From Competency to Entrustment in Medical Education

By: Neel Sharma, MBChB, MSc, National University Hospital Singapore and Harvard Macy Institute Michael Whitcomb highlighted his concerns regarding an overemphasis on competency-based medical education in his commentary published earlier this year. We are now beginning to see a further shift in the paradigm of competency-based education to one of entrustment. Entrustment, or more precisely entrustable professional activities, highlights the importance of determining when a trainee can be entrusted to perform a particular task unsupervised. As a trainee, I have two concerns with this notion. First, is it really something novel? During my training thus far, initially in internal medicine and now in gastroenterology, although my supervisors never explicitly use the word entrustment, they certainly have been signing off on my knowledge, skills, and attitudes on the basis of their confidence in my abilities. I don’t recall them using the exact term entrustment, but it has been implied by the very nature of the supervision process. For example, a trainee is deemed competent to complete an upper GI endoscopy after having adequately completed the various elements of the procedure (e.g., successful sedation, oesophageal intubation, and biopsy sampling) over a prolonged period of time. The second concern I have is in regards to the post training phase. There are countless scenarios in which trained specialists face situations that are difficult to manage. Again using the example of an...
Source: Academic Medicine Blog - Category: Universities & Medical Training Authors: Tags: Featured Guest Perspective competencies entrustable professional activities entrustment Source Type: blogs