Presentation Description
Gareth Davies1
1 University of Cape Town
1 University of Cape Town
Research Question:
Can the entrustment framework developed within Competency Based Medical Education (CBME) be applied to a rural Low- and Middle-Income Country (LMIC) context; assessing non-specialist physicians’ readiness to provide safe anaesthesia care in rural workplaces?
Can the entrustment framework developed within Competency Based Medical Education (CBME) be applied to a rural Low- and Middle-Income Country (LMIC) context; assessing non-specialist physicians’ readiness to provide safe anaesthesia care in rural workplaces?
Thesis Methodology:
Pragmatism paradigm. Data collection: mixed methods, including surveys, interviews, observations and artefact review
Findings so far:
Trust is fundamental to the provision of healthcare, between healthcare providers and their patients and educational supervisors and their trainees. Entrustment as an assessment construct has gained general acceptance within CBME. The framework allows supervisors to assess trainees outside of the “classroom” as they perform healthcare tasks in clinical workplaces. Here supervisors are not only considering individual competency, but also determining the degree of autonomy a trainee should be permitted and the appropriate level of supervision.
The current framework was developed in predominantly well-resourced academic settings to assess post-graduate medical trainees. By contrast, rural operating theatres in LMICs are clinical, often under-resourced workplaces, with physicians (most commonly non-specialists) employed to provide safe anaesthesia with remote supervision. These workplaces are not conventional training or assessment spaces and the physicians are considered employees, not trainees affiliated to an academic or university department.
Entrustment decision-making at present underscores the principal aim of CBME, which is the graduation of competent healthcare professionals. This is in contrast to the primary consideration of the rural LMIC healthcare context: ensuring optimal patient safety.
What is your question(s) for discussion with participants:
- Can the current entrustment framework developed in health professions education and generally employed in well-resourced academic settings be transferred to under- resourced rural workplaces to enable safe anaesthesia care?
- How is trust defined within a rural LMIC anaesthesia care context and which parameters of entrustment are fundamental in this setting to ensure safe patient care?
References (maximum three)
- Holzhausen Y, Maaz A, Cianciolo AT, ten Cate O, Peters H. Applying occupational and organizational psychology theory to entrustment decision-making about trainees in health care: a conceptual model. Perspect Med Educ. 2017 Apr 1;6(2):119–26.
- Ten Cate O, Hart D, Ankel F, Busari J, Englander R, Glasgow N, et al. Entrustment Decision Making in Clinical Training. Acad Med. 2016 Feb;91(2):191–8.
- Sterkenburg A, Barach P, Kalkman C, Gielen M, ten Cate O. When Do Supervising Physicians Decide to Entrust Residents With Unsupervised Tasks? Academic Medicine. 2010 Sep;85(9):1408.