Beyond the Numbers: Exploring Tensions Between Formal Entrustment and Trainee Readiness in Internship Training - A...

Area of Science:

• Pharmacy Education and Practice
• Professional Development and Training
• Healthcare Professional Competency

Background:

• Research on entrustment decision-making has predominantly focused on supervisors.
• Trainee experiences and internalization of entrustment are less understood.
• This study addresses the gap by exploring the trainee perspective in pharmacy internships.

Purpose of the Study:

• To investigate how trainee entrustment develops during a pharmacy internship.
• To examine the lived experiences influencing progression towards unsupervised practice.
• To understand the trainee's interpretation and internalization of the entrustable professional activities (EPA) framework.

Main Methods:

• Convergent mixed-methods design utilizing questionnaires and focus groups with provisionally registered pharmacists in Australia.
• Quantitative data collected at three time points on EPA utility and self-perceived readiness.
• Qualitative data from focus groups analyzed using reflexive thematic analysis and triangulated with quantitative findings.

Main Results:

• Self-perceived readiness for entrustment significantly increased, with median ratings reaching independent practice with reactive supervision by internship end.
• Entrustment, coupled with structured feedback and reflection, boosted trainee confidence.
• Overemphasis on numerical benchmarks risked superficial learning and diminished feedback post-achievement.

Conclusions:

• Entrustable Professional Activities (EPAs) facilitate trainee progression to autonomy through structure, feedback, and self-reflection.
• Tying entrustment solely to observation numbers can lead to premature conferral and reduced feedback depth.
• Framing EPAs as assessments *for* learning enhances the transition to confident, autonomous practice.