Applying occupational and organizational psychology theory to entrustment decision-making about trainees in health care: a conceptual model

Abstract

In medical contexts around the world, supervising physicians continuously decide what degree of supervision to apply as trainees carry out professional activities. Although the implications for patients can be far-reaching, little is known about how these entrustment decisions are formed. The concept of ‘Entrustable Professional Activities’ has initiated interest and valuable research on factors that may influence the entrustment decision process.The aim of the current article is to link models of entrustment developed in the fields of occupational and organizational psychology and military psychology to medical education studies that have explored the factors influencing physicians’ entrustment decisions. We provide a conceptual framework of the entrustment decision-making process, which we suggest will contribute to the understanding of how supervising physicians arrive at the decision to entrust a medical trainee with a professional activity.

Trust, entrustment decisions and a few things we shouldn’t forget

“…In this issue of Perspectives on Medical Education, the paper by Holzhausen, Maaz, Cianciolo, Ten Cate and Peters presents a conceptual framework of entrustment decisions, drawing from work in domains of organizational psychology and military psychology [7]. It aims to advance our understanding of how (ad-hoc) entrustment decisions are made in day-to-day clinical practice.…”

Entrustable Professional Activities in final year undergraduate medical training – advancement of the final year training logbook in Germany

“…A crucial challenge in the creation of EPAs was to determine the granularity, which can range from smaller tasks for students, to the complex activities at a specialist doctor level [22], [23]. As students in the FY increasingly undertake real medical tasks and have to perform them safely and independently on patients at the time of starting their careers [http://www.nklm.de], [https://www.gesetze-im-internet.de/_appro_2002/BJNR240500002.html], EPAs were formulated as rather comprehensive units of activity (e.g.…”

“…This facilitates the transition from undergraduate to postgraduate training with its excessive demands on novice doctors and ensures patient safety [21]. Central to this is the question which activities an individual is allowed to carry out, with how much independence and/or under which degree of supervision [22]. Thus, the EPA framework is an assessment-centred concept.…”

Improvement in Context: Exploring Aims, Improvement Priorities, and Environmental Considerations in a National Sample of Programs Using “Small Data”

“…It appeared in 2 strength themes: (1) focus on preparing residents for unsupervised practice, and (2) attributes of a collegial and supportive learning environment. It also appeared under improvement priorities as gaps in the assessment system, which provided insufficient data to support entrustment 15 decisions. Finally, it appeared under the threats theme of reduced faculty time for education and exposure to residents, where interviews noted growth in faculty, reduced continuity between residents and faculty, and recruitment of physicians who lack a deep interest in education.…”