Knowing Limits, Seeking Help Are Major Factors in Entrustment Decisions

Published March 2022 | Medical Education

One of the most important factors in deciding what we trust trainees to do in the future is the trainee’s ability to know their own limits and seek help, but evaluation committees often lack robust data confirming those attributes, according to research by Daniel Schumacher, MD, PhD, MEd, and colleagues.

Entrustment committees (in undergraduate medical education) and clinical competency committees (in graduate medical education) understandably look at past performance as a predictor of future performance. This study explored what else is needed to make decisions about what a trainee would be allowed to do in future, unknown situations.

The team undertook a constructivist grounded theory study with 23 faculty participants from clinical competency and entrustment committees in the United States between October 2020 and March 2021.

“What we heard quite clearly and consistently is that ability to know limits and seek help is very important to decisions about what study participants would entrust someone to do in the future. We need to collect more data focusing on these areas,” Schumacher says. “The other finding that stood out for me is that these committees often lack the data they need to make robust decisions and instead put trainees on default pathways of advancement unless red flags arise. As an assessment researcher for the past few decades, this is not a surprising finding to me. However, it is the first study to actually capture this sentiment from study participants. This has important implications for ensuring safe, effective patient care.”