Clarifying essential terminology in entrustment

Abstract

With the rapid uptake of entrustable professional activties and entrustment decision-making as an approach in undergraduate and graduate education in medicine and other health professions, there is a risk of confusion in the use of new terminologies. The authors seek to clarify the use of many words related to the concept of entrustment, based on existing literature, with the aim to establish logical consistency in their use. The list of proposed definitions includes independence, autonomy, supervision, unsupervised practice, oversight, general and task-specific trustworthiness, trust, entrust(ment), entrustable professional activity, entrustment decision, entrustability, entrustment-supervision scale, retrospective and prospective entrustment-supervision scales, and entrustment-based discussion. The authors conclude that a shared understanding of the language around entrustment is critical to strengthen bridges among stages of training and practice, such as undergraduate medical education, graduate medical education, and continuing professional development. Shared language and understanding provide the foundation for consistency in interpretation and implementation across the educational continuum.

Keywords:

• Clinical assessment
• outcomes-based
• undergraduate education
• postgraduate education

Acknowledgments

The concept for this article originated during a two-day forum meeting of the International Competency-Based Medical Education (ICBME) Collaborators in Ottawa, Canada, July 2019.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Glossary

Prospective entrustment-supervision scale: A tool/mechanism for estimating or recommending readiness for future practice. Prospective scales include anchors such as: ‘I judge (or estimate) this learner to be ready for indirect supervision,’ or, if used summatively, ‘From tomorrow, this learner is allowed to practise this EPA under supervisory oversight only.’ Prospective entrustment is a tautology, as all entrustment decisions are prospective.

Additional information

Notes on contributors

Daniel J. Schumacher

Daniel J. Schumacher, MD, PhD, MEd, is an associate professor of pediatrics at Cincinnati Children’s Hospital Medical Center/University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.

Olle ten Cate

Olle ten Cate, PhD, is a professor of medical education and a senior scientist at the Center for Research Development of Education, University Medical Center Utrecht, The Netherlands.

Arvin Damodaran

Arvin Damodaran, FRACP, MMedEd, is a rheumatologist and director of medical education, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Australia.

Denyse Richardson

Denyse Richardson, BScPT, MD, MEd, FRCPC, is an associate professor and clinician educator in the Department of Medicine at the University of Toronto and a clinician educator at the Royal College of Physicians and Surgeons, Canada.

Stanley J. Hamstra

Stanley J. Hamstra, PhD, is vice president, milestones research and evaluation, Accreditation Council for Graduate Medical Education, Chicago, IL, USA, an adjunct professor of education at the University of Ottawa, Ontario, Canada, and an adjunct professor, Department of Medical Education, Feinberg School of Medicine, Northwestern University, Chicago, Illinois USA.

Shelley Ross

Shelley Ross, PhD, is an associate professor and director of innovation and research, CBAS Program, in the Department of Family Medicine at the University of Alberta and is the president of the Canadian Association for Medical Education.

Jennie Hodgson

Jennie Hodgson, BVSc, DACVM, PhD, is the associate dean for professional programs and professor of population health sciences at the Virginia-Maryland College of Veterinary Medicine, Blacksburg, Virginia, USA.

Claire Touchie

Claire Touchie, MD, MHPE, FRCPC, is chief medical education officer at the Medical Council of Canada and professor of medicine at the University of Ottawa, Ottawa, Ontario, Canada.

Laura Molgaard

Laura Molgaard, DVM, is the interim dean at the University of Minnesota College of Veterinary Medicine, St. Paul, Minnesota, USA.

Wade Gofton

Wade Gofton MD, MEd, FRCSC, is a clinician educator at the Royal College of Physicians and Surgeons of Canada and a professor of surgery at the University of Ottawa, Ottawa, Ontario, Canada.

Carol Carraccio

Carol Carraccio, MD, MA, is vice president of competency-based asssessment programs, American Board of Pediatrics, Chapel Hill, North Carolina, USA.