Variation in Entrustment When Sharing a Single Assessment System Between University- and Community-Based Residency Programs: A Comparison.

Abstract

Given resource constraints, many residency programs would consider adopting an entrustment-based assessment system from another program if given the opportunity. However, it is unclear if a system developed in one context would have similar or different results in another. This study sought to determine if entrustment varied between programs (community based and university based) when a single assessment system was deployed in different contexts. The Good Samaritan Hospital (GSH) internal medicine residency program adopted the observable practice activity (OPA) workplace-based assessment system from the University of Cincinnati (UC). Comparisons for OPA-mapped subcompetency entrustment progression for programs and residents were made at specific timepoints over the course of 36 months of residency. Data collection occurred from August 2012 to June 2017 for UC and from September 2013 to June 2017 for GSH. GSH entrustment ratings were higher than UC for all but the 11th, 15th, and 36th months of residency (P < .0001) and were also higher for the majority of subcompetencies and competencies (P < .0001). The rate of change for average monthly entrustment was similar, with GSH having an increase of 0.041 each month versus 0.042 for UC (P = .73). Most residents progressed from lower to higher entrustment, but there was significant variation between residents in each program. Despite the deployment of a single entrustment-based assessment system, important outcomes may vary by context. Further research is needed to understand the contributions of tool, context, and other factors on the data these systems produce.