How Entrustment Is Informed by Holistic Judgments Across Time in a Family Medicine Residency Program: An Ethnographic Nonparticipant Observational Study

Sagasser, Margaretha H.; Fluit, Cornelia; Weel, Chris van; Vleuten, Cees van der; Kramer, Anneke

doi:10.1097/acm.0000000000001464

Cited by 33 publications

(34 citation statements)

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“…37 In the second stage of trust development, when the trust development process focuses on working and learning in daily practice, trainers and trainees have different styles in trusting each other, and different goals for trusting each other. The factors influencing the trust of trainers in their trainees were the same ones identified by Hauer et al, 14 and Sagasser et al 15 in their studies into this process. Trainees in the second stage of trust development develop trust in their trainer based on the availability and accessibility of the trainer for the trainee, and on their personal relationship.…”

Section: Discussionsupporting

confidence: 54%

Insight in the development of the mutual trust relationship between trainers and trainees in a workplace-based postgraduate medical training programme: a focus group study among trainers and trainees of the Dutch general practice training programme

et al. 2020

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ObjectivesTrust plays an important role in workplace-based postgraduate medical education programmes. Trainers must trust their trainees for granting them greater independence. Trainees must trust their trainer for a safe learning environment. As trainers’ and trainees’ trust in each other plays an important role in trainee learning and development, the authors aimed to explore the development of the mutual trust relationship between trainers and trainees.SettingThis study was performed in a general practice training department in the Netherlands.ParticipantsAll trainers and trainees of the general practice training department were invited to participate. Fifteen trainers and 34 trainees, voluntarily participated in focus group discussions.Outcome measuresThe authors aimed to gain insight in the factors involved in the development of the mutual trust relationship between trainers and trainees, in order to be able to create a model for the development of a mutual trust relationship between trainers and trainees. The risk-based view of trust was adopted as leading conceptual framework.ResultsIn the first stage of trust development, trainers and trainees develop basic trust in each other. Basic trust forms the foundation of the trust relationship. In the second stage, trainers develop trust in trainees taking into account trainees’ working and learning performance, and the context in which the work is performed. Trainees trust their trainer based on the trainer’savailability and accessibility and the personal relationship between the trainee and their trainer. Trainee self-confidence modifies the development of a trust relationship.ConclusionThe development of a mutual trust relationship between trainers and trainees is a complex process that involves various stages, goals, factors and interactive aspects. As the mutual trust relationship influences the learning environment for trainees, greater emphasis on the mutual trust relationship may improve learning outcomes. Further research may explore the effect of long-term and short-term educational relationships on the trust relationship between trainers and trainees.

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Section: Discussionsupporting

confidence: 54%

Insight in the development of the mutual trust relationship between trainers and trainees in a workplace-based postgraduate medical training programme: a focus group study among trainers and trainees of the Dutch general practice training programme

et al. 2020

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“…d. The context includes patient complexity, available facilities, time of day or night, staffing requirements, but also the rules of supervision, restrictions of the working hours, and perception of student mentality. 36 e. The relationship between the student and the clinical supervisor must evolve beyond the initial impressions to allow for criticism in entrustment decisions 37,38 and this relationship in postgraduate studies has been described as a dance that takes place between the experienced resident and the clinical supervisor, when residents reach the end of their training. 39 As the 'summative-entrustment decision' is of a certification nature, sometimes referred to as the 'Statement of Awarded Responsibility' (STAR) 19 , it must be based on sufficiently substantiated trust, 26 which, to avoid risks of subjectivity, would include an agreement between multiple observers and multiple observations so that entrustment can be justified.…”

Section: Entrustment Decisionsmentioning

confidence: 99%

Guia Atualizado sobre Atividades Profissionais Confiáveis (APCs)

Cate

2019

Rev. bras. educ. med.

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Since the turn of the millennium, competency-based medical education (CBME) has become a new standard for medical training in many countries. CBME has been operationalized in detailed frameworks of competencies that every physician should demonstrate at graduation, and similar frameworks have been created for specialties. However, the competencies, describing qualities that physicians should possess, do not directly translate into everyday activities of physicians. For that reason, the Entrustable Professional Activities (EPAs) were introduced. EPAs are units of professional practice that may be entrusted to undergraduate students, once they show the competencies needed to perform them without supervision. EPAs have become a popular topic within CBME programs in many countries and hundreds of publications within only a few years. This paper was written to introduce the strengths and weaknesses of EPAs. After a brief historical overview, the reason why EPAs are a bridge between a competency framework and daily clinical practice is explained. While competencies are qualities of individuals, EPAs are units of work. The two can be seen as two dimensions of a matrix, showing that almost all activities in health care are based on multiple competencies, such as communication skill, collaboration, professional behavior, content knowledge. Next, entrustment decision-making as a form of assessment is created and a framework of levels of supervision is presented. Entrustment decisions focus on the level of supervision a student requires for a specific activity, divided into five levels (1: allowed to observe; 2; allowed to perform under direct supervision; 3: allowed to perform under indirect supervision; 4: allowed to perform the activity unsupervised; 5: allowed to supervise the activity performed by more junior learners). For readers interested in applying the concept to practice, a stepwise approach to the curriculum development is proposed. The paper concludes with an overview of the state-of-the-art of working with EPAs across disciplines, professions and countries.

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“…-El contexto incluye la complejidad del paciente, las instalaciones disponibles, la hora del día o de la noche, la necesidad de personal, pero también las reglas sobre la supervisión, las restricciones horarias laborales y la percepción de la mentalidad de trabajo de los alumnos [37]. -La relación entre el alumno y el clínico supervisor debe evolucionar más allá de las primeras impresiones para permitir las decisiones de encomienda [38,39]; se ha comparado a un baile que tiene lugar entre el residente sénior y el clínico supervisor cuando los residentes se acercan a la finalización de su formación [40].…”

Section: Decisiones De Encomiendaunclassified

Guía sobre las actividades profesionales confiables

Cate

2017

FEM

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Guía sobre las actividades profesionales confiables Olle ten Cate Resumen. Las actividades profesionales confiables (APROC)-entrustable professional activities-se han convertido en un tema de actualidad en los programas de educación médica basados en competencias en diferentes países y han sido objeto de centenares de publicaciones en pocos años. Este trabajo se ha traducido al castellano con el fin de introducir las ventajas e inconvenientes de las APROC. Tras una breve revisión histórica, se describe la razón de ser de las APROC como un puente entre el marco competencial y la practica clínica diaria. A continuación, se elabora la toma de decisiones como sistema de evaluación y se presenta el marco de los diferentes niveles de supervisión. Para los lectores interesados en aplicar este concepto en la práctica, se propone un proceso paso a paso para el desarrollo de un currículo basado en las APROC. El artículo concluye con una revisión del estado de la cuestión del trabajo con APROC en diferentes disciplinas, profesiones y países. Palabras clave. Actividades profesionales confiables. Competencias. Currículo. Educación médica. Práctica clínica.

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How Entrustment Is Informed by Holistic Judgments Across Time in a Family Medicine Residency Program: An Ethnographic Nonparticipant Observational Study

Cited by 33 publications

References 40 publications

Insight in the development of the mutual trust relationship between trainers and trainees in a workplace-based postgraduate medical training programme: a focus group study among trainers and trainees of the Dutch general practice training programme

Insight in the development of the mutual trust relationship between trainers and trainees in a workplace-based postgraduate medical training programme: a focus group study among trainers and trainees of the Dutch general practice training programme

Guia Atualizado sobre Atividades Profissionais Confiáveis (APCs)

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