Terms of reference of the Clinical Competence Committee CBD

ROLE:

A Competence Committee reviews and makes decisions related to the progress of residents enrolled in a competency-based residency program, in achieving the national standards established by each Royal College discipline.

PRINCIPLES:

The roles, responsibilities and activities of a Competence Committee are guided by the following principles.

1. The Competence Committee is a sub-committee of the Residency Program Committee (RPC).
2. The competence committee allows for an informed group decision-making process where patterns of performance can be collated to reveal a broad picture of a resident’s progression toward competence.
3. The Competence Committee has authority to make decisions on individual EPA achievement. The Competence Committee presents status change determinations as recommendations to the RPC. The RPC ratifies these status recommendations with input from the Postgraduate Dean (when required).
4. Committee work is guided by the national specialty competency framework, including specialty-specific milestones and EPAs by stage, as established by the specialty committee as well as the relevant university and Royal College assessment policies.
5. The Competence Committee is expected to exercise judgment in making EPA decisions and status recommendations: i.e., they will use Specialty defined EPAs and the expected number of observations as a guideline, but they are not bound to a specific number, context or type of assessments. The key is that the committee must feel it has adequate information on the EPAs to make holistic judgments on the progress of the resident. The wisdom of the Competence Committee is considered the gold standard for EPA decisions and learner status recommendations.
6. In addition to utilizing milestones and EPAs, Committee discussions will be based on all of the assessment tools and relevant evidence from the program as uploaded in an ePortfolio.
7. As a general guideline, based on Elentra's 5 point descriptive rating scale, evaluations with an overall rating of a 4/5 "I needed to be there just in case" may sometimes be considered to be a level at which competence has been demonstrated by the learner. However, EPAs completed with global scores below the level of 4/5 may sometimes be considered in the total number of required observations of achievement at the discretion of the committee members. For example, when considering achievement of EPA C3 "Performing gross dissection of complex surgical specimens", 100 assessments are required with an overall demonstration of competence; in assessing competency for this or other EPAs, a trend towards consistent 4/5 or 5/5 ratings by the end of the stage along with holistic assessment of competence may be determined to be sufficient at the discretion of the committee members.
8. Under unusual and extenuating circumstances, morning gross review of specimens (may be considered as simulation sessions) may allow residents to achieve partially/fully the EPAs related to grossing simple cases under supervision of a staff pathologist/delegate.
9. Individual milestones within a given EPA will also be judged holistically, without necessarily requiring a certain threshold number of achievements. This serves to acknowledge that individual milestones within an EPA may not fully align with all of the permitted tasks that can be assessed. The main purpose of the milestones should be to prompt discussion and feedback with the preceptor.
10. For EPA assessment purposes, current non-CBD PGY 5 residents will be considered as Transition to Practice (TTP) residents and PGY2-4 will be considered as Core stage residents.
11. All committee discussions are strictly confidential and only shared on a professional need-to-know basis. This principle is equivalent to patient confidentiality in clinical medicine.
12. Committee decisions must be based on the evidence available in the trainee's ePortfolio at the time of the committee meeting. Individual committee member experience can only be introduced with appropriate documentation within the ePortfolio. Committee members must make every attempt to avoid the introduction of hearsay into the deliberations. Discussions are informed only by the evidence available in the program’s ePortfolio system.
13. The functioning of the Competence Committee, including its decision making processes, will be a focus of accreditation surveys in the future.
14. Committee work must be timely in order to ensure fairness and appropriate sequencing of training experiences.
15. Competence Committees operate with a growth mindset. This means that Committee work is done in a spirit of supporting each trainee to achieve their own individual progression of competence.
16. Competence Committees have a responsibility to make decisions in the spirit of protecting patients from harm, including weighing a trainees' progress in terms of what they can safely be entrusted to perform with indirect supervision. Some Committee discussions must be shared to provide focused support and guidance for residents. This principle is equivalent to patient handover in clinical medicine.
17. Competence Committee decisions/recommendations and their associated rationales must be documented within the program’s ePortfolio system.

COMPOSITION:

The Competence Committee will ordinarily be chaired by a member of the clinical teaching faculty but the Program Director should serve as a Committee member to supervise the overall function of the committee and to be an advocate for the residents. Members of the Committee are normally from the Residency Program Committee. Including a member that is ‘external’ to the RPC can be helpful. This individual may be a faculty at the university.

REPORTING:

The Competence Committee will report outcomes of discussions and decisions to the Residency Program Committee, which is chaired by the Program Director. Any decision made by the Competence Committee must be ratified by the RPC.

TERM OF OFFICE:

Ordinarily, members should be appointed by the Program Director to serve a defined term of 3 years with an appropriate process for renewals.

MEETINGS:

The Competence Committee will meet 4 times per year, though more frequent meetings may be required to support the transition between stages. This may be called on an ad hoc basis by the Chair of the committee in consultation of the Program Director. Meetings should be face to face.

Quorum: There should be at least 50% attendance from the members of the Competence Committee to achieve quorum. The program director (or ‘delegate’) MUST be present for all discussions.