How do small groups make decisions?: A theoretical framework to inform the implementation and study of clinical competency committees

Saad Chahine; Sayra Cristancho; Jessica Jessica Padgett; Lorelei Lingard

doi:10.1007/S40037-017-0357-X

Abstract

In the competency-based medical education (CBME) approach, clinical competency committees are responsible for making decisions about trainees’ competence. However, we currently lack a theoretical model for group decision-making to inform this emerging assessment phenomenon. This paper proposes an organizing framework to study and guide the decision-making processes of clinical competency committees.

This is an explanatory, non-exhaustive review, tailored to identify relevant theoretical and evidence-based papers related to small group decision-making. The search was conducted using Google Scholar, Web of Science, MEDLINE, ERIC, and PsycINFO for relevant literature. Using a thematic analysis, two researchers (SC & JP) met four times between April–June 2016 to consolidate the literature included in this review.

Three theoretical orientations towards group decision-making emerged from the review: schema, constructivist, and social influence. Schema orientations focus on how groups use algorithms for decision-making. Constructivist orientations focus on how groups construct their shared understanding. Social influence orientations focus on how individual members influence the group’s perspective on a decision. Moderators of decision-making relevant to all orientations include: guidelines, stressors, authority, and leadership.

Clinical competency committees are the mechanisms by which groups of clinicians will be in charge of interpreting multiple assessment data points and coming to a shared decision about trainee competence.

References

Nasca TJ Philibert I Brigham T The next GME accreditation system – rationale and benefits N Engl J Med 2012 366 1051 1056 10.1056/NEJMsr1200117
Open DOI Search in Google Scholar Back to article
Frank JR Snell LS ten Cate O Competency-based medical education: theory to practice Med Teach 2010 32 638 645 10.3109/0142159X.2010.501190
Open DOI Search in Google Scholar Back to article
Iobst WF Sherbino J ten Cate O Competency-based medical education in postgraduate medical education Med Teach 2010 32 651 656 10.3109/0142159X.2010.500709
Open DOI Search in Google Scholar Back to article
Holmboe ES Sherbino J Long DM Swing SR Frank JR The role of assessment in competency-based medical education Med Teach 2010 32 676 682 10.3109/0142159X.2010.500704
Open DOI Search in Google Scholar Back to article
Andolsek K Padmore J Hauer K Holmboe ES Clinical competency committees. A guidebook for programs 2015 Chicago The Accreditation Council for Graduate Medical Education
Search in Google Scholar Back to article
Colbert CY Dannefer EF French JC Clinical competency committees and assessment: Changing the conversation in graduate medical education J Grad Med Educ 2015 7 162 165 10.4300/JGME-D-14-00448.1
Open DOI Search in Google Scholar Back to article
Hauer KE ten Cate O Boscardin CK Ensuring resident competence: a narrative review of the literature on group decision making to inform the work of clinical competency committees J Grad Med Educ 2016 8 156 164 10.4300/JGME-D-15-00144.1
Open DOI Search in Google Scholar Back to article
Franks P Clancy CM Nutting PA Gatekeeping revisited – protecting patients from overtreatment N Engl J Med 1992 327 424 429 10.1056/NEJM199208063270613
Open DOI Search in Google Scholar Back to article
Nagy P The three roles of assessment: gatekeeping, accountability, and instructional diagnosis Can J Educ 2000 25 4 262 279 10.2307/1585850
Open DOI Search in Google Scholar Back to article
Promes SB Wagner MJ Starting a clinical competency committee J Grad Med Educ 2014 6 163 164 10.4300/JGME-D-13-00444.1
Open DOI Search in Google Scholar Back to article
French JC Dannefer EF Colbert CY A systematic approach toward building a fully operational clinical competency committee J Surg Educ 2014 71 22 27 10.1016/j.jsurg.2014.04.005
Open DOI Search in Google Scholar Back to article
Tichter AM Mulcare MR Carter WA Interrater agreement of emergency medicine milestone levels: resident self-evaluation vs clinical competency committee consensus Am J Emerg Med 2016 34 1677 1679 10.1016/j.ajem.2016.04.055
Open DOI Search in Google Scholar Back to article
Hauer KE Chesluk B Iobst W Reviewing residents’ competence Acad Med 2015 90 1084 1092 10.1097/ACM.0000000000000736
Open DOI Search in Google Scholar Back to article
Doty CI Roppolo LP Asher S How do emergency medicine residency programs structure their clinical competency committees? A survey Acad Emerg Med 2015 22 1351 1354 10.1111/acem.12804
Open DOI Search in Google Scholar Back to article
Ketteler ER Auyang ED Beard KE Competency champions in the clinical competency committee: a successful strategy to implement milestone evaluations and competency coaching J Surg Educ 2014 71 36 38 10.1016/j.jsurg.2013.09.012
Open DOI Search in Google Scholar Back to article
Dhaliwal S Ayyala RS Post graduate training program in ophthalmology in India: idealistic vs realistic J Clin Ophth Res 2015 3 39 43 10.4103/2320-3897.149375
Open DOI Search in Google Scholar Back to article
Swanson RA Chermack TJ Theory building in applied disciplines 2013 San Francisco Berrett-Koehler Publishers
Search in Google Scholar Back to article
Lynham SA The general method of theory-building research in applied disciplines Adv Dev Hum Resour 2002 4 221 241 10.1177/1523422302043002
Open DOI Search in Google Scholar Back to article
Mann KV The role of educational theory in continuing medical education: Has it helped us? J Contin Educ Health Prof 2004 24 S1 S22 S30 10.1002/chp.1340240505
Open DOI Search in Google Scholar Back to article
Laidley TL Braddock CH III Role of adult learning theory in evaluating and designing strategies for teaching residents in ambulatory settings Adv Health Sci Educ 2000 5 43 54 10.1023/A:1009863211233
Open DOI Search in Google Scholar Back to article
Grant MJ Booth A A typology of reviews: an analysis of 14 review types and associated methodologies Health Info Libr J 2009 26 91 108 10.1111/j.1471-1842.2009.00848.x
Open DOI Search in Google Scholar Back to article
Citrome L The grey literature is far from drab Int J Clin Pract 2016 70 790 10.1111/ijcp.12899
Open DOI Search in Google Scholar Back to article
Fiske ST Linville PW What does the schema concept buy us? Pers Soc Psychol Bull 1980 6 543 557 10.1177/014616728064006
Open DOI Search in Google Scholar Back to article
Laughlin PR Social choice theory, social decision scheme theory, and group decision-making Group Process Intergroup Relat 2010 14 63 79 10.1177/1368430210372524
Open DOI Search in Google Scholar Back to article
Juni MZ Eckstein MP Flexible human collective wisdom J Exp Psychol Hum Percept Perform 2015 41 1588 1611 10.1037/xhp0000101
Open DOI Search in Google Scholar Back to article
Bonner BL Expertise in group problem solving: Recognition, social combination, and performance Group Dyn 2004 8 4 277 290 10.1037/1089-2699.8.4.277
Open DOI Search in Google Scholar Back to article
Rokou E Kirytopoulos K A calibrated group decision process Group Decis Negot 2014 23 1369 1384 10.1007/s10726-013-9374-2
Open DOI Search in Google Scholar Back to article
Roth PL Bobko P A research agenda for multi-attribute utility analysis in human resource management Hum Res Manage Rev 1997 7 341 368
Search in Google Scholar Back to article
Stasser G A primer of social decision scheme theory: models of group influence, competitive model-testing, and prospective modeling Organ Behav Hum Decis Process 1999 80 3 20 10.1006/obhd.1999.2851
Open DOI Search in Google Scholar Back to article
Tindale RS Kameda T Social sharedness’ as a unifying theme for information processing in groups Group Process Intergroup Relat 2000 3 123 140 10.1177/1368430200003002002
Open DOI Search in Google Scholar Back to article
Kerr NL Tindale RS Group performance and decision making Annu Rev Psychol 2004 55 623 655 10.1146/annurev.psych.55.090902.142009
Open DOI Search in Google Scholar Back to article
Orlitzky M Hirokawa RY To err is human, to correct for it divine: a meta-analysis of research testing the functional theory of group decision-making effectiveness Small Group Res 2001 32 313 341 10.1177/104649640103200303
Open DOI Search in Google Scholar Back to article
Hirokawa RY Group communication and decision-making performance: a continued test of the functional perspective Hum Commun Res 1988 14 487 515 10.1111/j.1468-2958.1988.tb00165.x
Open DOI Search in Google Scholar Back to article
Hinsz VB Tindale RS Vollrath DA The emerging conceptualization of groups as information processors Psychol Bull 1997 121 43 64 10.1037/0033-2909.121.1.43
Open DOI Search in Google Scholar Back to article
Liberatore MJ Nydick RL The analytic hierarchy process in medical and health care decision making: a literature review Eur J Oper Res 2008 189 194 207 10.1016/j.ejor.2007.05.001
Open DOI Search in Google Scholar Back to article
Mayer RE Learners as information processors: legacies and limitations of educational psychology’s second Educ Psychol 2011 31 151 161 10.1080/00461520.1996.9653263
Open DOI Search in Google Scholar Back to article
Salas E Rosen MA Burke CS Nicholson D Howse WR Markers for enhancing team cognition in complex environments: the power of team performance diagnosis Aviat Space Environ Med 2007 78 Supplement 1 B77 B85
Search in Google Scholar Back to article
van Ginkel WP van Knippenberg D Knowledge about the distribution of information and group decision making: when and why does it work? Organ Behav Hum Decis Process 2009 108 218 229 10.1016/j.obhdp.2008.10.003
Open DOI Search in Google Scholar Back to article
Schulz-Hardt S Mojzisch A How to achieve synergy in group decision making: lessons to be learned from the hidden profile paradigm Eur Rev Soc Psychol 2012 23 305 343 10.1080/10463283.2012.744440
Open DOI Search in Google Scholar Back to article
Wittenbaum GM Hollingshead AB Botero IC From cooperative to motivated information sharing in groups: moving beyond the hidden profile paradigm Commun Monogr 2004 71 286 310 10.1080/0363452042000299894
Open DOI Search in Google Scholar Back to article
Kameda T Tindale RS Groups as adaptive devices: human docility and group aggregation mechanisms in evolutionary context Evolution and social psychology 2006 New York Psychology Press
Search in Google Scholar Back to article
Rashotte L Social influence Blackwell Encycl Soc Psychol 2007 9 562 563
Search in Google Scholar Back to article
Back KW Influence through social communication J Abnorm Psychol 1951 46 9 23 10.1037/h0058629
Open DOI Search in Google Scholar Back to article
Asch SE Studies of independence and conformity: a minority of one against a unanimous majority Psychol Monogr 1956 70 1 70 10.1037/h0093718
Open DOI Search in Google Scholar Back to article
Bond R Smith PB Culture and conformity: a meta-analysis of studies using Asch’s (1952b, 1956) line judgment task Psychol Bull 1996 119 111 137 10.1037/0033-2909.119.1.111
Open DOI Search in Google Scholar Back to article
Janis IL Groupthink Psychol Today 1971 5 43 46 74–76
Search in Google Scholar Back to article
Kameda T Sugimori S Psychological entrapment in group decision making: an assigned decision rule and a groupthink phenomenon J Pers Soc Psychol 1993 65 282 292 10.1037/0022-3514.65.2.282
Open DOI Search in Google Scholar Back to article
Pavitt C An interactive input-process-output model of social influence in decision-making groups Small Group Res 2014 45 704 730 10.1177/1046496414548353
Open DOI Search in Google Scholar Back to article
Hirokawa R Poole M Communication and group decision making 1996 2 Thousand Oaks SAGE 10.4135/9781452243764
Open DOI Search in Google Scholar Back to article
De Dreu CK West MA Minority dissent and team innovation: the importance of participation in decision making J Appl Psychol 2001 86 1191 1201 10.1037/0021-9010.86.6.1191
Open DOI Search in Google Scholar Back to article
Plott CR Levine ME A model of agenda influence on committee decisions Am Econ Rev 1978 68 146 160
Search in Google Scholar Back to article
Klein G Streetlights and shadows: searching for the keys to adaptive decision making 2011 Cambridge MIT
Search in Google Scholar Back to article
Bonner BL Sillito SD Baumann MR Collective estimation: accuracy, expertise, and extroversion as sources of intra-group influence Organ Behav Hum Decis Process 2007 10 121 133 10.1016/j.obhdp.2006.05.001
Open DOI Search in Google Scholar Back to article
Stasson MF Kameda T Davis JH A model of agenda influences on group decisions Group Dyn 1997 1 316 323 10.1037/1089-2699.1.4.316
Open DOI Search in Google Scholar Back to article

How do small groups make decisions?: A theoretical framework to inform the implementation and study of clinical competency committees

Abstract

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