Making Sense of Trainee Performance: Entrustment Decision-Making in InternalMedicine Program Directors

摘要

Background: Competency-based assessment is an important butchallenging aspect of residency education but determines trainees’ progression towardsthe ultimate goal of graduation. Entrustment decision making has been proposed as asupplementary metric to assess trainee competence. This study explores the process bywhich Program Directors (PDs) make entrustment decisions in Internal Medicine (IM)training programs. Study Design: Purposive sampling was used to recruit PDsfrom ACGME-accredited IM training programs to participate in a semi-structuredinterview. We analyzed interviews using an iterative, grounded theory-based approach toallow identification of themes that define the process of trainee entrustment.Results: Sixteen PDs were interviewed. Qualitative analysis showed thatPDs use a dynamic process to understand trainee entrustability and progression towardscompetence, including construction of assessment networks, comparing performance toexpected trajectory of trainee competence development, and bidirectional filtering andweighing of assessment data. Conclusions: PDs serve as a central processorby which assessment data on trainees is filtered, weighted, and compared an expectedtrajectory, all to gain understanding of trainee performance. Assessment networks arecrucial to understanding trainee competence. While expected trajectory is an importanttool to determine how trainees are progressing, its continued use may inject bias intothe assessment process and slow transition to true competency-basedassessment.