Do summative entrustment decisions actually lead to entrustment?

Abstract

Entrustable professional activities (EPAs) were introduced across Dutch postgraduate programmes between 2017 and 2019. We aimed to understand the extent to which residents actually were granted increased clinical responsibility upon receiving summative entrustment for an EPA, a critical feature of its use. A survey study was conducted among all Dutch residents who started dermatology training in 2018 and 2019 and all Dutch dermatology programme directors (PDs). We chose an EPA designed for early entrustment in residency (identification, treatment and care regarding a simple dermatological problem in the ambulatory setting). The survey contained two hypothetical clinical cases that aligned with this EPA. The questions were aimed to determine whether and when residents should request supervision. Similar questions were posed to PDs. Twenty four residents (56%) and 19 PDs (79%) completed the survey. The majority of the residents (65%) and PDs (63%) confirmed that competent dermatology residents (level 4) are generally allowed to perform EPA1 unsupervised, particularly when seeing patients from GPs. However, still a substantial proportion of the level 4 residents, working in University Medical Centers (36%) indicated that they had to request supervision in the assessment of these patients. For 2nd opinions, the results were typically the opposite. This study demonstrated that, at least in one specialty and one country, the introduction of EPAs and entrustment decision making procedure generally led to the intended autonomy of the resident.