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Cited by 478Innovations in Medical EducationClinical Reasoning and Diagnostic SkillsHospital Admissions and Outcomes

Entrustment Decision Making in Clinical Training

Open access
ten Cate, Olle, Hart, Danielle, Ankel, Felix, Busari, Jamiu, Englander, Robert, Glasgow, Nicholas, Holmboe, Eric, Iobst, William +5 more·2016·Academic Medicine
DOI 10.1097/acm.0000000000001044
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Abstract

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.

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Authors
ten Cate, O., Hart, D., Ankel, F., Busari, J., Englander, R., Glasgow, N., Holmboe, E., Iobst, W., Lovell, E., Snell, L. S., Touchie, C., Van Melle, E., & Wycliffe-Jones, K.
Affiliations
University of Toronto (CA)
ORCID
Venue
Academic Medicine
Publisher
Oxford University Press (OUP)
Published
2016-02
Volume
91
Issue
2
Pages
191-198
ISSN
1040-2446 (ISSN-L)
DOI
10.1097/acm.0000000000001044
OpenAlex
W2416666225
Cited by
478
References
53
Citations by year
2026: 44 · 2025: 36 · 2024: 38 · 2023: 35 · 2022: 45 · 2021: 55 · 2020: 53 · 2019: 64 · 2018: 48 · 2017: 39 · 2016: 15 · 2015: 3 · 2013: 2
FWCI
5.04
Type
journal article
Language
en
Open access
Licence
other-oa
Locations
  • Academic Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Research Publications (Maastricht University) (publishedVersion, other-oa)
  • ANU Open Research (Australian National University) (submittedVersion)
  • Research Publications (Maastricht University) (submittedVersion, other-oa)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
  • Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
  • Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
Keywords
entrustment, clinical teaching, trust, entrustable professional activities, competency-based medical education, workplace-based assessment, trainee autonomy, supervision, trainee-supervisor relationship, patient safety, medical trainees
MeSH terms
Clinical Competence, Competency-Based Education, Decision Making, Education, Medical, Graduate, Humans, Internship and Residency, Interprofessional Relations

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