A qualitative study on entrustment decision making in the intensive care unit: about more than the learner
| Autor: | Conroy, Megan Elizabeth, MD |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Health Sciences
Health Care Health Education Medicine Science Education Continuing Education Education Educational Psychology Educational Theory entrustment entrustment decision making medical education qualitative medical intensive care unit ICU MICU supervision medicine graduate medical education clinical learning environment progressive autonomy |
| Druh dokumentu: | Text |
| Popis: | The provision of graded supervision affording progressive autonomy is fundamental to the progression of a medical learner towards competency for independent practice; the decision of how much supervision versus trust and autonomy to provide a trainee in the execution of clinical care constitutes an entrustment decision. Despite entrustment decision making occurring both daily in practice and summatively at points of matriculation through stages of medical training, the factors influencing entrustment decisions remain poorly understood across clinical contexts. This study was designed to explore the central research question of: How are entrustment decisions made in the medical intensive care unit?This qualitative case study utilized semi-structured interviews with attending pulmonary and critical care physicians in the medical intensive care unit at a major midwestern medical center to explore the entrustment decision making process as it was enacted in the clinical environment.Five major themes emerged from the data: (1) Task, circumstance, and trainee factors contribute to entrustment decision making, (2) Ad hoc entrustment decisions are enacted by supervisors with a consideration of the care team as a unit, not only an individual, (3) Autonomy does not arise only out of entrustment, but outcomes of prior autonomy inform ongoing intention to entrust, (4) Entrustment decision making includes a social process of back-and-forth akin to negotiation, and (5) Entrustment decision making is a learned skill. The process of entrustment decision making in the ICU is more complex than prior frameworks have captured; a model with more complete incorporation of the factors that influence entrustment in the ICU is presented. Lastly, recommendations for the application of our model of entrustment to improve the quality of entrustment decisions in order to better inform the use of entrustment decisions for assessment are discussed. |
| Databáze: | Networked Digital Library of Theses & Dissertations |
| Externí odkaz: |
|