Capturing Entrustment: Using an End-of-Training Simulated Workplace to Assess the Entrustment of Near-graduating Medical Students from Multiple Perspectives

Background The AAMC has identified 13 Entrustable Professional Activities (EPAs) that all entering residents should be entrusted to perform on day 1 of residency, regardless of specialty choice. However, there is currently no consensus on how to best measure entrustment. Objective This study embedded a range of entrustment measures from multiple rater perspectives in an immersive simulation event designed to assess competence in all 13 EPAs. Methods One hundred forty-four near-graduating medical students were recruited to complete a 4-h immersive simulation designed around four clinical cases where they interacted with standardized patients, nurses, attendings, and interns. A total of 16 entrustment ratings were collected for each of the learners across 6 of the 9 simulation activities. To test the hypothesis that the given items in the immersive simulation enabled measurement of entrustment, a three-factor (entrustment) confirmatory factor analysis (CFA) was conducted with the ratings between the assessors by case allowed to correlate. Results A three-factor CFA model fit the data ( χ 2 (94) = 147.28, p = 0.0002, CFI = 0.98, TLI = 0.97, RMSEA = 0.07 (CI = 0.04–0.08), p = 0.111). All but 1 of the 16 factor loadings was greater than 0.3. Conclusions A three-factor model with 16 measures fit the a priori entrustment framework suggesting that entrustment, operationalized across different rater perspectives and types of questions, is measurable as a construct. Using an end-of-training event provides a timely and feasible assessment approach to capture structured entrustment judgments for the educational handoff between medical school and residency.