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Competency Committees in Undergraduate Medical Education: Approaching Tensions Using a Polarity Management Framework

Monrad, Seetha U. MD; Mangrulkar, Rajesh S. MD; Woolliscroft, James O. MD; Daniel, Michelle M. MD, MHPE; Hartley, Sarah E. MD; Gay, Tamara L. MD; Highet, Alexandra; Vijayakumar, Nithya; Santen, Sally A. MD, PhD

doi: 10.1097/ACM.0000000000002816
Perspectives
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Implementing competency-based medical education in undergraduate medical education (UME) poses similar and unique challenges to doing so in graduate medical education (GME). To ensure that all medical students achieve competency, educators must make certain that the structures and processes to assess that competency are systematic and rigorous. In GME, one such key structure is the clinical competency committee. In this Perspective, the authors describe the University of Michigan Medical School’s (UMMS’s) experience with the development of a UME competency committee, based on the clinical competency committee model from GME, and the first year of implementation of that committee for a single cohort of matriculating medical students in 2016–2017.

The UMMS competency committee encountered a number of inter dependent but opposing tensions that did not have a correct solution; they were “both/and” problems to be managed rather than “either/or” decisions to be made. These tensions included determining the approach of the committee (problem identification versus developmental); committee membership (curricular experts versus broad-based membership); student cohort makeup (phase-based versus longitudinal); data analyzed (limited assessments versus programmatic assessment); and judgments made (grading versus developmental competency assessment).

The authors applied the Polarity Management framework to navigate these tensions, leveraging the strengths of each while minimizing the weaknesses. They describe this framework as a strategy for others to use to develop locally relevant and feasible approaches to competency assessment in UME.

S.U. Monrad was director of the foundational basic/clinical science curriculum at the time this work was completed. She currently is assistant dean for assessment, evaluation, and quality improvement and associate professor of internal medicine and learning health sciences, University of Michigan Medical School, Ann Arbor, Michigan.

R.S. Mangrulkar is Marguerite S. Roll Professor of Medical Education, associate dean for medical student education, and associate professor of internal medicine and learning health sciences, University of Michigan Medical School, Ann Arbor, Michigan.

J.O. Woolliscroft is Lyle C. Roll Professor of Medicine and professor of internal medicine and learning health sciences, University of Michigan Medical School, Ann Arbor, Michigan.

M.M. Daniel is assistant dean for curriculum and associate professor of emergency medicine and learning health sciences, University of Michigan Medical School, Ann Arbor, Michigan.

S.E. Hartley is associate program director and associate professor of internal medicine, University of Michigan Medical School, Ann Arbor, Michigan.

T.L. Gay is assistant dean for student services and associate professor of psychiatry, University of Michigan Medical School, Ann Arbor, Michigan.

A. Highet is a fourth-year medical student and Honor Council member, University of Michigan Medical School, Ann Arbor, Michigan.

N. Vijayakumar is a fourth-year medical student and Honor Council member, University of Michigan Medical School, Ann Arbor, Michigan.

S.A. Santen was assistant dean for educational research and quality improvement and professor of emergency medicine and learning health sciences, University of Michigan Medical School, Ann Arbor, Michigan, at the time this work was completed. She currently is senior associate dean for assessment, evaluation, and scholarship and professor of emergency medicine, Virginia Commonwealth School of Medicine, Richmond, Virginia.

Supplemental digital content for this article is available at http://links.lww.com/ACADMED/A690.

Funding/Support: This work was supported by a grant from the American Medical Association’s Accelerating Change in Medical Education initiative.

Other disclosures: None reported.

Ethical approval: Reported as not applicable.

Previous presentations: This work was presented at the Second World Summit on Competency-Based Medical Education, August 24–25, 2018, in Basel, Switzerland.

Correspondence should be addressed to Seetha U. Monrad, University of Michigan Medical School, 6125 Taubman Health Sciences Library, 1135 Catherine St., Ann Arbor, MI 48109-5726; telephone: (734) 764-9188; email: seetha@med.umich.edu.

Copyright © 2019 by the Association of American Medical Colleges