There has been increased attention to and emphasis on competency-based medical education and the transformation from highly supervised medical students towards independent, entrustable physicians. We explored how program directors (PDs) justify decisions about whether they would trust finishing Post Graduate Year 1 (PGY1) residents to care for the PD or a loved one. Using an end of year survey with validity evidence, we assessed PDs’ responses (Yes, No, Not Sure) and written comments about this entrustment decision for USUHS medical students from graduating classes of 2013–2015 (PGY1). We performed a qualitative inductive content analysis to identify themes in how PDs justified their decisions as well as descriptive statistics and a contingency table analysis to examine associations between trust decisions and election to membership in Alpha Omega Alpha (AOA), or conversely, referral to the Student Promotions Committee (SPC) for remediation. Qualitative analyses revealed five themes related to this trust decision about medical residents: personal, interpersonal, knowledge, competence, and developmental. Neither AOA status, nor SPC referral status was significantly associated with the trust measure, overall, but positive trust decisions were significantly higher among those elected to AOA than in those who were not. Positive trust decisions were significantly associated with AOA status but negative trust decisions were not significantly associated with referral to the SPC. This study offers insights into what attributes may underpin trust decisions by PDs. Our findings suggest that PDs’ frequent use of personal and interpersonal characteristics to justify trust decisions contrasts with the use of clinical and knowledge based assessments during undergraduate medical education (UME), and emphasize the importance of critical intrinsic abilities.

中文翻译：

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这是一个信任问题：探索项目主管关于是否信任居民照顾亲人的决定的基础

人们越来越关注和强调以能力为基础的医学教育以及从高度监督的医学生向独立、可信赖的医生的转变。我们探讨了项目主管 (PD) 如何证明他们是否信任完成研究生 1 年 (PGY1) 居民来照顾 PD 或亲人的决定是合理的。使用具有有效性证据的年终调查，我们评估了 PD 的回答（是、否、不确定），并针对 USUHS 2013-2015 年毕业班 (PGY1) 医学生的这一委托决定做出了书面评论。我们进行了定性归纳内容分析，以确定 PD 如何证明其决策合理的主题，以及描述性统计和列联表分析，以检查信任决策与 Alpha Omega Alpha (AOA) 成员资格选举之间的关联，或者相反，转介给学生促进委员会 (SPC) 进行补救。定性分析揭示了与医疗居民的这种信任决策相关的五个主题：个人、人际关系、知识、能力和发展。Neither AOA status, nor SPC referral status was significantly associated with the trust measure, overall, but positive trust decisions were significantly higher among those elected to AOA than in those who were not. 积极的信任决定与 AOA 状态显着相关，但消极的信任决定与转介到 SPC 没有显着相关。这项研究提供了关于哪些属性可能支持 PD 的信任决策的见解。我们的研究结果表明，PD 频繁使用个人和人际关系特征来证明信任决策的合理性与本科医学教育 (UME) 期间使用临床和基于知识的评估形成对比，并强调关键内在能力的重要性。