Entrustment in Practice: A Competency-Based Curriculum Assessed

Introduction: The entrustable professional activity (EPA) is a commonly used approach in competencybased curricula for entrusting residents. However, knowledge about where the entrustment decision is based upon is limited. Therefore, we looked into an EPA-based training program to find out which factors are taken into account during the decision to hand over trust to a resident. Methods: The e-portfolio of the Dutch obstetrician and gynecology training is used for selecting all entrustment decisions for obstetric activities from January 2010 until April 2014. Entrustment is based on an argumentation of both resident and program director. All argumentations were labeled and template analysis is used to analyze the differences between entrustment decisions more closely. Results: In total, 5139 entrustment decisions have been selected and analyzed, with 49% of all argumentations being about the experience of the resident. In just over 16% the performance of the resident on technical skills was considered, while 0.4% was about the level of performance on generic competencies. The qualitative analysis confirmed these findings. Conclusions: Experience seems to be the most influential factor in entrusting a resident. Often, the performance of the resident is an argument for entrustment as well. However, there only seems to be attention for the technical skills, and there is little consideration for the generic competence of a resident. Based on the portfolio data we can conclude that despite the introduction of competency frameworks and EPAs the formal handover of trust is still mainly based on the experience and technical skills.