“Languaging” tacit judgment in formal postgraduate assessment: the documentation of ad hoc and summative entrustment decisions

Abstract

While subjective judgment is recognized by the health professions education literature as important to assessment, it remains difficult to carve out a formally recognized role in assessment practices for personal experiences, gestalts, and gut feelings. Assessment tends to rely on documentary artefacts—like the forms, standards, and policies brought in under competency-based medical education, for example—to support accountability and fairness. But judgment is often tacit in nature and can be more challenging to surface in explicit (and particularly written) form. What is needed is a nuanced approach to the incorporation of judgment in assessment such that it is neither in danger of being suppressed by an overly rigorous insistence on documentation nor uncritically sanctioned by the defense that it resides in a black box and that we must simply trust the expertise of assessors. The concept of entrustment represents an attempt to effect such a balance within current competency frameworks by surfacing judgments about the degree of supervision learners need to care safely for patients. While there is relatively little published data about its implementation as yet, one readily manifest variation in the uptake of entrustment relates to the distinction between ad hoc and summative forms. The ways in which these forms are languaged, together with their intended purposes and guidelines for their use, point to directions for more focused empirical inquiry that can inform current and future uptake of entrustment in competency-based medical education and the responsible and meaningful inclusion of judgment in assessment more generally.

The Implementation of Entrustable Professional Activities in Postgraduate Medical Education in the Netherlands: Rationale, Process, and Current Status

“…In addition, the committees are advised to attend to the general criteria that have been acknowledged as important for entrustment: capability (specific knowledge, skills, experience, situational awareness), integrity (truthful, benevolent, patient centered), reliability (conscientious, predictable, accountable, responsible), humility (recognizes limits, asks for help, receptive to feedback), and agency (proactive toward work, team, safety, personal development), 30 acknowledging that a well-grounded decision does not only weigh "objective" criteria but also aim to include intersubjective judgment. 31 Once the resident has demonstrated the required competence to work under distant supervision and has gained trust for the EPA, the committee makes a summative entrustment decision, documented, and motivated in the portfolio. A more extensive explanation of this process can be found in the literature.…”

How does multisource feedback influence residency training? A qualitative case study

“…Raters must feel confident in their task, 7,35 and trust in raters is needed and appropriate. 36 Training of raters should include information on 'unable to comment' ratings and the scale, including clear reference points and shared discussions on the community's expectations.…”

Actividades profesionales a confiar: hacia una estandarización del lenguaje y significado en español y portugués

“…This is an Open Access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-ncnd/4.0/). relevante en cuanto a tomar decisiones para confiar las EPAs a quienes aprenden 13,14 . Se han realizado publicaciones 2,11,15,16 , presentaciones y cursos para diseminar la estandarización del lenguaje relacionado con las EPAs.…”