1. Charge

In order to successfully complete their studies at the Washington University School of Medicine, students must demonstrate the ability to become safe and effective physicians by the attainment of competency in the WUSM Medical Education Program Objectives, which are as follows: 

1. Foundational knowledge for practice
2. Patient care
3. Systems-based practice
4. Practice-based learning and improvement
5. Interpersonal and communication skills
6. Professionalism

As subcommittees of the Committee for Academic Promotion (CAP), the Competency Attainment Committee (CAC) and the Clerkship Competency Committees (CCCs) have the tasks of evaluating progress toward and attainment of competency and of making recommendations for promotion and remediation. In addition, there may be situations in which cases are referred to CAC in which students are alleged to have violated the School of Medicine's Academic and Professional Integrity policy for review and determination as pertains to specific medical education program objectives. This document describes the bylaws and procedures of these committees in support of the policy for Review of Student Attainment of Competency. Please note that the bylaws for the Committee for Academic Promotion are separate.

2. Responsibilities

2.A. The CAC/CCCs are responsible for the following:

2.A.1. Review of the evidence supporting progression toward and attainment of competence of students in the Gateway Curriculum will be made by the CAC in conjunction, in Phase 2, with the CCCs. The committees review evidence provided through multiple student assessments. Student progression toward successful competency attainment is reviewed by the committees at multiple times within each phase of the Gateway Curriculum to allow for early identification of students not on trajectory to meet competency attainment, thereby providing early support for successful competency attainment and timely release of financial aid (Standards for Satisfactory Academic Progress for Financial Aid Eligibility).

2.A.2. Review of cases referred by the Student Success Team (SST) against a medical student for alleged violations of the Medical Education Program’s Academic and Professional Integrity policies or at the behest of the SST. The CAC is responsible for incorporating this information into their standard decisions and/or workflow.

2.B. The CAC/CCCs will follow the procedures for each review as described below:

2.B.1. For students whose competency attainment is under review, based on the totality and sufficiency of evidence regarding a student's performance in each of the WUSM Medical Education Program Objectives, the committees determine if the evidence supports that a student has attained competency. The deliberations of the CAC and the CCCs are generally positive in approach and committed to the ultimate aim of assisting students in the successful completion of the courses of study.

In determining whether the student has attained competency, the CAC and the CCCs do the following:

1. Review all assessment data, via individual student competency portfolios/dashboards, to determine if a student is on a trajectory to attain competence.
2. Evaluate competency attainment based on the review of the totality of a student's assessment data to make the following competency decisions of not competent, competent, or competent with distinction (where applicable).
3. Make recommendations regarding a student's academic progress to the CAP based on competency decisions, including the following:
   1. Promotion to the next phase of training.
   2. Remediation, with or without promotion. Formal remediation recommendations will be submitted, along with the student's assessment evidence, to the Student Success Team for review and for the development of a formal remediation plan. The CAC, based on the individualized review of each student's unique performance and trajectory, will make recommendations to the CAP regarding when details of a formal remediation should be included within the Medical Student Performance Evaluation.
   3. Dismissal or other academic sanctions, including but not limited to probation or suspension. When warranted, such as in situations including but not limited to the persistence of dyscompetence despite remediation or marked critical deficiency, the committees may recommend a student warrants dismissal, suspension, probation, or other academic actions that may impact student status. While the committees encourage the use of progressive actions and opportunities for remediation, the nature or severity of the dyscompetence may prompt, at their discretion, more immediate or severe actions.
   4. For the CAC only, qualification to receive the Doctor of Medicine degree for those students who have successfully met competence in all Medical Education Program Objectives and completed all prescribed requirements of the School of Medicine.

2.B.2. Review any remediation processes to determine if competency has been attained following remediation efforts.

2.B.3. For the CAC only, recommend to the CAP and Executive Faculty those students who have successfully met competence in all Medical Education Program Objectives and completed all prescribed requirements of the School of Medicine and who are qualified to receive the Doctor of Medicine degree.

In circumstances wherein the committees recommend an adverse outcome (remediation without promotion, probation, suspension, or dismissal) or competency without distinction (where applicable), students will be notified of this recommendation to allow for an opportunity to present themselves to the CAP, as another source of information alongside review of the original committee's minutes and recommendations, prior to ratification and/or final decisions by the CAP.

Further details of procedures related to contesting individual assessments, course credit, or the MSPE as well as procedures related to the policy for Student Promotion and Appeals can be found in separate documents in this Bulletin.

Competency Attainment Committee Specific Details 

1. Membership

1.A. Members will be appointed by the Dean or the Dean’s designee.  There will be a minimum of eight voting members of the CAC representing leadership from each phase of the Gateway Curriculum plus a faculty member from the broader faculty community representing any area of study or training in which students participate. Each member will serve a three-year term with the possibility for two one-year extensions.

1.B. In addition, faculty holding any of the following roles are excluded from membership on the CAC and may only attend as an invited guest of the CAC Chair:

• Residency program directors
• Gateway coaches
• Members of any Gateway clerkship competency committee
• Any person holding an Associate or Assistant Dean level position

1.C. Chair: The chair of the CAC will be the Assistant Dean for Assessment with a voting member selected by other voting members serving as the alternate should the chair be unavailable.

1.D. Guests: Any faculty, administrator, student, or staff member may be invited as a guest, at the discretion of the chair, if their presence is deemed important for providing additional evidence in support of decisions of competency attainment. Guests would be present to provide said evidence and/or answer questions but would not be present during nor participate in deliberations or voting.

2. Meeting Frequency and Quorum

2.A. CAC meetings occur throughout each phase of the Gateway Curriculum with sufficient frequency to do the following:

2.A.1. Allow for the review of assessment data to determine if a student is on trajectory to achieve competence in each Educational Program Objectives.

2.A.2. Allow reasonable opportunities for early support and remediation to be completed, if required.

2.A.3. Make recommendations near the completion of each phase regarding promotion, remediation with or without promotion, suspension, or dismissal with sufficient time to for students to present themselves to the CAP.

2.B. CAC meetings may be called ad hoc when significant concerns regarding competence occur or as needed to conduct other CAC reviews.

2.C. A quorum (competency decision meetings only) will constitute attendance, virtual or in person, of five voting members and at least one representative from each of the domain subgroups, excluding those who face a conflict of interest.*

2.D. Except as otherwise stated herein, decisions of the CAC must be supported by five of the voting members and at least one representative from each of the domain subgroups, excluding those with conflicts of interest.*

2.E. In the rare situation in which a quorum cannot be met because too many members have conflicts of interest*, an ad hoc committee will be convened by the Assistant Dean for Assessment.

*

The policy on conflicts of interest provides specific details. 

3. Deliberations and Outcomes

CAC deliberations, decisions, and associated recommendations will be summarized in the meeting minutes. All deliberations will be presented to the CAP for students being reviewed for adverse outcomes. Students will be notified, in writing, by the Registrar of all recommendations and generally no less than 10 calendar days prior to CAP review. Students wishing to present themselves to the CAP must follow the appropriate process as outlined in the Policy for Student Promotion and Appeals.

Decisions will be communicated with additional School of Medicine leadership and offices as appropriate to the circumstances.

Clerkship Competency Committee Specific Details 

1. Membership and Quorum

1.A. Members of the CCC must be board certified in the specialty associated with that clerkship. The Clerkship Director serves as a non-voting chair of the CCC which should have at least 3 members in addition to the clerkship and associate clerkship directors. Any CCC member who had a longitudinal supervisory role for a student may participate in deliberations but not voting for that student. Deliberations and voting require at least three voting members to be in attendance. 

1.B. Faculty holding any of the following roles are excluded from participation on the CCC unless as an invited guest:

• Residency program directors
• Gateway coaches
• Members of the CAC
• Any person holding an Associate or Assistant Dean level position

1.C. Any faculty, administrator, student, or staff member may be invited as a guest, at the discretion of the chair, if their presence is deemed important for providing additional evidence in support of decisions of competency attainment. Guests would be present to provide said evidence and/or answer questions but would not be present during nor participate in deliberations or voting.

2. Meeting Frequency

CCC meetings occur at the conclusion of each clerkship block with sufficient time to meet the LCME requirement of grade return, which is defined as both the completion of the End-of-Clerkship narrative (which is what notifies the students, via the electronic learning management system, of their competency outcomes) and the return of competency outcomes to the Registrar for posting in the transcript. CCC meetings may also be scheduled on an as-needed basis.

3. Deliberations and Outcomes

CCC deliberations, decisions, and associated recommendations will be summarized in the meeting minutes.

Decisions will be communicated with additional School of Medicine leadership and offices as appropriate to the circumstances.

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