Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Nov;95(11):1662-1669.
doi: 10.1097/ACM.0000000000003427.

Assessing Trainees and Making Entrustment Decisions: On the Nature and Use of Entrustment-Supervision Scales

Olle Ten Cate  1 , Alan Schwartz  2 , H Carrie Chen  3
Affiliations

Assessing Trainees and Making Entrustment Decisions: On the Nature and Use of Entrustment-Supervision Scales

Olle Ten Cate et al. Acad Med. 2020 Nov.

Abstract

Clinical teachers are continuously entrusting trainees with care responsibilities in health care settings. Entrustable professional activities employ entrustment decision making as an approach to assessment in the workplace.Various scales have been created to measure "entrustment," all basically expressing the level or type of supervision a trainee requires for safe and high-quality care. However, some of these scales are only weakly related to the purpose of making decisions about the autonomy trainees will be granted. The authors aim to increase understanding about the nature, purpose, and practice of supervision scales aimed at entrustment.After arguing for entrustment as a component of workplace-based assessment, the distinction between ad hoc entrustment decisions (daily decisions in health care settings) and summative entrustment decisions (with a certifying nature) is clarified. Next, the noncontinuous nature of entrustment-supervision (ES) scales, as opposed to most workplace-based assessment scales, is explained. ES scales have ordinal, rather than interval, properties and focus on discrete decisions. Finally, some scales are retrospective ("how much supervision was provided?"), and others are prospective ("how much supervision will be needed in the near future?"). Although retrospective scales reflect observed behavior, prospective scales truly focus on entrustment and ask for more holistic judgment, as they include a broader evaluation and a risk estimation to enable a decision about increase of autonomy.The analysis concludes with a discussion about entrustment for unsupervised practice and supervision of others, as well as the program, context, and specialty specificity of scales.

PubMed Disclaimer

References

    1. Carraccio C, Wolfsthal SD, Englander R, Ferentz K, Martin C. Shifting paradigms: From Flexner to competencies. Acad Med. 2002;77:361–367
    1. Frank JR, Snell LS, Cate OT, et al. Competency-based medical education: Theory to practice. Med Teach. 2010;32:638–645
    1. ten Cate O. Competency-based postgraduate medical education: Past, present and future. GMS J Med Educ. 2017;34:Doc69
    1. Lurie SJ. History and practice of competency-based assessment. Med Educ. 2012;46:49–57
    1. Lurie SJ, Mooney CJ, Lyness JM. Commentary: Pitfalls in assessment of competency-based educational objectives. Acad Med. 2011;86:412–414

References cited only in Table 1

    1. ten Cate O, Chen HC, Hoff RG, Peters H, Bok H, van der Schaaf M. Curriculum development for the workplace using entrustable professional activities (EPAs): AMEE guide no. 99. Med Teach. 2015;37:983–1002
    1. Peters H, Holzhausen Y, Boscardin C, ten Cate O, Chen HC. Twelve tips for the implementation of EPAs for assessment and entrustment decisions. Med Teach. 2017;39:802–807
    1. Mink RB, Schwartz A, Herman BE, et al. Steering Committee of the Subspecialty Pediatrics Investigator Network (SPIN). Validity of level of supervision scales for assessing pediatric fellows on the common pediatric subspecialty entrustable professional activities. Acad Med. 2018;93:283–291
    1. Kennedy TJ, Lingard L, Baker GR, Kitchen L, Regehr G. Clinical oversight: Conceptualizing the relationship between supervision and safety. J Gen Intern Med. 2007;22:1080–1085
    1. Whalen T, Wendel G. Philibert I, Amis S, eds. Chapter 6: New supervision standards: Discussion and justification. In: The ACGME 2011 Duty Hour Standards: Enhancing Quality of Care, Supervision, and Resident Professional Development. 2011Accreditation Council for Graduate Medical Education;39–45http://www.acgme.org/acgmeweb/Portals/0/PDFs/jgme-11-00-39-45[1].pdf. Accessed April 10, 2020.

LinkOut - more resources