Abstract
Background
Graduate medical education is transitioning to the use of entrustable professional
activities to contextualize educational competencies. Factors influencing entrustment
decisions have been reported in adult medicine. Knowing how such decisions are made
in pediatrics is critical to this transition.
Purpose
To understand how supervisors determine the level of procedural supervision to provide
a resident, taking into consideration simulation performance; to understand factors
that affect supervisors' transparency to parents about residents' procedural experience.
Methods
We conducted 18 one-on-one interviews with supervisors in a tertiary care pediatric
emergency department, iteratively revising interview questions as patterns in the
data were elucidated. Two researchers independently coded transcripts and then met
with the investigative team to refine codes and create themes.
Results
Five factors influenced supervisors' entrustment decisions: 1) resident characteristics
that include self-reported confidence, seniority, and prior interactions with the
resident; 2) supervisor style; 3) nature of the procedure/characteristics of the patient;
4) environmental factors; and 5) parental preferences. Supervisors thought that task-based
simulators provided practice opportunities but that simulated performance did not
provide evidence for entrustment. Supervisors reported selectively omitting details
about a resident's experience level to families to optimize experiential learning
for residents they entrusted to perform a procedure.
Conclusions
In pediatrics, supervisors consider various factors when making decisions regarding
resident procedural readiness, including parental preferences. An educational system
using entrustable professional activities may facilitate holistic assessment and foster
expertise-informed decisions about residents' progression toward entrustment; such
a system may also lessen supervisors' need to omit information to parents about residents'
procedural readiness.
Keywords
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Article Info
Publication History
Accepted:
June 5,
2014
Received:
January 27,
2014
Footnotes
The authors declare that they have no conflict of interest.
The authors would like to acknowledge the R Baby Foundation for their financial support related to this project and the transcription of manuscripts.
Identification
Copyright
© 2014 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.
