So what is entrustment?
Let's step back and talk about the process of patient care.
So patient care is complicated, right?
When you're taking care of a patient we think about data gathering, so
the information that we collect.
We think about the interpretation, the integration, and more data gathering.
So we get a little piece of information and then we start get more information and
we're trying to formulated differential diagnosis.
Trying to figure out what things mean.
So, it's a very complicated process.
And in that process we're taking pieces of information,
integrating it into a diagnosis and then coming up with a treatment plan.
So the question is, when you're dealing in a collaborative setting,
where there is both a resident and an attending, or
a house officer when attending, or maybe a junior house officer and
a senior house officer, or maybe a medical student and a senior resident.
There are all of these different configurations where you're going to
get different levels of training and different levels of responsibility.
And we're doing that same patient care process of
data gathering integration analysis, but we're doing it on multiple levels.
And the question in, with autonomy is what pieces do
we actually entrust to different trainees along the way?
So do we allow a medical student to get and figure out what the allergies are.
Do we do we ask a student to go and
talk to the family about what the patient's wishes might be?
Those sorts of things.
And so it's really this entrustment and responsibility that we
give from the trainees to the attending and back and forth.
So that together we're collaborating and providing patient care.
In this process there what I, what I often call tacit trust decisions.
So along the way we're deciding do I trust this learner to do the piece of,
the important piece of patient care or
responsibility that is necessary at this time?
Or do I really kind of not trust them and I'm in a pull back and
have a little bit more ownership of this piece rather than allowing them to do it?
So, entrustment is really this tacit trust decision of what responsibility we give to
the trainees along the way, and it can go from very minimal,
indirect supervision to having quite a lot of autonomy and responsibility for
the patients that we're taking care of.
But in the end, it is a collaborative process, and
it is very dynamic as we move forward in patient care.