Is the proof in the PUDding? Reflections on previously undocumented data (PUD) in clinical competency committees
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Perspect Med Educ (2020) 9:269–271 https://doi.org/10.1007/s40037-020-00621-0
Is the proof in the PUDding? Reflections on previously undocumented data (PUD) in clinical competency committees Daniel J. Schumacher · Benjamin Kinnear Received: 4 September 2020 / Revised: 14 September 2020 / Accepted: 15 September 2020 / Published online: 1 October 2020 © The Author(s) 2020
In the current issue of the journal, Tam and colleagues explore the use of previously undocumented data, or PUD, about resident performance in making assessment decisions at the level of the clinical competency committee (CCC) at a relatively small postgraduate subspecialty program [1]. Tam and colleagues define previously undocumented data as any information contributing to CCC discussions that was not in documentation brought to the meeting. They provide four categories of this data: summary impressions, contextualizing factors, personal anecdotes and hearsay. While others have described use of such data in CCCs, [2, 3] Tam et al. elaborate on reasons for using this data during CCC meetings and methods for managing it during discussions. The authors suggest that given current limitations of most programs of assessment, there are likely benefits of using previously undocumented data in CCCs to make decisions, and they advocate for this as an acceptable practice. They argue that this practice can help fill gaps in assessment data that are often lacking in quantity, quality or clarity [1]. We agree whole-heartedly that suboptimal assessment data is a major barrier to CCCs making optimal and defensible decisions [4, 5] and that a better understanding of previously undocumented data can help CCCs manage it during meetings. However, Tam and colleagues also acknowledge the potential limitations of their findings. Building on this, we believe four issues warrant further exploration: 1) use of preD. J. Schumacher () · B. Kinnear Department of Pediatrics, University of Cincinnati College of Medicine/Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA [email protected] B. Kinnear Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
viously undocumented data as a symptom of suboptimal programmatic assessment that perhaps should not be used to justify its routine use, 2) the role of program size in the study’s findings, 3) the potential introduction of bias created when using previously undocumented data, and 4) the likely range of trainee acceptance regarding previously undocumented data use. Tam et al. note that multiple barriers exist to capturing previously undocumented data in formal documentation, such as documentation of “idiosyncratic experiences,” limited time, and challenges in capturing complex constructs (e.g. professionalism) or contextual factors [1]. Rather than working around these barriers by using more of this type of data, we believe these short-comings should provide a call to improve programmatic assessment. Filling these gaps should include emphasizing the power of
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