Optimising prospective entrustment: Defaulting on default progression

Hall, Andrew K.; Oswald, Anna

doi:10.1111/medu.14856

Cited by 1 publication

(10 citation statements)

References 15 publications

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“…discernment and humility) as the most central pieces of information about trustworthiness (M) to make defensible PEDs (O) While trustworthiness as a whole was also important in the study producing our IPT, knowing limits and seeking help stood out from the other components. 6,15,20,22,23,[26][27][28][30][31][32][33][34][35][36][37][38][39] Thus, we have retained this emphasis when moving from IPT to MRT. This component of trustworthiness serves as a safety mechanism as trainees encounter novel future problems or contexts, ensuring that support and supervision are appropriate for their ability.…”

Section: Red Flags In Performancementioning

confidence: 99%

“…20,30 As detailed at the beginning of the results, entrustment decisions are often made without as much assessment data as desired. Efforts to increase data are needed 15,23,37,[46][47][48][49] to avoid a 'garbage in, garbage out' situation 50 where non-deliberate (default) decisions are the only possible pathway, as shown in Figure 3. Alternatively, possessing sufficient data can lead to deliberate and effortless decision making.…”

Section: Demi-regularity #3: E/ccc Members (C) Must Possess Sufficien...mentioning

confidence: 99%

“…• quantitative and qualitative data about performance, 37,[52][53][54][55][56] with narrative/written comments found to be most helpful 21,25,37,43,54,57 ;…”

Section: Demi-regularity #3: E/ccc Members (C) Must Possess Sufficien...mentioning

confidence: 99%

“…oral exams, objective structured clinical examination [OSCE] and clinical metrics), including frontline ad hoc entrustment decisions 22,23,31,32,37,38,48,54,56,57 ;…”

Section: Demi-regularity #3: E/ccc Members (C) Must Possess Sufficien...mentioning

confidence: 99%

“…• data from multiple sources (e.g. multi-source feedback), 15,22,32,36,38,58 including trusted frontline assessors, 15,32,37 ad hoc (e.g. hallway conversations and anecdotal) reports, 21,35 resident self-assessment, 54 and patients and other non-physicians 26,33 ; and…”

Section: Demi-regularity #3: E/ccc Members (C) Must Possess Sufficien...mentioning

confidence: 99%

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A realist synthesis of prospective entrustment decision making by entrustment or clinical competency committees

Schumacher,

Michelson,

Winn

et al. 2023

Medical Education

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IntroductionThe real‐world mechanisms underlying prospective entrustment decision making (PEDM) by entrustment or clinical competency committees (E/CCCs) are poorly understood. To advance understanding in this area, the authors conducted a realist synthesis of the published literature to address the following research question: In E/CCC efforts to make defensible prospective entrustment decisions (PEDs), what works, for whom, under what circumstances and why?MethodsRealist work seeks to understand the contexts (C), mechanisms (M) and outcomes (O) that explain how and why things work (or do not). In the authors' study, contexts included individual E/CCC members, E/CCC structures and processes, and training programmes. The outcome (i.e. desired outcome) was a PED. Mechanisms were a substantial focus of the analysis and informed the core findings. To define a final corpus of 52 included papers, the authors searched four databases, screened all results from those searches and performed a full‐text review of a subset of screened papers. Data extraction focused on developing context–mechanism–outcome configurations from the papers, which were used to create a theory for how PEDM leads to PEDs.ResultsPEDM is often driven by default (non‐deliberate) decision making rather than a deliberate process of deciding whether a trainee should be entrusted or not. When defaulting, some E/CCCs find red flags that sometimes lead to being more deliberate with decision making. E/CCCs that seek to be deliberate describe PEDM that can be effortful (when data are insufficient or incongruent) or effortless (when data are robust and tell a congruent story about a trainee). Both information about trainee trustworthiness and the sufficiency of data about trainee performance influence PEDM. Several moderators influence what is considered to be sufficient data, how trustworthiness data are viewed and how PEDM is carried out. These include perceived consequences and associated risks, E/CCC member trust propensity, E/CCC member personal knowledge of and experience with trainees and E/CCC structures and processes.DiscussionPEDM is rarely deliberate but should be. Data about trainee trustworthiness are foundational to making PEDs. Bias, equity and fairness are nearly absent from the papers in this synthesis, and future efforts must seek to advance understanding and practice regarding the roles of bias, equity and fairness in PEDM.

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Section: Red Flags In Performancementioning

confidence: 99%

Section: Demi-regularity #3: E/ccc Members (C) Must Possess Sufficien...mentioning

confidence: 99%

“…• quantitative and qualitative data about performance, 37,[52][53][54][55][56] with narrative/written comments found to be most helpful 21,25,37,43,54,57 ;…”

Section: Demi-regularity #3: E/ccc Members (C) Must Possess Sufficien...mentioning

confidence: 99%

“…oral exams, objective structured clinical examination [OSCE] and clinical metrics), including frontline ad hoc entrustment decisions 22,23,31,32,37,38,48,54,56,57 ;…”

Section: Demi-regularity #3: E/ccc Members (C) Must Possess Sufficien...mentioning

confidence: 99%

Section: Demi-regularity #3: E/ccc Members (C) Must Possess Sufficien...mentioning

confidence: 99%

See 3 more Smart Citations

A realist synthesis of prospective entrustment decision making by entrustment or clinical competency committees

Schumacher,

Michelson,

Winn

et al. 2023

Medical Education

View full text Add to dashboard Cite

show abstract

Optimising prospective entrustment: Defaulting on default progression

Abstract: Hall and Oswald argue that when clinical competence committees default to progression in the face of inadequate data requires revision to programs of assessment, improved data visualization, and targeted faculty development.

Cited by 1 publication

References 15 publications

A realist synthesis of prospective entrustment decision making by entrustment or clinical competency committees

A realist synthesis of prospective entrustment decision making by entrustment or clinical competency committees

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