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Acad Med. 2016 Feb;91(2):191-8. doi: 10.1097/ACM.0000000000001044.

Entrustment Decision Making in Clinical Training.

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O. ten Cate is professor of medical education and director, Center for Research and Development of Education, University Medical Center, Utrecht, the Netherlands. D. Hart is associate program director of emergency medicine and director of simulation, Hennepin County Medical Center, and assistant professor, University of Minnesota Medical School; both in Minneapolis, Minnesota. F. Ankel is executive director of health professional education, Healthpartners Institute for Education and Research, Bloomington, Minnesota, and professor of emergency medicine, University of Minnesota Medical School, Minneapolis, Minnesota. J. Busari is program director, Department of Pediatrics, Atrium Medical Center, Heerlen, and associate professor of medical education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands. R. Englander, at the time this article was written, was senior director of competency-based learning and assessment, Association of American Medical Colleges, Washington, DC. N. Glasgow is dean, Medical School, Australian National University, Canberra, Australia. E. Holmboe is senior vice president, Accreditation Council for Graduate Medical Education, Chicago, Illinois. W. Iobst is vice dean and vice president for academic and clinical affairs, Commonwealth Medical College, Scranton, Pennsylvania. E. Lovell is associate program director of emergency medicine, Advocate Christ Medical Center, Oak Lawn, Illinois, and clinical associate professor, University of Illinois at Chicago, Chicago, Illinois. L.S. Snell is professor of medicine, Centre for Medical Education, McGill University, Montreal, Quebec, Canada, and senior clinician educator, Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada. C. Touchie is chief medical education advisor, Medical Council of Canada, and associate professor, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada. E. Van Melle is education researcher, Queen's Univ


The decision to trust a medical trainee with the critical responsibility to care for a patient is fundamental to clinical training. When carefully and deliberately made, such decisions can serve as significant stimuli for learning and also shape the assessment of trainees. Holding back entrustment decisions too much may hamper the trainee's development toward unsupervised practice. When carelessly made, however, they jeopardize patient safety. Entrustment decision-making processes, therefore, deserve careful analysis.Members (including the authors) of the International Competency-Based Medical Education Collaborative conducted a content analysis of the entrustment decision-making process in health care training during a two-day summit in September 2013 and subsequently reviewed the pertinent literature to arrive at a description of the critical features of this process, which informs this article.The authors discuss theoretical backgrounds and terminology of trust and entrustment in the clinical workplace. The competency-based movement and the introduction of entrustable professional activities force educators to rethink the grounds for assessment in the workplace. Anticipating a decision to grant autonomy at a designated level of supervision appears to align better with health care practice than do most current assessment practices. The authors distinguish different modes of trust and entrustment decisions and elaborate five categories, each with related factors, that determine when decisions to trust trainees are made: the trainee, supervisor, situation, task, and the relationship between trainee and supervisor. The authors' aim in this article is to lay a theoretical foundation for a new approach to workplace training and assessment.

[Indexed for MEDLINE]

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