Finding a Path to Entrustment in Undergraduate Medical Education: A Progress Report From the AAMC Core Entrustable Professional Activities for Entering Residency Entrustment Concept Group

Brown, David R.; Warren, Jamie B.; Hyderi, Abbas; Drusin, Ronald E.; Moeller, Jeremy J.; Rosenfeld, Melvin G.; Orlander, Philip R.; Yingling, Sandra; Call, Stephanie; Terhune, Kyla P.; Bull, Janet; Englander, Robert; Wagner, Dianne

doi:10.1097/acm.0000000000001544

Cited by 87 publications

(52 citation statements)

References 9 publications

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“…While we did not explicitly present this distinction during the focus groups, we found hesitation among participants to make critical decisions to grant responsibility when insufficient information was available [ 13 ]. Faculty development will be necessary to explain these types of entrustment decisions as being situational versus focused on summative assessment, when introducing workplace curricula based on EPAs [ 12 , 14 ]; clearly in the latter case, our participants felt a need to have sufficient information to ground entrustment decisions. Further research could optimize the decision variables in the clinical workplace and could outline decision variables specific in ad hoc situations and variables that ground summative entrustment.…”

Section: Discussionmentioning

confidence: 99%

“…Using entrustable professional activities (EPAs)—units of professional practice to be entrusted to learners once they have demonstrated sufficient competence—in medical training programs requires elaboration of entrustment decision processes [ 11 – 14 ]. Entrustment decisions require a grounded entrustment process, based on decision variables collected in the clinical workplace over time.…”

Section: Introductionmentioning

confidence: 99%

“…Entrustment decisions combine traditional assessment of ability with the right to execute an EPA without (or with indirect) supervision [ 23 ]. There are many variables of influence in determining how, when, and whether learners are granted responsibilities under indirect or distant supervision [ 7 , 14 ]. Clinical teachers should take these variables into account and push learners to stretch their scope of performance with the need for safe, high-quality patient care.…”

Section: Introductionmentioning

confidence: 99%

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When to trust our learners? Clinical teachers’ perceptions of decision variables in the entrustment process

Duijn¹,

Welink²,

Bok³

et al. 2018

Perspect Med Educ

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IntroductionClinical training programs increasingly use entrustable professional activities (EPAs) as focus of assessment. However, questions remain about which information should ground decisions to trust learners. This qualitative study aimed to identify decision variables in the workplace that clinical teachers find relevant in the elaboration of the entrustment decision processes. The findings can substantiate entrustment decision-making in the clinical workplace.MethodsFocus groups were conducted with medical and veterinary clinical teachers, using the structured consensus method of the Nominal Group Technique to generate decision variables. A ranking was made based on a relevance score assigned by the clinical teachers to the different decision variables. Field notes, audio recordings and flip chart lists were analyzed and subsequently translated and, as a form of axial coding, merged into one list, combining the decision variables that were similar in their meaning.ResultsA list of 11 and 17 decision variables were acknowledged as relevant by the medical and veterinary teacher groups, respectively. The focus groups yielded 21 unique decision variables that were considered relevant to inform readiness to perform a clinical task on a designated level of supervision. The decision variables consisted of skills, generic qualities, characteristics, previous performance or other information. We were able to group the decision variables into five categories: ability, humility, integrity, reliability and adequate exposure.DiscussionTo entrust a learner to perform a task at a specific level of supervision, a supervisor needs information to support such a judgement. This trust cannot be credited on a single case at a single moment of assessment, but requires different variables and multiple sources of information. This study provides an overview of decision variables giving evidence to justify the multifactorial process of making an entrustment decision.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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When to trust our learners? Clinical teachers’ perceptions of decision variables in the entrustment process

Duijn¹,

Welink²,

Bok³

et al. 2018

Perspect Med Educ

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“…The entrustment of an activity is clearly defined from level to level and is based on an explicit and transparent decision after adequate discussion in the responsible and (preferably) inter-professional team [32]. This takes place on a regular basis (e.g.…”

Section: Concept Developmentmentioning

confidence: 99%

“…The extent to which assessments of supervisors from previous electives are adopted is left to the respective supervisor and depends, among other things, on the extent to which the EPA concept can be implemented throughout a hospital in the context of the FY training. Of particular importance, however, is also the perceived trustworthiness and reliability of the student [18], [32]. The principle of trust and entrustment requires the following three fundamen-tal elements: …”

Section: Concept Developmentmentioning

confidence: 99%

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

Berberat

Rotthoff

Baerwald

et al. 2019

GMS Journal for Medical Education; 36(6):Doc70

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Comparing Entrustment Decision-Making Outcomes of the Core Entrustable Professional Activities Pilot, 2019-2020

et al. 2022

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ImportanceGaps in readiness for indirect supervision have been identified for essential responsibilities encountered early in residency, presenting risks to patient safety. Core Entrustable Professional Activities (EPAs) for entering residency have been proposed as a framework to address these gaps and strengthen the transition from medical school to residency.ObjectiveTo assess progress in developing an entrustment process in the Core EPAs framework.Design, Setting, and ParticipantsIn this quality improvement study in the Core EPAs for Entering Residency Pilot, trained faculty made theoretical entrustment determinations and recorded the number of workplace-based assessments (WBAs) available for each determination in 2019 and 2020. Four participating schools attempted entrustment decision-making for all graduating students or a randomly selected subset of students. Deidentified, individual-level data were merged into a multischool database.InterventionsSchools implemented EPA-related curriculum, WBAs, and faculty development; developed systems to compile and display data; and convened groups to make theoretical summative entrustment determinations.Main Outcomes and MeasuresOn an EPA-specific basis, the percentage of students for whom an entrustment determination could be made, the percentage of students ready for indirect supervision, and the volume of WBAs available were recorded.ResultsFour participating schools made 4525 EPA-specific readiness determinations (2296 determinations in 2019 and 2229 determinations in 2020) for 732 graduating students (349 students in 2019 and 383 students in 2020). Across all EPAs, the proportion of determinations of “ready for indirect supervision” increased from 2019 to 2020 (997 determinations [43.4%] vs 1340 determinations [60.1%]; 16.7 percentage point increase; 95% CI, 13.8-19.6 percentage points; P &lt; .001), as did the proportion of determinations for which there were 4 or more WBAs (456 of 2295 determinations with WBA data [19.9%] vs 938 [42.1%]; 22.2 percentage point increase; 95% CI, 19.6-24.8 percentage points; P &lt; .001). The proportion of EPA-specific data sets considered for which an entrustment determination could be made increased from 1731 determinations (75.4%) in 2019 to 2010 determinations (90.2%) in 2020 (14.8 percentage point increase; 95% CI, 12.6-16.9 percentage points; P &lt; .001). On an EPA-specific basis, there were 5 EPAs (EPA 4 [orders], EPA 8 [handovers], EPA 10 [urgent care], EPA 11 [informed consent], and EPA 13 [patient safety]) for which few students were deemed ready for indirect supervision and for which there were few WBAs available per student in either year. For example, for EPA 13, 0 of 125 students were deemed ready in 2019 and 0 of 127 students were deemed ready in 2020, while 0 determinations in either year included 4 or more WBAs.Conclusions and RelevanceThese findings suggest that there was progress in WBA data collected, the extent to which entrustment determinations could be made, and proportions of entrustment determinations reported as ready for indirect supervision. However, important gaps remained, particularly for a subset of Core EPAs.

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Finding a Path to Entrustment in Undergraduate Medical Education: A Progress Report From the AAMC Core Entrustable Professional Activities for Entering Residency Entrustment Concept Group

Cited by 87 publications

References 9 publications

When to trust our learners? Clinical teachers’ perceptions of decision variables in the entrustment process

When to trust our learners? Clinical teachers’ perceptions of decision variables in the entrustment process

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

Comparing Entrustment Decision-Making Outcomes of the Core Entrustable Professional Activities Pilot, 2019-2020

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