Entrustment Decision Making in the Intensive Care Unit: It's About More Than the Learner

Area of Science:

• Medical Education
• Clinical Supervision
• Healthcare Quality

Background:

• Graded supervision and progressive autonomy are crucial for medical learners' competency.
• Entrustment decisions, balancing supervision and autonomy, are fundamental but poorly understood.
• Factors influencing entrustment decisions across clinical contexts require further exploration.

Purpose of the Study:

• To investigate how entrustment decisions are made in the medical intensive care unit (ICU).
• To explore the nuances of supervisor-trainee interactions in clinical care entrustment.

Main Methods:

• Qualitative case study design.
• Semistructured interviews with attending pulmonary and critical care physicians.
• Exploration of entrustment decision-making within a major midwestern medical center's ICU.

Main Results:

• Task, circumstance, and trainee factors influence entrustment.
• Decisions consider the care team, not solely the individual trainee.
• Autonomy can stem from prior trainee actions, and entrustment is a learned skill involving negotiation.

Conclusions:

• Entrustment decision-making in the ICU is complex and not fully captured by existing frameworks.
• A new model incorporating ICU-specific factors is proposed.
• The role of trainee competence in ad hoc entrustment decisions needs further investigation for assessment purposes.