Table 3 Results

Individual-Level Factors: Trustor Factors

Propensity to Trust [15, 17, 18, 28, 33, 40]

A general willingness to trust others that varies with people’s different experiences, personality types, and cultures

Committee members have different propensities to trust other members and the process that the committee uses to make collective decisions. A large degree of propensity to trust asymmetry may adversely affect group level trust.

Vulnerability [15, 23]

Exposure to the possibility of being harmed, either physically or emotionally

Committee members with higher levels of trust toward other individuals or the group are willing to accept more personal vulnerability than less trusting individuals.

Individual-Level Factors: Trustee Factors

Perceived Trustworthiness [15]

Characteristics and actions of an individual or group that help explain why some parties are more trusted than others

At the individual level, a committee member’s ability, benevolence, and integrity contribute to his/her perceived trustworthiness by other members, which determines how much he/she will be trusted within the group. Collectively at the group level one may also judge these factors from an external perspective (e.g. the training program, patients, etc) to determine the perceived trustworthiness of competency committee decisions and the group itself.

Ability [15, 41]

A group of skills and competencies that enable an individual to have influence within some specific domain

Benevolence [15]

The extent to which a trustee is believed to want to do good to those individuals on the giving end of a trusting relationship (i.e. trustors)

Integrity [15]

The trustor’s perception that the trustee adheres to a set of principles that the trustor finds acceptable

Perceived Commitment to the Group [41]

Established group members are more likely to trust new members who seem more committed to the group

A committee member’s commitment to the group and how that commitment is perceived within the group may influence how much that individual is trusted by other members.

Individual-Level Factors: Interpersonal Interactions

Imported Information [40]

Preexisting knowledge, stereotypes, and preconceptions stored in group members’ memories

Committee members bring their own personal experiences regarding individual trainees to the committee. This information forms the basis for discussions regarding trainee competence and attainment of specific educational milestones.

Shared Mental Model [42, 43]

The shared knowledge and organized understanding of the information and resources used by the group, tasks and problems faced by the group, and individual group members’ imported information

Developing a shared model of trainee competence is critical for these committee decisions. Sources of shared information include written evaluations, results of knowledge exams, conversations amongst faculty members with their own experiences with the trainees, etc.

Potential for Future Interactions and Relationships [33]

A person’s early feelings about group members can create a sense of optimism about the potential of the relationship

New committee members may be more willing to cooperate with other members given the potential of building stronger future relationships.

Political Skill [44]

A social effectiveness construct defined as the ability to effectively understand others at work and to use such knowledge to influence others to act in ways that enhance one’s personal and/or organizational objectives

A committee member who has particularly strong opinions about a trainee may be more persuasive (and potentially trusted as well) based upon his or her degree of political skill.

Relational Identity Orientation [45]

One’s conception of his/her relatedness to other individuals

Committee members with a high relational identity orientation may take great steps to build relationships within the group and will likely be more trusted as well.

Need for Affiliation [33]

An overlapping common factor among group members that motivates them to view each other as trustworthy

This collective need helps a committee build a shared level of trust amongst members and within the group.

Standing in the Group [38]

A person’s inclusion or membership in a group (e.g. power or hierarchy differentials)

An individual’s position, whether specified (e.g. the committee chair) or unspecified (e.g. based upon seniority, rank, job title outside the committee, etc.) may affect how other members interact with this person. Large perceived differences in this category may adversely affect interactions and therefore trust.

Group Level Factors: Group Structure

Diversity [21, 22, 34, 40, 42, 45]

While cultural diversity has positive and negative influences on group trust, skill diversity has been shown to positively impact intragroup trust and group performance

Members of the committee should have a number of shared traits given that they are associated with the healthcare field and educating trainees, thus cultural diversity should have a smaller influence on these committee decisions. Diversity of opinions and skill diversity are likely beneficial to committee decisions, leading to higher levels of trust.

Group Member Stability [42]

Positively impacts communication patterns, the social interaction of teams, and interpersonal trust

Committee member stability is important, especially if faculty members are assigned specific trainees to follow longitudinally.

Group Size [25]

Smaller groups have been shown to be more trustworthy than larger groups

While small groups are perceived to be more trustworthy from an external perspective, training programs need to weigh factors such as the number of trainees and faculty availability when deciding the optimal size of their competency committee(s).

Group Level Factors: Group Processes

Cooperation and Monitoring [8, 17, 28, 33, 46]

Group members who experience high trust tend to cooperate, share information, accept influences from others, and feel personally involved with the group. Monitoring behaviors usually occur when trust between members is low and manifest when members feel a need to be vigilant about the actions and intentions of others.

Trust between committee members will most likely lead to increased cooperation. If trust is low, committee members may increase their monitoring behaviors, which detracts from the collective decision-making process and likely affects the quality of these committee decisions.

Conflict [26, 31,32,33, 43, 47, 48]

One of the most important factors influencing group trust. Task conflict is generally felt to be functional while relationship conflict may be dysfunctional. Higher levels of either type of conflict usually lead to diminished group trust

To a certain extent, task conflict in a competency committee may lead to better decisions. When faculty members have different opinions about trainees, the discussion may be livelier. As long as the discussion doesn’t get hijacked by those with strong opinions or degenerate into relationship conflict, variable faculty member opinions and experiences with trainees likely leads to better group decisions.

Procedural Fairness [16, 42, 49, 50]

For decision-making groups, this includes consideration of member input and influence over a decision. Fairness of procedures used by a group has been associated with increased levels of trust and commitment to group decisions.

Committee decisions are likely to be more trustworthy when the group follows procedures that are judged as fair by faculty members and trainees.

Swift Trust [33, 40]

Occurs when individuals decide to trust others prior to developing longer term relationships. Swift trust develops as a function of members’ own dispositional tendencies, quickly discernable surface-level cues of others, and imported trust-related information.

Initial/swift trust usually occurs in newly formed committees or with new members (especially if they don’t work with more established members in other contexts). These individuals will have to decide if they are going to trust other members of the group and the committee itself before developing deeper relationships.

Task Interdependence [8, 34]

The degree to which group members rely on one another and interact in order for the group to accomplish its goals, which may have an effect on group trust and trust between group members

Making collective decisions about trainee competence relies on the “wisdom of the group.” Each faculty member only has a portion of the data based upon their own experiences. The group must compile performance data and members’ experiences to build a collective picture of individual trainee competence.

Climate [36, 41,42,43,44,45, 51, 52]

Components include a common group identity, group efficacy, psychological safety, psychological collectivism, and psychological ownership

The internal climate of a committee may be influenced by each of these factors. A common group identity, group efficacy, and psychological safety are probably most important for competency committees.

Leadership [23, 37, 38, 40, 42, 43, 45, 53, 54]

Components include leadership style, characteristics, and behaviors

The committee chair is responsible for implementing the training program’s policies and procedures related to this committee. Committee chairs may be more effective at building individual and collective trust if they are prototypical of the group, utilize an authentic or transformational leadership style, create a safe atmosphere, manage conflict/discussions, and demonstrate relational behaviors.

Environmental Factors

Reporting Relationships [54]

In settings where groups report to diverse outside entities, these reporting relationships can be associated with role conflict, confusing expectations or role ambiguity, excessive demands, and competing priorities

The committee reports to their respective training program, which in turn reports information about resident performance to various accreditation agencies. If a committee is required to report to another entity outside of this chain, it may decrease trust amongst members of the group, especially given the sensitive nature of trainee performance information.

Task Complexity and Uncertainty [40, 41]

Associated with decreased levels of trust within a group, especially if the group is newly formed

For a competency committee, it may be challenging to determine the attainment of various clinical competence domains for all trainees, especially with gaps in evaluation data or for large training programs. Increasing complexity and uncertainty may adversely affect trust by members in the committee’s processes and decisions.

Outside Group Membership/ Social Ties [41]

Group members may be worried that membership in other groups can lead new members to act in ways that harm their own group.

Committee members who serve on other hospital committees (e.g. credentials, risk management, etc.) may be perceived as more or less trustworthy from other members. However, this is probably a small contributor to trust within these committees.

Threats [41]

External dangers or conflict with another group

Time pressures and faculty availability (either for individual meetings or to serve longitudinally on the committee) are potential threats to group level trust within a competency committee. However, an understaffed committee may lead to higher trust between group members.

Staffing Levels [41]

Understaffed groups may develop stronger trust amongst members than larger groups

Trust Outcomes

Attitudes [22,23,24, 27, 33, 36, 40]

May include confidence, resiliency, creativity, group satisfaction and identity, cooperation, and commitment

Individual and group level trust within competency committees may lead to greater cooperation, commitment to the group, satisfaction, and confidence in group decisions.

Performance [22, 40, 42, 43, 55]

May include group performance, group learning, information sharing, and decision quality

Individual and group level trust within competency committees may lead to better sharing of information, group learning, and quality of decisions.