B. Kinnear is associate professor of internal medicine and pediatrics, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; ORCID: https://orcid.org/0000-0003-0052-4130 .
E.J. Warm is professor of internal medicine and program director, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio; ORCID: https://orcid.org/0000-0002-6088-2434 .
Acad Med. 2021 Jul 1;96(7S):S56-S63. doi: 10.1097/ACM.0000000000004108.
Educators use entrustment, a common framework in competency-based medical education, in multiple ways, including frontline assessment instruments, learner feedback tools, and group decision making within promotions or competence committees. Within these multiple contexts, entrustment decisions can vary in purpose (i.e., intended use), stakes (i.e., perceived risk or consequences), and process (i.e., how entrustment is rendered). Each of these characteristics can be conceptualized as having 2 distinct poles: (1) purpose has formative and summative, (2) stakes has low and high, and (3) process has ad hoc and structured. For each characteristic, entrustment decisions often do not fall squarely at one pole or the other, but rather lie somewhere along a spectrum. While distinct, these continua can, and sometimes should, influence one another, and can be manipulated to optimally integrate entrustment within a program of assessment. In this article, the authors describe each of these continua and depict how key alignments between them can help optimize value when using entrustment in programmatic assessment within competency-based medical education. As they think through these continua, the authors will begin and end with a case study to demonstrate the practical application as it might occur in the clinical learning environment.
教育工作者使用委托，这是基于能力的医学教育中的一个常见框架，以多种方式使用，包括一线评估工具、学习者反馈工具以及晋升或能力委员会中的集体决策。在这些多种情况下，委托决策在目的（即预期用途）、利害关系（即感知风险或后果）和过程（即委托的呈现方式）方面可能有所不同。这些特征中的每一个都可以被概念化为具有两个截然不同的极点：（1）目的具有形成性和总结性，（2）利害关系具有低风险和高风险，以及（3）过程具有临时和结构化。对于每个特征，委托决策通常不会完全落在一个极点上，而是介于两者之间。虽然不同，但这些连续体可以而且有时应该相互影响，并可以进行操作以在评估计划中最佳地整合委托。在本文中，作者描述了每个连续体，并描述了它们之间的关键对齐方式如何有助于在基于能力的医学教育中的课程评估中使用委托时优化价值。在考虑这些连续体时，作者将从一个案例研究开始和结束，以展示在临床学习环境中可能发生的实际应用。
