Entrustment Checkpoint: Clinical Supervisors' Perceptions of the Emergency Department Oral Case Presentation

Phenomenon: The oral case presentation represents a unique method of communication and forms the foundation for trainee-supervisor interactions in the clinical setting. Recently, entrustment has been highlighted as an essential element of trainee-supervisor interactions. Despite the growing body of knowledge concerning entrustment in medical education, how supervisors conceptualize the oral case presentation as a contributor to entrustment decision making during clinical supervision remains unknown. Given their widespread use, oral case presentations may represent a potential tool for future frameworks of workplace-based assessment. This study sought to explore what factors influence supervisors' expectations of oral case presentation content and how the oral case presentation may contribute to entrustment decision making. Approach: Using qualitative methodology, semistructured interviews were conducted from a purposive sample of attending emergency medicine physicians at an academic medical center from 2015 to 2016. Thematic analysis of the semistructured interview transcripts was conducted by 2 investigators using line-by-line coding and constant comparative analysis. Key themes were identified through consensus. Theoretical sampling occurred until thematic saturation was reached. Findings: Twenty-one attending physicians were interviewed. Four factors were found to influence supervisor expectations pertaining to oral case presentation content (trainee level, trainee familiarity, clinical context, and clinical task). Further, the oral case presentation was found to serve as a means of indirect observation and an entrustment check point informing future decisions relating to trainee supervision. Insights: The oral case presentation represents a core activity within the trainee-supervisor relationship in which entrustment plays a central role. Given the numerous factors influencing oral case presentation content, we caution supervisors against relying solely on the oral case presentation as an entrustment check point, as this may lead to inaccurate judgments of trainee competence. We recommend that the oral case presentation be used in conjunction with other means of direct and indirect observation to assist with entrustment decisions relating to trainee supervision.