We need to talk: clinical competency committees in the key of c(onversation)

James Suroweicki’s book, The Wisdom of Crowds [1], provided examples of how diverse, independently deciding individuals make some decisions and predictions better than any individual, even an expert one. However, there have been epic failures where group dynamics derail decisionmaking and crowds become herds. Over the past decades, there has been a steady movement towards competency-based medical education accompanied by assessment programs emphasizing the judgment of experts in promotion and progress decisions [2]. While competency committees are not new in undergraduate medical education [3] or graduate medical education [4], they are now required of all residency training programs in the US accredited by the Accreditation Council for Graduate Medical Education (ACGME) [5] and will soon be required in training programs in Canada [6]. What is not well understood is how members of a clinical competency committee (CCC) reach a judgment or conclusion. In their article, Chacine et al. report on their synthesis of literature on group decision-making which yielded three orientations (schema, constructivist, and social influence) that are within a context of ‘moderators’ (moderating influences) that can help to frame an approach to examining how CCC decisions are made. Why is the ‘how’ an important question to answer? Simply put, CCCs represent a visible commitment to the im-