Share this article on:

When Do Supervising Physicians Decide to Entrust Residents With Unsupervised Tasks?

Sterkenburg, Anneke MD; Barach, Paul MD, MPH; Kalkman, Cor MD, PhD; Gielen, Mathieu MD, PhD; ten Cate, Olle PhD

doi: 10.1097/ACM.0b013e3181eab0ec
Patient Safety

Purpose Patient-care responsibilities stimulate trainee learning but training may compromise patient safety. The authors investigated factors guiding clinical supervisors' decisions to trust residents with critical patient-care tasks.

Method In a mixed quantitative and qualitative descriptive study carried out at University Medical Center Utrecht, Utrecht, the Netherlands, from March to September 2008, the authors surveyed attending anesthetists and resident anesthetists regarding when attendings should entrust each of six selected critical tasks to residents. The authors conducted structured interviews with both groups, using trigger case vignettes to solicit opinions on factors that affect entrustment decisions.

Results Thirty-two attending anesthetists and 31 residents answered the questionnaire (response rate 58%), and 10 participants from each group were interviewed. Attendings varied in their opinions regarding how much independence to give residents, particularly postgraduate year (PGY) 2, 3, and 4 residents. PGY1 residents reported working above their expected level of competence but estimate their own ability as sufficient, whereas PGY5 residents reported working below their expected level of competence. The authors classified factors that determine entrustment into four groups: characteristics of the resident, the attending, the clinical context, and the critical task.

Conclusions Residents' and attendings' opinions and impressions differ regarding what is expected from residents, what residents actually do, and what residents think they can do safely. The authors list factors affecting why and when supervisors trust residents to proceed without supervision. Future studies should address drivers behind entrustment decisions, correlations with patient outcomes, and tools that enable faculty to justify their entrustment decisions.

Dr. Sterkenburg was, at the time of this study, research associate, Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, the Netherlands.

Dr. Barach was, at the time of this study, anesthetist, Department of Anesthesiology; he currently is visiting researcher, Patient Safety Center, University Medical Center Utrecht, Utrecht, the Netherlands.

Dr. Kalkman is professor of anesthesiology, Department of Anesthesiology, and director, Patient Safety Center, University Medical Center Utrecht, Utrecht, the Netherlands.

Dr. Gielen is senior anesthetist, University Medical Center St. Radboud, Nijmegen, the Netherlands.

Dr. ten Cate is professor of medical education and director, Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, the Netherlands.

Editor's Note: A commentary on this article appears on pages 1399–1400.

Please see the end of this article for information about the authors.

Correspondence should be addressed to Dr. ten Cate, Center for Research and Development of Education, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, the Netherlands; telephone: (+31) 88-755-7010; fax: (+31) 88-755-3409; e-mail: t.j.tencate@umcutrecht.nl.

© 2010 Association of American Medical Colleges