Group Trust in the Setting of Competency Committee Decisions: A Qualitative Observational Study

Trust is an important foundational component of a competency committee. Little work has been done in health professions education to look at trust and group decisions. A recent scoping review defined "group trust," examined factors that may influence group trust, and proposed a model to illustrate the relationship between trust at the individual and group levels. The purpose of this study was to test this model in the context of competency committee decisions and assignment of the ACGME Milestones. Methods: The authors conducted structured observations of competency committee meetings in internal medicine and pediatrics residency and subspecialty programs within the National Capital Consortium. Data were analyzed using a constant comparison method. Results: The authors observed six meetings from May to June 2018 (15 hours) reaching thematic saturation by the final meeting. The proposed model served as an organizing framework for reporting findings into the following categories: individual and group level factors, interpersonal interactions, and environmental factors. Results suggest that diversity of opinion promotes a more complete understanding of trainee competence. Varied faculty experiences, interactions, and actions by committee chairs helped to build a shared group mental model, which was identified as one of the most important aspects of making collective decisions and assigning Milestones. Meetings generally had similar structure based upon the size of the training program, and groupthink was more of a risk for larger training programs, especially when assigning individual Milestones. An important environmental factor identified was decision making fatigue, which was most prevalent towards the end of committee meetings. Conclusions: As training programs develop policies, procedures, and determine the membership of competency committees, utilizing these findings may help improve the design and execution of these groups, enhancing the translation of evaluation data and individual opinions into Milestone and competency decisions. Sapp J, Larsen K, Torre D, Holmboe E, Durning S