valuable information on resident performance and identify deficiencies not obtained from individual assessments.4,5The CCC should institute a process for continuous improvement. The CCC data can be used to inform the annual program evaluation. Examples include the following: