A Qualitative Systematic Review of the Role of Entrustment in Pre-Registration Healthcare Practice-Based Learning:...

This qualitative systematic review explored how entrustment is understood, experienced and enacted within pre-registration practice-based learning (PBL) across international healthcare education, with a specific focus on implications for the UK dietetic profession. Fifteen qualitative and mixed methods studies were synthesised using thematic synthesis, identifying how entrustment shapes learner participation, supervision, and capability development. The review found that entrustment functions as a 'credible developmental space' that enables learners to engage in authentic workplace activities with supported autonomy, while also revealing how workplace pressures and local contextual factors influence entrustment decisions. Feedback emerged as the central mechanism through which learners make sense of supervision levels, understand expectations, and professionally develop; without high quality dialogic feedback, entrustment risks becoming a procedural rather than educational process. Entrustment was shown to be inherently relational and co-constructed, shaped by trust, supervisor familiarity, contextual constraints, perceived risk, and the quality of supervisory relationships. These findings challenge overly technical or checklist based interpretations of entrustment and highlight the need for assessment approaches that prioritise narrative feedback, shared sensemaking and contextual awareness. For UK dietetics, an entrustment informed approach offers a defensible, capability-aligned way to structure PBL across diverse settings, particularly as the profession implements a national common assessment tool. A proportionate, light touch approach, using a small number of meaningful EPA aligned tasks supported by succinct narrative feedback, may enhance developmental value without increasing burdens on practice educators. Entrustment has the potential to strengthen fairness, consistency, and capability development in dietetic PBL when implemented in a relational, context sensitive manner. These insights have relevance globally, providing a conceptual foundation for international dietetics and wider health professions to strengthen supervision and assessment in diverse PBL contexts.