TY - JOUR
T1 - How Entrustment Is Informed by Holistic Judgments Across Time in a Family Medicine Residency Program
T2 - An Ethnographic Nonparticipant Observational Study
AU - Sagasser, Margaretha H.
AU - Fluit, Cornelia R. M. G.
AU - van Weel, Chris
AU - van der Vleuten, Cees P. M.
AU - Kramer, Anneke W. M.
PY - 2017/6
Y1 - 2017/6
N2 - PurposeEntrustment has mainly been conceptualized as delegating discrete professional tasks. Because residents provide most of their patient care independently, not all resident performance is visible to supervisors; the entrustment process involves more than granting discrete tasks. This study explored how supervisors made entrustment decisions based on residents' performance in a long-term family medicine training program.MethodA qualitative nonparticipant observational study was conducted in 2014-2015 at competency-based family medicine residency programs in the Netherlands. Seven supervisor-resident pairs participated. During two days, one researcher observed first-year residents' patient encounters, debriefing sessions, and supervisor-resident educational meetings and interviewed them separately afterwards. Data were collected and analyzed using iterative, phenomenological inductive research methodology.ResultsThe entrustment process developed over three phases. Supervisors based their initial entrustment on prior knowledge about the resident. In the ensuing two weeks, entrustment decisions regarding independent patient care were derived from residents' observed general competencies necessary for a range of health problems (clinical reasoning, decision making, relating to patients); medical knowledge and skills; and supervisors' intuition. Supervisors provided supervision during and after encounters. Once residents performed independently, supervisors kept reevaluating their decisions, informed by residents' overall growth in competencies rather than by adhering to a predefined set of tasks.ConclusionsSupervisors in family medicine residency training took a holistic approach to trust, based on general competencies, knowledge, skills, and intuition. Entrustment started before training and developed over time. Building trust is a mutual process between supervisor and resident, requiring a good working relationship.
AB - PurposeEntrustment has mainly been conceptualized as delegating discrete professional tasks. Because residents provide most of their patient care independently, not all resident performance is visible to supervisors; the entrustment process involves more than granting discrete tasks. This study explored how supervisors made entrustment decisions based on residents' performance in a long-term family medicine training program.MethodA qualitative nonparticipant observational study was conducted in 2014-2015 at competency-based family medicine residency programs in the Netherlands. Seven supervisor-resident pairs participated. During two days, one researcher observed first-year residents' patient encounters, debriefing sessions, and supervisor-resident educational meetings and interviewed them separately afterwards. Data were collected and analyzed using iterative, phenomenological inductive research methodology.ResultsThe entrustment process developed over three phases. Supervisors based their initial entrustment on prior knowledge about the resident. In the ensuing two weeks, entrustment decisions regarding independent patient care were derived from residents' observed general competencies necessary for a range of health problems (clinical reasoning, decision making, relating to patients); medical knowledge and skills; and supervisors' intuition. Supervisors provided supervision during and after encounters. Once residents performed independently, supervisors kept reevaluating their decisions, informed by residents' overall growth in competencies rather than by adhering to a predefined set of tasks.ConclusionsSupervisors in family medicine residency training took a holistic approach to trust, based on general competencies, knowledge, skills, and intuition. Entrustment started before training and developed over time. Building trust is a mutual process between supervisor and resident, requiring a good working relationship.
KW - ENTRUSTABLE PROFESSIONAL ACTIVITIES
KW - LONGITUDINAL INTEGRATED CLERKSHIPS
KW - QUALITATIVE RESEARCH
KW - HEALTH-CARE
KW - CLINICAL EDUCATION
KW - GENERAL-PRACTICE
KW - COMPETENCE
KW - SUPERVISORS
KW - TRAINEES
KW - TRUST
U2 - 10.1097/ACM.0000000000001464
DO - 10.1097/ACM.0000000000001464
M3 - Article
C2 - 28557945
SN - 1040-2446
VL - 92
SP - 792
EP - 799
JO - Academic Medicine
JF - Academic Medicine
IS - 6
ER -