Procedural Entrustment Alignment Between Pediatric Residents and Their Preceptors in the Pediatric Emergency...

Area of Science:

• Medical Education
• Pediatric Residency Training
• Clinical Skills Assessment

Background:

• Entrustment, the balance of resident autonomy and preceptor supervision, is crucial for safe procedure completion and learning.
• Misalignment in entrustment can hinder resident development and patient safety.
• Understanding entrustment dynamics is key to optimizing clinical training.

Purpose of the Study:

• To assess procedural entrustment alignment between senior pediatric residents and preceptors.
• To evaluate the impact of a simulation-based formative assessment (SFA) on this alignment.

Main Methods:

• Prospective observational study of senior pediatric residents undergoing SFAs for simulated laceration (LAC) and lumbar puncture (LP) procedures.
• Residents self-assessed entrustability; a pediatric emergency medicine (PEM) preceptor panel rated resident performance from video recordings.
• Comparison of resident and panel scores using an 8-point scale and dichotomized "in versus out" of room supervision needs.

Main Results:

• Initial pre-SFA assessments showed significant discrepancies in entrustment alignment for LAC procedures (resident 4.08 vs. panel 4.97, P < 0.001).
• Post-SFA, alignment improved for both LAC (resident 5.21 vs. panel 4.97, P = 0.32) and LP (resident 5.54 vs. panel 5.31, P = 0.52) on the 8-point scale.
• Dichotomized analyses revealed substantial improvements in alignment post-SFA (LAC: kappa 0.03 to 0.46; LP: kappa -0.03 to 0.24).

Conclusions:

• Senior pediatric residents initially prefer more supervision (less entrustment) for procedures.
• SFAs effectively enhance procedural entrustment alignment between residents and preceptors.
• SFAs show promise as a tool to improve procedural learning and decision-making in residency training.