Clinical Competency Committee (CCC)

The ACGME Common Program Requirements are specific about how a Clinical Competency Committee is constituted and what it has to do. The program director appoints the committee, which must include at least three members of the program faculty with at least one core faculty member, and additional members can be faculty from the same or other programs or other health professionals who have extensive contact and experience with the program's residents.

The committee has three required duties. It must review all resident evaluations at least semi-annually, determine each resident's progress on achievement of the specialty-specific Milestones, and meet before the residents' semi-annual evaluations so that it can advise the program director on each resident's progress. Note the word advise: the ACGME is explicit that final responsibility for resident evaluation and promotion decisions stays with the program director, so the committee builds the case rather than issuing the verdict.

In practice the quality of a CCC meeting depends entirely on what the faculty brought to the table. Procedural and knowledge-based competencies arrive with case logs, exam scores, and written evaluations, so the discussion has something to argue about. Interpersonal and communication skills often arrive as a handful of end-of-rotation comments, which is why milestone ratings in that domain drift toward the middle of the scale and why a committee can find itself unable to say what a struggling learner should actually work on.

Committees that fix this problem do it by adding structured, observed communication encounters to the data set so that an ICS rating rests on scored performance rather than recollection. Once a learner's conversations are observed and scored against defined criteria, the committee can point to a specific behavior, which is also what makes a remediation plan defensible if the learner later contests it.