Table.

Concepts and Theories Relevant to the Science of Group Process Applicable to Clinical Competency Committees (CCCs)

Theory or Framework	Description	Problem This Theory/Framework Could Address for a CCC	How Theory/Framework Applies to Improve CCC Group Process
Social decision scheme (SDS) theory9	Based in an input-process-output framework, SDS theory considers how individual preferences, composition of preferences within the group, and patterns of group influence (how the group makes the decision using decision scheme or rules) yield collective decisions.21	A CCC that lacks structure with regard to membership or defined processes for how information is shared and decisions are made is hoping to reflect on and codify its recruitment and processes.	Establishing diverse membership to ensure a wide range of individual preferences are represented and making clear how decisions will be made promotes consistency and fairness in the committee's work.
Functional theory11	A group must achieve 5 “functions” for effective decision-making:21  1. Analyze problem: for thorough understanding.  2. Establish evaluation criteria: understand standards required to achieve an effective choice.  3. Generate realistic alternative options.  4. Evaluate advantages of potential solution options.  5. Evaluate disadvantages of potential solution options.	CCC members make different judgements about residents due to different understanding of the purpose and role of the committee or the criteria by which they judge residents' performance. For a particular resident, members may be uncertain how to support their learning through usual rotations or supplementary learning opportunities with a mentor or special schedule.	CCC members engage in training regarding the criteria by which they evaluate residents and the options for decisions about individual residents for proceeding in the program, undergoing remediation, or other.
Groupthink10	Group members' desire for group cohesion and unanimity overrides their motivation to consider information carefully and leads them to make poor quality decisions.	Members of a CCC that has included the same membership for many years feel that they function efficiently and harmoniously. However, 2 residents the CCC deemed ready for graduation recently were determined by their fellowship directors to have major gaps in their competence.	Rotating membership enhances the array of viewpoints on the CCC. The chair can invite all members to speak and share dissenting opinions prior to decision-making. Group training and reflection about the risks of groupthink and monitoring their own practice is needed.
The Wisdom of Crowds12	Groups tend to make better decisions than individuals when specific conditions are met:  1. Diverse group membership.  2. Each member makes initial decisions independently without influence of others.  3. Tacit knowledge and experience are acknowledged and integrated.  4. Individual decisions are aggregated into a group decision.	A CCC experiences some member dissatisfaction. Some members of a CCC feel that they are not contributing actively to the CCC, and recently some members have not spoken at all during committee meetings.	The CCC can recruit members with diversity of experiences, backgrounds, and opinions, who are then allowed to make individual judgments based on review of performance data before the group comes together to share opinions and come to consensus.