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Accuracy of Entrustment-Based Assessment: Implications for Programs and Patients.

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Faculty often misjudged resident performance, assigning incorrect entrustment ratings. This study reveals low agreement between faculty ratings and actual resident performance, indicating a need for improved assessment methods in medical education.

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Area of Science:

  • Medical Education
  • Healthcare Professional Training
  • Clinical Competency Assessment

Background:

  • Entrustment-supervision scales offer intuitive resident performance assessment.
  • The accuracy of these scales in evaluating appropriate resident care remains unclear.

Purpose of the Study:

  • To determine the frequency of inaccurate entrustment ratings by faculty.
  • To assess if entrustment scale accuracy varies with resident performance levels.

Main Methods:

  • Faculty rated standardized residents in 10 videos using a 4-point entrustment-supervision scale.
  • Generalizability (G) and decision (D) studies analyzed 768 ratings across 10 cases.
  • Analysis was repeated for cases with a scripted entrustment score of 2.

Main Results:

  • Faculty ratings differed from scripted scores in 43% of cases, with most errors overestimating supervision needs.
  • Generalizability studies indicated significant variance due to the case, not the rater.
  • Decision studies suggested 3 raters observing 10 cases for reliable assessment.

Conclusions:

  • Faculty tended to underestimate residents' need for supervision.
  • Overall agreement between faculty ratings and scripted performance levels was low.
  • Current entrustment-supervision scales may not reliably reflect resident competence.