Inside Their Minds: A Multi-Institutional Exploration into the Decision-Making of Medical School Competency Committee
Michael S Ryan1,2, Pim W Teunissen3, Andrew S Parsons2,4
1Department of Pediatrics, University of Virginia, Charlottesville, VA, USA.
Perspectives on Medical Education
|February 2, 2026
Summary
Medical school competency committee members interpret student data based on external factors and internal reasoning. Understanding these thought processes is key to evaluating learner competence in undergraduate medical education.
Area of Science:
- Medical Education
- Cognitive Psychology
- Social Sciences
Background:
- Competency committees are crucial for assessing medical learners' competence.
- Existing research primarily focuses on post-graduate medical education, with limited standards for undergraduate levels.
- Understanding how medical school competency committee members interpret assessment data is critical for consistent evaluation.
Purpose of the Study:
- To examine the cognitive processes and decision-making strategies of medical school competency committee members.
- To identify the factors influencing judgments about learner competence in undergraduate medical education.
- To explore the interpretation of assessment data within the context of committee decision-making.
Main Methods:
- Conducted think-aloud interviews with 22 competency committee members across 7 US medical schools.
- Participants reviewed student assessment data and verbalized their thought processes.
- Transcripts were analyzed using an interpretivist approach informed by sociocultural cognition theory.
Main Results:
- Two primary concepts emerged: contextual influences (goals, data availability, standards) and internal reasoning (first impressions, trend interpretation, conflict negotiation).
- Contextual influences, outside direct participant control, significantly shaped data interpretation.
- Internal reasoning involved strategies similar to other cognitive tasks, such as forming initial impressions and managing conflicting information.
Conclusions:
- This study offers the first insight into the decision-making thought processes of medical school competency committee members.
- Contextual factors fundamentally influence how assessment data is interpreted, demonstrating that competence is socially constructed.
- Findings highlight the need to consider the broader context when evaluating learner competence in medical education.
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