Entrustability Scales: Outlining Their Usefulness for Competency-Based Clinical Assessment.

Area of Science:

• Medical Education
• Clinical Assessment
• Residency Training

Background:

• Bedside education and in-training assessment are crucial for residency programs.
• Clinical supervisors' subjective judgments in workplace-based assessment (WBA) can be valuable but prone to bias.
• Improving WBA validity while retaining meaningful subjective judgment is a challenge.

Purpose of the Study:

• To introduce entrustability scales as a method to bridge the gap between clinical supervisor judgments and WBA instruments.
• To enhance the reliability and validity of WBA by structuring assessments around real-world entrustment decisions.

Main Methods:

• Proposed entrustability scales as behaviorally anchored ordinal scales based on progression to competence.
• Structured assessment measures around how evaluators make day-to-day clinical entrustment decisions.
• Utilized narrative descriptors reflecting real-world judgments for trainee readiness for independent practice.

Main Results:

• Entrustability scales provide a clinically meaningful judgment for assessors, increasing assessment reliability.
• These scales focus on a trainee's readiness for independent practice rather than deficiencies.
• Variations of entrustability scales in existing WBA tools show potential for valid judgments.

Conclusions:

• Entrustability scales offer a promising approach to improve the validity and reliability of workplace-based assessment in residency education.
• These scales facilitate milestone measurement and help identify residents needing additional support.
• Wider adoption of entrustability scales is recommended for enhanced clinical assessment.