Clinical Competency Committees and Assessment: Changing the Conversation in Graduate Medical Education

摘要

The Accreditation Council for Graduate Medical Education's (ACGME) new accreditation system has introduced a significantly different world of assessment with its language of milestones and centralized oversight of trainee performance by Clinical Competency Committees (CCCs). Just as the shift to competency-based education and assessment required a culture shift for graduate medical education programs across the United States,1 so, too, does the shift to using CCCs to determine trainee progression on milestones. In this article, we offer our perspectives on the role of the CCC and discuss challenges and opportunities for graduate medical education programs as they enter this new world of assessment.;It's Not Your Same Old Residency Evaluation Committee CCCs, as outlined by the ACGME, will not function in the same way that many of the old residency evaluation committees did. Simply identifying failing residents or fellows and discussing remediation plans will not be enough. Performance appraisals of progress will need to be conducted for each trainee—including high performers—on each milestone. Professional judgment, contributed by individual CCC members, will be critical to the integrity of the review process and the final determination of whether trainees are ready for unsupervised practice. Over time, these in-depth reviews will undoubtedly make CCCs privy to knowledge about the quality and quantity of assessments and the absence of curricular elements as they consider assessment evidence for each milestone. Thus, CCCs will become aware of gaps within their program's current assessment approach and the curriculum as a whole. Residency and fellowship programs will need to clarify the role of their CCC2 and specify what authority it will have in promoting needed change relative to assessment practices, faculty development,3 and curricular changes.;A Systems Approach The CCC members may be helped by viewing assessment as a system,4 rather than as independent assessment events. Utilizing a systems thinking lens5–8 will prompt CCC members to examine the purpose and function of assessment processes, the amount and quality of evidence, and feedback loops within their programs. We believe a systems approach to assessment will result in useful and defendable performance appraisals. Relationships with Stakeholders All systems include multiple stakeholders. A residency program's assessment system will include, but may not be limited to, the following stakeholders: residency program leaders, the CCC, chief residents, assessors (faculty and others), faculty development providers, trainees, the program evaluation committee, curriculum developers, and ultimately the public. For optimal program improvement, feedback loops6,9,10 between the CCC and other stakeholders may need to be examined and strengthened (figure). While department-wide faculty development is not part of the CCC's mission, feedback from the CCC to the program director may include recommendations for enhanced faculty development efforts for those engaged in assessment. For instance, if CCC members discover that faculty on the same rotation appear to be using different criteria to assess the same group of trainees (a reliability issue), feedback to the program director will be critical for enhancing the performance appraisal process. View larger version (34K) FIGURE Example of a Feedback Loop Abbreviation: CCC, Clinical Competency Committee.;Rethinking Assessment Milestones Are Not Assessments Milestones are developmental markers on the path to independent practice.11 Milestones offer specific performance criteria, which were lacking within prior ACGME competency language.11 The goal within competency frameworks is to provide continuous formative feedback to learners to promote optimal performance and support assessment for learning.12 The use of milestones can theoretically allow individual trainees to identify areas for improvement at an earlier stage. In the past, this was