Many Minds, One Model: Exploring Decision Making of an Undergraduate Medicine Competency Committee Using the Construct of a Shared Mental Model.

Introduction: Competency committees (CCs) are considered mandatory in competency-based medical education. There remains insufficient research to guide programs in optimizing the work of CCs especially in the undergraduate context. In order to address this gap, the functioning of an undergraduate CC is examined using the construct of a shared mental model (SMM) to explore factors and context that inform a holistic review of performance. Methods: A qualitative exploratory study was conducted. Using purposive sampling, 10 members of a Student Progress Committee (SPC) participated in 60-minute, semi-structured interviews (April 2022 to June 2023). An abductive thematic analysis approach generated themes which were then mapped onto a mental model construct. This heuristic helped construct and visualize the inner workings of a SMM as a holistic decision-making process that operates on manipulating multiple data inputs (quantitative and qualitative) in order to generate robust outcomes. Results: SPC members shared similar expectations of the task at hand while having multiple and conflicting perspectives about inputs important for decision making. Members grappled with what they perceived as a subjective process but agreed that having principles specific to holistic decision making can generate robust outcomes. Diversity of group membership was essential for minimizing member bias and group conformity in decision making. Discussion: This new understanding of how CCs operate at the undergraduate level can inform the SPC and guide its members in their quality improvement efforts and inform broader program-wide improvement, locally; moreover, it may contribute to the ongoing improvement of CCs in other settings.