Cost and Challenges of Clinical Competency Committees and Milestones Assessment.

Abstract

Background: Several challenges regarding Clinical Competency Committee (CCC) processes have been previously reported. Few studies have addressed the cost of assessment in healthcare professional education. This study aimed to assess the time spent on and the cost of CCC processes, and faculty perception of the Milestones assessment in three residency programs.

Methods: We surveyed CCC faculty members to capture time devoted to, and satisfaction with, CCC processes from three residency programs at the University of Michigan: Anesthesiology, Emergency Medicine, and Surgery. During preparatory periods before CCC meetings, administrative staff used daily logs to record time spent in the CCC preparatory period to develop meeting documents and resident reports. CCC faculty members supplied estimated time spent preparing residents' assessments through a survey administered the day following the meeting. Additionally, the duration of each CCC meeting was recorded, and salaries were confirmed to estimate total cost. Total faculty and staff time was summed and reviewed by each departmental CCC program director.

Results: CCC members found the unstandardized semi-annual report compiled by the programs was poorly organized, not easy to review, and did not provide high-quality information for setting Milestones. The majority of CCC members reported the current CCC process does not allow enough time for review of resident data, does not provide valuable feedback to inform resident progression, and does not provide adequate rigor to defend CCC decisions. Annually, administrative staff spent 162.9 ± 151.7 h preparing the reports. Faculty spent 147.0 ± 78.4 h for the resident assessment preparation and 97.3 ± 24.1 h in CCCs meeting. Based on salaries, the cost of CCC processes for Milestone assessment totaled USD83,437, with USD22,776, USD31,764, and USD28,897 for Anesthesiology, Emergency Medicine, and Surgery, respectively. With an average of USD395.44 per resident, the total annual CCC cost for University of Michigan Medical was extrapolated to be USD404,531.

Conclusions: Though Milestones were implemented more than ten years ago, CCC processes are still unsatisfactory to faculty and pose a significant institutional cost. Alternative approaches are still needed to improve resident competency assessment processes.