Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA.
Med Educ. 2022 Sep;56(9):892-900. doi: 10.1111/medu.14797. Epub 2022 Mar 16.
Many studies focused on entrustment have not considered prospective entrustment decisions, where clinical competency and entrustment committees determine how much supervision trainees will require in the future for tasks occurring in not completely known contexts. The authors sought to explore factors that influence and determine prospective entrustment decisions made by members of such committees in graduate medical education (GME) and undergraduate medical education (UME).
The authors conducted a constructivist grounded theory study with 23 faculty participants from GME and UME clinical competency and entrustment committees in the United States between October 2020 and March 2021. Interviews sought to explore factors and considerations participants weigh in making prospective entrustment decisions about trainees. Data collection and analysis occurred in an iterative fashion, ensuring constant comparison. Theoretical sampling was used to confirm, disconfirm and elaborate on the evolving results.
Trainees' ability to know limits and seek help is the foundation of participants' prospective entrustment decision making. Most participants, however, describe a presumption of trainee readiness to progress and describe commonly making default prospective entrustment decisions unless 'red flags' in performance are present. Although participants desire sufficient and trusted data about trainee performance to inform decisions, they often lack it. Finally, the perceived permanence and consequences of prospective entrustment decisions influence how participants weigh other factors contributing to prospective entrustment decisions.
Trainees' ability to know limits and seek help appears to be the foundation of prospective entrustment decision making. Training programmes should strive to collect and employ robust data supporting and questioning the presence of these attributes.
许多关注委托的研究并未考虑前瞻性委托决策，即临床能力和委托委员会决定未来学员在不完全了解的情况下完成任务需要多少监督。作者试图探讨影响和决定研究生医学教育（GME）和本科医学教育（UME）中此类委员会成员做出前瞻性委托决策的因素。
作者于 2020 年 10 月至 2021 年 3 月期间，对美国 GME 和 UME 临床能力和委托委员会的 23 名教师参与者进行了建构主义扎根理论研究。访谈旨在探讨参与者在对学员进行前瞻性委托决策时所考虑的因素和注意事项。数据收集和分析以迭代方式进行，以确保不断进行比较。理论抽样用于确认、否定和详细阐述不断发展的结果。
学员了解自身限制并寻求帮助的能力是参与者进行前瞻性委托决策的基础。然而，大多数参与者描述了学员准备好继续进步的假设，并描述了他们通常会做出默认的前瞻性委托决策，除非出现表现上的“红旗”。尽管参与者希望获得关于学员表现的充足和可信赖的数据来为决策提供依据，但他们往往缺乏这些数据。最后，前瞻性委托决策的永久性和后果影响了参与者如何权衡其他影响前瞻性委托决策的因素。
学员了解自身限制并寻求帮助的能力似乎是前瞻性委托决策的基础。培训计划应努力收集和使用支持和质疑这些属性存在的可靠数据。
