Understanding Entrustment Decision-Making by Surgical Program Directors.

Area of Science:

• Medical Education
• Surgical Training
• Competency Assessment

Background:

• Entrustment, or placing trust in trainees for independent task execution, is a proposed metric for competence assessment.
• Understanding entrustment decision-making (EDM) by supervisors in surgical training is crucial but not well-defined.

Purpose of the Study:

• To explore the underlying processes of entrustment decision-making (EDM) employed by general surgery program directors.
• To identify factors influencing supervisors' trust in trainees' ability to perform clinical tasks independently.

Main Methods:

• Conducted semistructured interviews with 20 program directors from Accreditation Council for Graduate Medical Education-accredited general surgery programs.
• Utilized purposive sampling for participant recruitment and employed iterative, inductive qualitative analysis of interview data.

Main Results:

• Program directors depend on faculty networks for entrustment decisions.
• Trainee competence perception varies; there's an overemphasis on technical skills in the operating room (OR) at the expense of cognitive abilities.
• Factors influencing OR entrustment include attending trust, physical presence, trainee labels, and presumed discernment; outside the OR, labels, discernment, and transference of competence are key.

Conclusions:

• Entrustment is influenced by both trainee and faculty behaviors.
• Despite acknowledging the importance of judgment outside the OR, entrustment decisions are more heavily swayed by in-OR performance.
• Integrating EDM into trainee evaluation is recommended as a supplement to existing Accreditation Council for Graduate Medical Education milestones.