Variation in Entrustment When Sharing a Single Assessment System Between University- and Community-Based Residency...

Area of Science:

• Medical Education
• Residency Training
• Assessment Systems

Background:

• Resource constraints often lead residency programs to consider adopting external assessment systems.
• The transferability of entrustment-based assessment systems across different institutional contexts is not well understood.

Purpose of the Study:

• To evaluate if entrustment progression varies between community-based and university-based residency programs using a single, adopted assessment system.
• To compare entrustment ratings and progression rates when the observable practice activity (OPA) system was implemented in two distinct residency programs.

Main Methods:

• The Good Samaritan Hospital (GSH) internal medicine program adopted the OPA system from the University of Cincinnati (UC).
• Longitudinal comparison of OPA-mapped subcompetency entrustment progression over 36 months for both programs and their residents.
• Data collected from August 2012 to June 2017 (UC) and September 2013 to June 2017 (GSH).

Main Results:

• GSH showed higher entrustment ratings than UC across most months and subcompetencies (P < .0001).
• The rate of change in average monthly entrustment was similar between programs (GSH: 0.041/month, UC: 0.042/month; P = .73).
• While most residents progressed, significant inter-resident variation in entrustment was observed within each program.

Conclusions:

• The context of residency programs can significantly impact outcomes, even when using an identical entrustment-based assessment system.
• Further investigation is required to elucidate the interplay between assessment tools, contextual factors, and resulting data in residency education.