Table.

Evidence-Based Strategies for Running International Clinical Competency Committees (CCCs)

Concept (Timing)	Evidence-Based Strategies	International Considerations
Membership (before meeting)	Include members of different experience, academic ranks, and roles within the programs. Consider including non-physician health professionals. Limit group to 5–10 members.17	Include the different perspectives of multicultural, diverse faculty to improve group decision-making.
Faculty development (before meeting)	Focus on the ACGME-I competencies and Milestones. Understand the purpose of the CCC, how to interpret the information, and how to make performance assessment decisions.	Consider workshops prior to the meeting, as well as a brief overview at the beginning of each meeting. Consider additional training on the core competencies and Milestones, especially for faculty unfamiliar with competency-based training. Consider repeating these sessions throughout the year, as international faculty can have high turnover rates. •Consider assigning each of the 6 ACGME-I competencies to faculty members, based on knowledge, expertise, or interest, who can then offer teaching and coaching to other members.18
Shared mental model (before meeting)	Have a common understanding of the purpose and goal of the CCC as well as the collaboration and teamwork necessary to accomplish the task.19	Members can still have divergent opinions and need not agree on issues discussed. However, they need to understand the task requirements and group processes.20
Multisource assessments (before meeting)	Include clinical performance data and patient experience surveys, in addition to end-of-rotation evaluations and examination scores.21 Share performance narratives and assessment data before the meetings to enhance discussion.22	Be mindful of cultural influences on nursing and peer evaluations. Consider workshops or discussions on the purpose of feedback and the importance of formative assessment.
Structure (during meeting)	Use a developmental approach, focusing on learner-centric support and feedback to provide residents with the skills to achieve competence.23 Facilitate information sharing and optimize group decision-making through well-structured discussions.	Continue to emphasize the importance of a developmental approach as members may be inclined to focus on problematic or struggling residents.14 Consider asking members to speak in a predetermined order, starting with the most junior, to ensure that all members have the opportunity to give their opinions.19
Information sharing (during meeting)	Establish a system where information is shared in a written, structured way rather than verbally/relying on memory during discussions.11	Use elaboration strategies to encourage information exchange: repeating, summarizing, and inquiring about additional information.12
Leadership role (during meeting)	Ask each CCC member to provide a written professional judgment of each resident's overall performance.24 Remain neutral during meeting so as not to influence other members.25	Be conscious of hierarchy relationships that exist among CCC members and encourage and support junior faculty involvement.
Time (during meeting)	Allow a fixed amount of discussion time for each resident.14	Avoid time pressures, as they can lower the quality of decision-making.19
Resident feedback (after meeting)	Each discussion should result in an action plan for each resident with positive feedback and points for improvement. Establish a culture of assessment and feedback where CCC feedback is part of an ongoing learning process rather than unrelated events.26	Encourage faculty to include strengths of each resident, as faculty may be inclined to focus only on areas of improvement. Embrace a positive, non-hierarchical learning culture that normalizes feedback to encourage residents and faculty to be active recipients and givers of feedback, as faculty may focus on faculty to resident feedback only.27
CCC feedback (after meeting)	Review the feedback given to residents after the previous meeting and its effect on the residents' performance.13	Incorporate both positive feedback and areas for improvement for each resident being reviewed. Duly provide praise when excellence/significant improvement in performance is noted by the committee. Ensure that feedback from the committee is timely, specific, and constructive to help guide learning.