A structured deliberation framework for Clinical Competency Committees: A simulation-based study

Area of Science:

• Medical Education
• Programmatic Assessment
• Faculty Development

Background:

• Clinical Competency Committees (CCCs) face challenges with implicit standards, leading to inconsistent entrustment decisions.
• Unstructured evidence-to-judgment processes and misaligned expectations contribute to variability in CCC decision-making.

Purpose of the Study:

• To examine the effectiveness of a structured deliberation scaffold in a simulation-based faculty development setting.
• To assess the impact of structured deliberation on the quality of CCC decision-making processes and agreement on entrustment decisions.

Main Methods:

• A simulation-based educational intervention was conducted with 72 faculty members from 32 otolaryngology residency programs.
• Participants evaluated simulated CCC cases and deliberation quality using the Objective Structured Clinical Competence Committee Evaluation (OSCCCE) checklist.
• Inter-group agreement in entrustment decisions was analyzed across seven simulated CCC groups.

Main Results:

• Structured deliberation significantly improved process quality compared to unstructured methods.
• The structured, principle-concordant video case and facilitated role-play received higher OSCCCE scores.
• Substantial inter-group agreement in entrustment decisions was observed for the standardized simulated case (Gwet's AC2 = 0.707).

Conclusions:

• A structured, simulation-based approach can enhance the explicitness and observability of CCC deliberative processes.
• Process-focused training may improve transparency and shared understanding in programmatic assessment.
• Further research is needed to evaluate the transferability to live settings and long-term impact.