A "Totally Different Beast": The Effect of Time Variability on Clinical Competency Committee Decision-Making

Area of Science:

• Medical Education
• Residency Training
• Program Evaluation

Background:

• Competency-based, time-variable training (CBTVT) shifts focus from duration to learner outcomes.
• Clinical Competency Committees (CCCs) are central to CBTVT, making promotion decisions.
• The impact of time variability on CCC decision-making requires further investigation.

Purpose of the Study:

• To explore how time variability influences the decision-making of CCC members in an internal medicine residency program.
• To understand the perceived effects of time-variable promotion decisions on CCC members.

Main Methods:

• An evaluative case study of the Transitioning in Internal Medicine Education Leveraging Entrustment Scores Synthesis (TIMELESS) pilot program.
• Semistructured interviews and observations with 11 unique CCC members.
• Longitudinal data collection from October 2020 to March 2022.

Main Results:

• Time variability significantly impacted CCC member decision-making.
• Participants perceived higher stakes associated with promotion decisions.
• Increased perceived stakes led to more deliberate and in-depth decision-making processes.

Conclusions:

• Time variability altered CCC members' perception of decision-making, increasing perceived risk and stakes.
• This perceptual shift resulted in more deliberate review and active decision-making by CCC members.
• The TIMELESS program involved consequential entrustment decisions, unlike many time-based programs.