Nursing

Quality (philosophy)

Grounded theory

Clinical decision making

Philosophy

Statistics

Data collection

Portfolio

Archaeology

Pedagogy

Economics

Data mining

Computer science

Qualitative research

Milestone

Psychology

Mathematics

Political science

Formative assessment

Summative assessment

Epistemology

Family medicine

Sociology

Financial economics

MEDLINE

Measure (data warehouse)

Medicine

Medical education

Social science

History

Academic Medicine

Purpose Resident-sensitive quality measures (RSQMs) are quality measures that are likely performed by an individual resident and are important to care quality for a given illness of interest. This study sought to explore how individual clinical competency committee (CCC) members interpret, use, and prioritize RSQMs alongside traditional assessment data when making a summative entrustment decision. Method In this constructivist grounded theory study, 19 members of the pediatric residency CCC at Cincinnati Children’s Hospital Medical Center were purposively and theoretically sampled between February and July 2019. Participants were provided a deidentified resident assessment portfolio with traditional assessment data (milestone and/or entrustable professional activity ratings as well as narrative comments from 5 rotations) and RSQM performance data for 3 acute, common diagnoses in the pediatric emergency department (asthma, bronchiolitis, and closed head injury) from the emergency medicine rotation. Data collection consisted of 2 phases: (1) observation and think out loud while participants reviewed the portfolio and (2) semistructured interviews to probe participants’ reviews. Analysis moved from close readings to coding and theme development, followed by the creation of a model illustrating theme interaction. Data collection and analysis were iterative. Results Five dimensions for how participants interpret, use, and prioritize RSQMs were identified: (1) ability to orient to RSQMs: confusing to self-explanatory, (2) propensity to use RSQMs: reluctant to enthusiastic, (3) RSQM interpretation: requires contextualization to self-evident, (4) RSQMs for assessment decisions: not sticky to sticky, and (5) expectations for residents: potentially unfair to fair to use RSQMs. The interactions among these dimensions generated 3 RSQM data user profiles: eager incorporation, willing incorporation, and disinclined incorporation. Conclusions Participants used RSQMs to varying extents in their review of resident data and found such data helpful to varying degrees, supporting the inclusion of RSQMs as resident assessment data for CCC review.

Use of Resident-Sensitive Quality Measure Data in Entrustment Decision Making: A Qualitative Study of Clinical Competency Committee Members at One Pediatric Residency