Entrustment versus performance scale in high-stakes OSCEs: Rater insights and psychometric properties

Abstract

Background

Although entrustment scales are increasingly applied in workplace-based assessments, their role in OSCEs remains unclear. We investigated raters’ perceptions using an entrustment scale and psychometric analyses.

Method

A mixed-methods design was used. OSCE raters’ (n = 162) perceptions were explored via questionnaire and four focus groups (n = 14). Psychometric OSCE properties were analyzed statistically.

Results

Raters (n = 53, response rate = 41%) considered the entrustment scale comprehensible (89%) and applicable (60%). A total of 43% preferred the entrustment scale, 21% preferred the global performance scale, and 36% were undecided. Raters’ written comments indicated that while they appreciated the authenticity of entrustment levels, they considered them subjective. The focus groups highlighted three main themes: (1) recollections of the clinical workplace as a cognitive reference triggered by entrustment scales; (2) factors influencing entrustment decisions; and (3) cognitive load is reduced at the perceived cost of objectivity. Psychometric analyses (n = 480 students) revealed improvements in some OSCE metrics when entrustment and global performance scales were combined.

Conclusion

Entrustment scales are beneficial for high-stakes OSCEs and have greater clinical relevance from the raters’ perspective. Our findings support the use of entrustment and global performance scales in combination.

Keywords:

• Entrustment scale
• objective structured clinical examination
• undergraduate medical education

Disclosure statement

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Glossary

Entrustment: The action of entrusting or the fact of being entrusted. Translated to clinical training, the object of care may be the patient in a general sense, and the task is a professional activity that usually involves this patient.

ten Cate O, Hart D, Ankel F, Busari J, Englander R, Glasgow N, Holmboe E, Iobst W, Lovell E, Snell LS, et al. 2016. Entrustment decision making in clinical training. Acad Med. 91(2):191–198.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors

Severin Pinilla

Severin Pinilla, MD, MEd, PhD, is a clinician researcher at University Hospital of Old Age Psychiatry and Psychotherapy and Department for Assessment and Evaluation (AAE), Institute for Medical Education, University of Bern.

Seraina Lerch

Seraina Lerch, MSc (Psy), is a PhD student at University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern Institute of Medical Psychology, Heidelberg University Hospital, Ruprecht-Karls University Heidelberg, Heidelberg, Germany.

Raphaela Lüdi

Raphaela Lüdi, BSc (Psy), is a psychology Master student at Department for Assessment and Evaluation (AAE), Institute for Medical Education, University of Bern.

Florian Neubauer

Florian Neubauer, MD, PhD, is an educational expert at Department for Assessment and Evaluation (AAE), Institute for Medical Education, University of Bern.

Sabine Feller

Sabine Feller, MA, MAS Ev, is an educational expert at Department for Assessment and Evaluation (AAE), Institute for Medical Education, University of Bern.

Daniel Stricker

Daniel Stricker, Dr. Phil, is a statistician at Department for Assessment and Evaluation (AAE), Institute for Medical Education, University of Bern.

Christoph Berendonk

Christoph Berendonk, MD, MME, is deputy Head of Department of Assessment and Evaluation at the Institute of Medical Education in Bern, Switzerland.

Sören Huwendiek

Sören Huwendiek, MD, PhD, MME, FAMEE, is Head of Department Assessment and Evaluation, Professor (assoc.) for Medical Education Department for Assessment and Evaluation (AAE), Institute for Medical Education, University of Bern.