Inside Their Minds: A Multi-Institutional Exploration into the Decision-Making of Medical School Competency Committee Members.

Introduction: A competency committee is a group of experts who make a consensus-based judgement about a learner's competence. While evidence-based practices for post-graduate committees have been described, research and standards are lacking in undergraduate medical education. Medical school competency committees often distribute student reviews to individual members; therefore, understanding how they interpret assessment data is critical. Methods: Approaching our investigation from a social constructionist orientation, we conducted think aloud interviews with 22 competency committee members at 7 medical schools in the United States from 2023-2025. Participants were tasked with reviewing local student assessment data in preparation for a competency committee meeting and verbalizing thoughts to an investigator. We analyzed transcripts using an interpretivist approach, with sociocultural cognition theory as the primary interpretive lens. Results: Two major concepts depicted how participants processed student assessment data to arrive at competency determinations: contextual influences and internal reasoning processes. Contextual influences (i.e. goals, data available, and standards for interpreting the data) were outside the direct control of participants. Internal reasoning processes included: first impressions, interpreting trends, and negotiating conflicting data. Contextual influences varied and served as the lens through which participants interpreted assessment data. Discussion: This study provides the first examination into the thought processes used by medical school competency committee members to make their decisions. Participants used decision-making strategies that parallel those observed in other cognitive reasoning tasks. Contextual influences were foundational in how participants interpreted assessment data, highlighting how competence is socially constructed.