Exploring how feedback reflects entrustment decisions using artificial intelligence
Open accessAbstract
Context: Clinical supervisors make judgements about how much to trust learners with critical activities in patient care. Such decisions mediate trainees' opportunities for learning and competency development and thus are a critical component of education. As educators apply entrustment frameworks to assessment, it is important to determine how narrative feedback reflecting entrustment may also address learners' educational needs. Methods: In this study, we used artificial intelligence (AI) and natural language processing (NLP) to identify characteristics of feedback tied to supervisors' entrustment decisions during direct observation encounters of clerkship medical students (3328 unique observations). Supervisors conducted observations of students and collaborated with them to complete an entrustment‐based assessment in which they documented narrative feedback and assigned an entrustment rating. We trained a deep neural network (DNN) to predict entrustment levels from the narrative data and developed an explainable AI protocol to uncover the latent thematic features the DNN used to make its prediction. Results: We found that entrustment levels were associated with level of detail (specific steps for performing clinical tasks), feedback type (constructive versus reinforcing) and task type (procedural versus cognitive). In justifying both high and low levels of entrustment, supervisors detailed concrete steps that trainees performed (or did not yet perform) competently. Conclusions: Framing our results in the factors previously identified as influencing entrustment, we find a focus on performance details related to trainees' clinical competency as opposed to nonspecific feedback on trainee qualities. The entrustment framework reflected in feedback appeared to guide specific goal‐setting, combined with details necessary to reach those goals. Our NLP methodology can also serve as a starting point for future work on entrustment and feedback as similar assessment datasets accumulate.
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Providing effective feedback to medical students can be challenging.
“Providing effective feedback to medical students can be challenging [144–147].”
From Artificial intelligence in undergraduate medical education: an updated scoping review (2025) · cites this paper as [147]
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- Authors
- Gin, B. C., ten Cate, O., O'Sullivan, P. S., Hauer, K. E., & Boscardin, C.
- Affiliations
- University of California, San Francisco (US)
- Utrecht Center for Research and Development of Health Professions Education University Medical Center Utrecht The Netherlands
- Department of Medicine University of California San Francisco San Francisco CA USA
- Corresponding author
- Gin, Brian C.
- Venue
- Medical Education
- Publisher
- Wiley
- Published
- 2021-12
- Volume
- 56
- Issue
- 3
- Pages
- 303-311
- ISSN
- 0308-0110 (ISSN-L)
- 1365-2923
- OpenAlex
- W3213621237
- Cited by
- 37
- References
- 62
- Citations by year
- 2026: 5 · 2025: 13 · 2024: 12 · 2023: 7
- FWCI
- 4.11
- Type
- journal article
- Language
- en
- Open access
- green
- dspace.library.uu.nl
- Licence
- Locations
- Medical Education (publishedVersion)
- PubMed (publishedVersion)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- eScholarship (California Digital Library) (submittedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
- Health Sciences › Medicine › Health Informatics › Artificial Intelligence in Healthcare and Education
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Keywords
- entrustment, clinical supervision, narrative feedback, medical students, clinical rotations, clinical competence, feedback types, task type, goal setting, explainable AI, natural language processing, deep neural network inference
- MeSH terms
- Artificial Intelligence, Clinical Competence, Competency-Based Education, Feedback, Humans, Internship and Residency, Learning, Students, Medical
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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