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Should I trust my senior resident to lead inpatient teaching rounds? Using an Entrustable Professional Activity (EPA) to balance learner autonomy and patient safety in clinical education.

Prep (Ph D & Early Career Researchers – Explore Your Ideas Pavilion)
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PREP (PhD & Early Career Researchers – explore your ideas Pavilion)

11:30 am

26 February 2024

M205

Clinically focused assessment

Presentation Description

Mohammed Najjar1
Larry Gruppen2
1 The Ohio State University
2 University of Michigan




Research Questions
Will introducing inpatient pediatrics family centered round as an EPA promote self- determination among senior residents? What is the effect of this implementation on patients’ outcome? 


Thesis
Trust is the cornerstone for determining learners’ readiness for less supervised and more autonomous workplace clinical activities. In the clinical environment, interconnected factors related to the supervisor, trainee, supervisor trainee relationship, the context and the clinical task are essential for medical educators to build entrustment of their trainees (1). Autonomous and self-determined learners are intrinsically motivated to pursue their goals, are more satisfied with their work and lives, and ultimately become higher achievers (2). 

EPAs exemplify workplace assessment based on trust. This research attempts to build family centered rounds (FCRs) in inpatient general pediatric services as an EPA and assess its influence on supervisors’ entrustment, learners’ self-determination and patients’ safety. This study provides evidence of validity for EPA driven entrustment decisions on teaching rounds that are directly related to learners’ autonomy, competence and relatedness and to patients’ care and safety. 


Methods
Six experienced hospital pediatricians from four academic centers in the United States will collaborate to develop an EPA for inpatient pediatrics FCR according to ten Cate’s theory and guidelines (3). We will use faculty development programs to teach clinical preceptors the new assessment tool and its implementation on entrustment decisions and autonomy. We will apply qualitative research methods to study preceptors’ and learners’ perspective on entrustment and autonomy. We will use patients and family surveys and changes in organizational records for family complaints and medical errors to assess the influence on patients’ outcome. 

Questions for discussion with participants: 

  • How to enhance validity and reliability for this EPA? 

  • Best way to decrease inter rater variability and reach higher level of entrustment? 

  • Do you suggest other approaches to evaluate the effect on patient’s care? 


References (maximum three) 

  • 1- Hauer KE, Ten Cate O, Boscardin C, Irby DM, Iobst W, O'Sullivan PS. Understanding trust as an essential element of trainee supervision and learning in the workplace. Adv Health Sci Educ Theory Pract. 2014 Aug;19(3):435-56. doi: 10.1007/s10459-013-9474-4. Epub 2013 Jul 27. PMID: 23892689. 

  • 2- Ryan, D. a. (2004). Handbook of Self-Determination research (E. D. a. R. Ryan Ed.): The university of rochester press. 

  • 3- ten Cate O, Schwartz A, Chen HC. 2020. Assessing trainees and making entrustment decisions: on the nature and use of entrustment-supervision scales. Acad Med. 95(11):1662– 1669. 

Speakers