Rachel Stork Poeppelman, Melissa Moore-Clingenpeel, Ashley Siems, Diana L Mitchell, Priti Jani, Claire Stewart
{"title":"儿科重症监护研究员特设委托中的教师决策:一项基于案例的全国性调查。","authors":"Rachel Stork Poeppelman, Melissa Moore-Clingenpeel, Ashley Siems, Diana L Mitchell, Priti Jani, Claire Stewart","doi":"10.1080/10401334.2023.2269402","DOIUrl":null,"url":null,"abstract":"<p><p><b><i>Phenomenon</i>:</b> Ad hoc entrustment decisions reflect a clinical supervisor's estimation of the amount of supervision a trainee needs to successfully complete a task in the moment. These decisions have important consequences for patient safety, trainee learning, and preparation for independent practice. Determinants of these decisions have previously been described but have not been well described for acute care contexts such as critical care and emergency medicine. The ad hoc entrustment of trainees caring for vulnerable patient populations is a high-stakes decision that may differ from other contexts. Critically ill patients and children are vulnerable patient populations, making the ad hoc entrustment of a pediatric critical care medicine (PCCM) fellow a particularly high-stakes decision. This study sought to characterize how ad hoc entrustment decisions are made for PCCM fellows through faculty ratings of vignettes. The authors investigated how acuity, relationship, training level, and task interact to influence ad hoc entrustment decisions. <b><i>Approach</i>:</b> A survey containing 16 vignettes that varied by four traits (acuity, relationship, training level, and task) was distributed to U.S. faculty of pediatric critical care fellowships in 2020. Respondents determined an entrustment level for each case and provided demographic data. Entrustment ratings were dichotomized by \"high entrustment\" versus \"low entrustment\" (direct supervision or observation only). The authors used logistic regression to evaluate the individual and interactive effects of the four traits on dichotomized entrustment ratings. <b><i>Findings</i>:</b> One hundred seventy-eight respondents from 30 institutions completed the survey (44% institutional response rate). Acuity, relationship, and task all significantly influenced the entrustment level selected but did not interact. Faculty most frequently selected \"direct supervision\" as the entrustment level for vignettes, including for 24% of vignettes describing fellows in their final year of training. Faculty rated the majority of vignettes (61%) as \"low entrustment.\" There was no relationship between faculty or institutional demographics and the entrustment level selected. <b><i>Insights</i>:</b> As has been found in summative entrustment for pediatrics, internal medicine, and surgery trainees, PCCM fellows often rated at or below the \"direct supervision\" level of ad hoc entrustment. This may relate to declining opportunities to practice procedures, a culture of low trust propensity among the specialty, and/or variation in interpretation of entrustment scales.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"56-63"},"PeriodicalIF":2.1000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Faculty Decision Making in Ad Hoc Entrustment of Pediatric Critical Care Fellows: A National Case-Based Survey.\",\"authors\":\"Rachel Stork Poeppelman, Melissa Moore-Clingenpeel, Ashley Siems, Diana L Mitchell, Priti Jani, Claire Stewart\",\"doi\":\"10.1080/10401334.2023.2269402\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p><b><i>Phenomenon</i>:</b> Ad hoc entrustment decisions reflect a clinical supervisor's estimation of the amount of supervision a trainee needs to successfully complete a task in the moment. These decisions have important consequences for patient safety, trainee learning, and preparation for independent practice. Determinants of these decisions have previously been described but have not been well described for acute care contexts such as critical care and emergency medicine. The ad hoc entrustment of trainees caring for vulnerable patient populations is a high-stakes decision that may differ from other contexts. Critically ill patients and children are vulnerable patient populations, making the ad hoc entrustment of a pediatric critical care medicine (PCCM) fellow a particularly high-stakes decision. This study sought to characterize how ad hoc entrustment decisions are made for PCCM fellows through faculty ratings of vignettes. The authors investigated how acuity, relationship, training level, and task interact to influence ad hoc entrustment decisions. <b><i>Approach</i>:</b> A survey containing 16 vignettes that varied by four traits (acuity, relationship, training level, and task) was distributed to U.S. faculty of pediatric critical care fellowships in 2020. Respondents determined an entrustment level for each case and provided demographic data. Entrustment ratings were dichotomized by \\\"high entrustment\\\" versus \\\"low entrustment\\\" (direct supervision or observation only). The authors used logistic regression to evaluate the individual and interactive effects of the four traits on dichotomized entrustment ratings. <b><i>Findings</i>:</b> One hundred seventy-eight respondents from 30 institutions completed the survey (44% institutional response rate). Acuity, relationship, and task all significantly influenced the entrustment level selected but did not interact. Faculty most frequently selected \\\"direct supervision\\\" as the entrustment level for vignettes, including for 24% of vignettes describing fellows in their final year of training. Faculty rated the majority of vignettes (61%) as \\\"low entrustment.\\\" There was no relationship between faculty or institutional demographics and the entrustment level selected. <b><i>Insights</i>:</b> As has been found in summative entrustment for pediatrics, internal medicine, and surgery trainees, PCCM fellows often rated at or below the \\\"direct supervision\\\" level of ad hoc entrustment. This may relate to declining opportunities to practice procedures, a culture of low trust propensity among the specialty, and/or variation in interpretation of entrustment scales.</p>\",\"PeriodicalId\":51183,\"journal\":{\"name\":\"Teaching and Learning in Medicine\",\"volume\":\" \",\"pages\":\"56-63\"},\"PeriodicalIF\":2.1000,\"publicationDate\":\"2025-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Teaching and Learning in Medicine\",\"FirstCategoryId\":\"95\",\"ListUrlMain\":\"https://doi.org/10.1080/10401334.2023.2269402\",\"RegionNum\":3,\"RegionCategory\":\"教育学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2023/11/7 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"EDUCATION, SCIENTIFIC DISCIPLINES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Teaching and Learning in Medicine","FirstCategoryId":"95","ListUrlMain":"https://doi.org/10.1080/10401334.2023.2269402","RegionNum":3,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/11/7 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"EDUCATION, SCIENTIFIC DISCIPLINES","Score":null,"Total":0}
Faculty Decision Making in Ad Hoc Entrustment of Pediatric Critical Care Fellows: A National Case-Based Survey.
Phenomenon: Ad hoc entrustment decisions reflect a clinical supervisor's estimation of the amount of supervision a trainee needs to successfully complete a task in the moment. These decisions have important consequences for patient safety, trainee learning, and preparation for independent practice. Determinants of these decisions have previously been described but have not been well described for acute care contexts such as critical care and emergency medicine. The ad hoc entrustment of trainees caring for vulnerable patient populations is a high-stakes decision that may differ from other contexts. Critically ill patients and children are vulnerable patient populations, making the ad hoc entrustment of a pediatric critical care medicine (PCCM) fellow a particularly high-stakes decision. This study sought to characterize how ad hoc entrustment decisions are made for PCCM fellows through faculty ratings of vignettes. The authors investigated how acuity, relationship, training level, and task interact to influence ad hoc entrustment decisions. Approach: A survey containing 16 vignettes that varied by four traits (acuity, relationship, training level, and task) was distributed to U.S. faculty of pediatric critical care fellowships in 2020. Respondents determined an entrustment level for each case and provided demographic data. Entrustment ratings were dichotomized by "high entrustment" versus "low entrustment" (direct supervision or observation only). The authors used logistic regression to evaluate the individual and interactive effects of the four traits on dichotomized entrustment ratings. Findings: One hundred seventy-eight respondents from 30 institutions completed the survey (44% institutional response rate). Acuity, relationship, and task all significantly influenced the entrustment level selected but did not interact. Faculty most frequently selected "direct supervision" as the entrustment level for vignettes, including for 24% of vignettes describing fellows in their final year of training. Faculty rated the majority of vignettes (61%) as "low entrustment." There was no relationship between faculty or institutional demographics and the entrustment level selected. Insights: As has been found in summative entrustment for pediatrics, internal medicine, and surgery trainees, PCCM fellows often rated at or below the "direct supervision" level of ad hoc entrustment. This may relate to declining opportunities to practice procedures, a culture of low trust propensity among the specialty, and/or variation in interpretation of entrustment scales.
期刊介绍:
Teaching and Learning in Medicine ( TLM) is an international, forum for scholarship on teaching and learning in the health professions. Its international scope reflects the common challenge faced by all medical educators: fostering the development of capable, well-rounded, and continuous learners prepared to practice in a complex, high-stakes, and ever-changing clinical environment. TLM''s contributors and readership comprise behavioral scientists and health care practitioners, signaling the value of integrating diverse perspectives into a comprehensive understanding of learning and performance. The journal seeks to provide the theoretical foundations and practical analysis needed for effective educational decision making in such areas as admissions, instructional design and delivery, performance assessment, remediation, technology-assisted instruction, diversity management, and faculty development, among others. TLM''s scope includes all levels of medical education, from premedical to postgraduate and continuing medical education, with articles published in the following categories: