# Inside Their Minds: A Multi-Institutional Exploration into the Decision-Making of Medical School Competency Committee Members

## TL;DR

This study explores how medical school competency committee members make decisions about student competence by analyzing their thought processes and contextual influences.

## Contribution

The study is the first to examine the decision-making processes of undergraduate medical school competency committees using think-aloud interviews.

## Key findings

- Participants' decision-making strategies align with those in other cognitive reasoning tasks.
- Contextual influences, such as goals and available data, shape how committee members interpret student assessments.
- Internal reasoning processes include first impressions, trend interpretation, and resolving conflicting data.

## Abstract

A competency committee is a group of experts who make a consensus-based judgement about a learner’s competence. While evidence-based practices for post-graduate committees have been described, research and standards are lacking in undergraduate medical education. Medical school competency committees often distribute student reviews to individual members; therefore, understanding how they interpret assessment data is critical.

Approaching our investigation from a social constructionist orientation, we conducted think aloud interviews with 22 competency committee members at 7 medical schools in the United States from 2023–2025. Participants were tasked with reviewing local student assessment data in preparation for a competency committee meeting and verbalizing thoughts to an investigator. We analyzed transcripts using an interpretivist approach, with sociocultural cognition theory as the primary interpretive lens.

Two major concepts depicted how participants processed student assessment data to arrive at competency determinations: contextual influences and internal reasoning processes. Contextual influences (i.e. goals, data available, and standards for interpreting the data) were outside the direct control of participants. Internal reasoning processes included: first impressions, interpreting trends, and negotiating conflicting data. Contextual influences varied and served as the lens through which participants interpreted assessment data.

This study provides the first examination into the thought processes used by medical school competency committee members to make their decisions. Participants used decision-making strategies that parallel those observed in other cognitive reasoning tasks. Contextual influences were foundational in how participants interpreted assessment data, highlighting how competence is socially constructed.