SUMMARY OF RECOMMENDATIONS

Committee members may vary in their experience and knowledge of different assessment methods, competency frameworks, and committee processes.^{Reference Ekpenyong, Baker and Harris9,Reference Oudkerk Pool, Govaerts, Jaarsma and Driessen10} Frame of reference training can help members develop a shared mental model of the purpose of the committee and the performance expectations at each stage of training.^{Reference Holmboe and Hawkins11} Faculty development that focuses on group process can also help members mitigate the potential influences of personal cognitive biases and groupthink on committee decisions and outputs.^{Reference Hauer, ten Cate and Boscardin6,Reference Dickey, Thomas, Feroze, Nakshabandi and Cannon12} Member turnover and the expected evolution of committee processes (see recommendation 8) make it essential that new and longstanding members receive regular training. Such training can be scheduled during committee meetings or may occur as separate faculty development sessions that are organized locally or by national stakeholders.

Committee member characteristics can influence the diversity and representativeness of information available during committee deliberations.^{Reference Hauer, ten Cate and Boscardin6} Individuals with a demonstrated commitment to improving trainee education should be recruited,^{Reference Holmboe, Rodak, Mills, McFarlane and Schultz13} and locally determined qualifications should be clearly outlined in the committee's Terms of Reference. Rotating members can help introduce new and diverse opinions and minimize groupthink.^{Reference Lewis, Belliveau, Herndon and Keller14} This can be accomplished by defining terms of service. The work of competence committees may require members to give of their time and energy outside of meetings (e.g., to review resident data). The member's statement of work should outline these expectations and supports available. To help streamline decision-making processes, the statements of work should also define individual member roles within the committee (e.g., Chair, Program Director) and delineate who are voting and nonvoting members.^{Reference Kinnear, Warm and Hauer15}

To make summative judgments of resident competence, the committee must incorporate multiple assessment methods that provide data that is sampled across content and clinical contexts, as well as over time.^{Reference Van Der Vleuten, Schuwirth and Driessen16} Competence is specific, not generic. Performance in one context does not predict performance in another. Regardless of what is being measured, or how it is being measured, assessment of resident competence and the observed performance are specific to the context.^{Reference van der Vleuten, Sluijsmans, Joosten-ten Brinke and Mulder17} Additionally, the concern over rater idiosyncrasies in workplace-based assessment can be mitigated by ensuring that data are collected from multiple observers.^{Reference Carraccio, Englander and Van Melle18} Designing a program of assessment, in which each competency domain is intentionally informed by multiple assessment sources and each source can be used to inform multiple competency domains, can help programs ensure that adequately sampled performance data inform competence committee decisions.^{Reference Schuwirth and Van Der Vleuten19}

Applying structured group procedures facilitates information sharing among members and improves decision quality.^{Reference Hauer, ten Cate and Boscardin6,Reference Lu, Yuan and McLeod20} Committees should follow clear processes that outline what information is reviewed before and during meetings, how information is shared, and the defined goals of committee discussions. Structured procedures that enable sufficient time for discussion, solicit multiple perspectives, and encourage discussion of alternatives can also help to mitigate biased outcomes.^{Reference Mesmer-Magnus and Dechurch21,Reference Kerr and Tindale22} Competence committees should develop a “Process and Procedures” document that details the approach to group decision-making, including steps and requirements to reach a final decision (e.g., definition of quorum, process for reaching consensus or majority vote). Ensuring a transparent deliberation and decision-making process will enhance the credibility of the committee's outputs for stakeholders.^{Reference Donato, Alweis and Wenderoth23}

The high-stakes decisions made by the competence committee must be credible and trustworthy.^{Reference Van Der Vleuten, Schuwirth, Driessen, Govaerts and Heeneman24} The introduction of undocumented personal attestations threatens to obscure the committee's decision-making process and introduce potential bias. Dickey et al., have highlighted several cognitive biases that committee members are susceptible to (e.g., bandwagon bias),^{Reference Dickey, Thomas, Feroze, Nakshabandi and Cannon12} which can emerge when discussions center around undocumented personal experiences. While data from informal sources, such as hallway conversations, may warrant further consideration, they may not always be captured by the formal program of assessment. Therefore, programs should have a process to document these informal data and reconcile them with other resident performance data at the competence committee. Ultimately, the judgments of the committee should stem from a transparent process that relies on data that can be audited by outsiders, if ncessary.^{Reference Donato, Alweis and Wenderoth23}

Regular communication and performance feedback are powerful learning tools for medical trainees and are essential for personal and professional development.^{Reference Renting, Gans, Borleffs, Van Der Wal, Jaarsma and Cohen-Schotanus25} Residents with identified deficiencies in certain core knowledge areas, procedural dexterities, attitudes or any CanMEDS competencies should receive high-quality and detailed feedback to guide clinical and academic focus and remediation when needed.^{Reference Holmboe, Sherbino, Long, Swing and Frank26} Early identification and correction of perceived deficiencies promote clinical advancement, resident well-being, and improved patient care.^{Reference Carraccio, Wolfsthal, Englander, Ferentz and Martin27,Reference Bing-You and Trowbridge28} Regular feedback is equally important for residents progressing on track and those identified on an accelerated path to provide support and nurture them on a continued path toward mastery in EM.^{Reference Hauer, Chesluk and Iobst1} Regular communication should include not only the resident cohort, but also relevant stakeholders including their academic advisors and faculty coaches, when applicable.^{Reference Kinnear, Warm and Hauer15}

Reflective practice, essential for critical thinking and professional development, is an important skill residents must develop to achieve competence and progress through their training.^{Reference Albanese29,Reference Ericsson30} Transparency of progress decisions and consistent communication facilitate the development of trainee self-regulation and can inform individualized learning plans. These learning plans can help to close the gap between current and desired performance, and for those on an accelerated path, help them achieve mastery.^{Reference Nicol and Macfarlane-Dick31} Ensuring the trainee's faculty advisor or academic coach is also given timely access to the committee's findings enhances the utility of feedback, encourages reflective practice, and ensures the trainee has a point of contact to help maintain their developmental trajectory.^{Reference Gonzalo, Wolpaw, Krok, Pfeiffer and McCall-Hosenfeld32} An effective coach can help advance the trainee's potential and maximize clinical, professional, and academic performance.^{Reference Lovell33}

Evaluation of individual competence committee processes and practices is crucial to reduce undesired resident assessment variability and to maintain a transparent, innovative and effective system for progress decisions.^{Reference Baartman, Prins, Kirschner and van der Vleuten34} Both internal and external stakeholders can be involved in systematically addressing and prioritizing gaps and challenges in the system with regular feedback from administration, faculty, and residents.^{Reference Brateanu, Thomascik, Koncilja, Spencer and Colbert35} The use of structured continuous quality-improvement practices can empower training programs with an approach to evaluate their processes and effectively restructure their procedures as necessary.^{Reference Kinnear, Warm and Hauer15,Reference Brateanu, Thomascik, Koncilja, Spencer and Colbert35}

Competence committees across the country should engage in collaborative efforts and share information regarding challenges, best practices, and innovations. We live in the era of technological advancement where cross-program communication and collaboration by means of multiple online platforms is possible. Collaboration between programs will lead to increased efficiency, decreased time and effort on program assessment and redesign, and added mentorship and coaching from programs with greater infrastructure and resources. This collaboration has the potential to enhance the national standard for competence committee procedures and practices.^{Reference Gill, West, Watzak, Quiram, Pillow and Graham36}