O. ten Cate is professor of medical education and senior scientist, Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, the Netherlands; ORCID: https://orcid.org/0000-0002-6379-8780.
A. Schwartz is Michael Reese Endowed Professor of Medical Education, interim head, Department of Medical Education, and research professor, Department of Pediatrics, University of Illinois College of Medicine, Chicago, Illinois, and director, Longitudinal Educational Assessment Research Network, Association of Pediatric Program Directors, McLean, Virginia; ORCID: http://orcid.org/0000-0003-3809-6637.
Acad Med. 2020 Nov;95(11):1662-1669. doi: 10.1097/ACM.0000000000003427.
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.
临床教师在医疗环境中不断将护理责任委托给受训者。可委托的专业活动采用委托决策作为工作场所评估的一种方法。已经创建了各种量表来衡量“委托”，所有这些量表基本上都表达了受训者进行安全和高质量护理所需的监督级别或类型。然而，其中一些量表与关于将自主权授予受训者的决策的目的仅弱相关。作者旨在提高对旨在委托的监督量表的性质、目的和实践的理解。在论证委托作为基于工作场所的评估的一个组成部分之后，澄清了临时委托决策（医疗环境中的日常决策）和总结性委托决策（具有证明性质）之间的区别。接下来，解释了委托-监督（ES）量表的非连续性，与大多数基于工作场所的评估量表相反。ES 量表具有序数而不是区间属性，并且侧重于离散决策。最后，一些量表是回顾性的（“提供了多少监督？”），而另一些则是前瞻性的（“在不久的将来需要多少监督？”）。虽然回顾性量表反映了观察到的行为，但前瞻性量表真正专注于委托，并要求更全面的判断，因为它们包括更广泛的评估和风险估计，以便能够做出关于增加自主权的决策。分析最后讨论了无监督实践和对他人的监督的委托，以及计划、背景和专业的特殊性。
