Table 1.
Current Obstacles and Key Enablers to Advancing the CCC Towards Competency-Based Advancement and Competency-Based Time-Variable Promotion Decisions
| CCC goal | Current landscape | Specific limitations | Proposed improvements | Examples for vignette |
|---|---|---|---|---|
| Discern and describe the developmental status of each resident to optimize education | Lack of a shared mental model of how to conduct trainee developmental assessment50 | Straight-line scoring on the Milestones |
Provide faculty development activities aimed at a shared model of assessment and competency-based advancement. CCCs synthesize evaluative feedback for all trainees, whether struggling, average, or exceptional (like Leila), to inform individualized learning plans, co-produced by trainees with program leadership |
Data is available that takes into account Leila’s unique journey, allowing individualization |
| Lack of a shared mental model of how to conduct trainee developmental assessment50 | Focus on outlier identification | Discuss EVERY trainee at the CCC meeting with a view to providing forward-oriented recommendations, based on the competency model. | Developmental perspective allows Leila to plan and adjust her training experiences; educational value becomes a criterion for activity scheduling | |
| Failure to address coach-evaluator tension | CCC members often fill both coach and evaluator roles | Diversify CCC membership to include a wide range of stakeholders, including those who do not necessarily have an education role | Clear separation of coach and evaluator increases opportunity for Leila to confide stressors and to adopt growth mindset | |
| CCC may not have sufficient diversity in terms of race, gender, ethnicity, LGBTQ+ | Prone to implicit bias and to counter-productive group dynamics | Ensure diversity of CCC membership, explicit consideration of the group processes | Leila was pleased to see a foreign medical graduate represented on the CCC. | |
| Determine each resident’s readiness for unsupervised practice | Lack of explicit competency-based criteria to determine readiness for graduation and unsupervised practice | Advancement is based on demonstration of specific, observable positive behaviors, rather than absence of problems or sanctions | Utilize explicit criteria for competency-based advancement including achievement of the ACGME Milestones | Leila understands what competencies she needs to demonstrate in order to graduate, and where this has or has not been accomplished |
| Foster each resident’s ability to self-assess | Resident self-evaluation and reflection often only done informally | Informed self-assessment, self-monitoring, and reflective practice are underemphasized by faculty and undervalued by trainees |
Ensure that residents practice the skills of informed self-assessment. Incorporate trainee Milestone self-assessment into CCC meeting discussion Utilizing CCC determinations for co-produced individualized learning plans |
As Leila learns to self-assess, she understands in which areas she is less strong than others and understands what additional growth is needed to graduate |
| Few data visualizations available, and even fewer that are informed by a competency model | When examinations are the key data point, that sends a message as to what is valued | Adopt a quality improvement mindset for self-improvement, where data visualizations play a key role | Leila works with her program director to make evidence-based decisions to determine which elective rotations or other experiences will enable her to achieve competency |