Validity of entrustment scales within anesthesiology residency training
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REPORTS OF ORIGINAL INVESTIGATIONS
Validity of entrustment scales within anesthesiology residency training Validite´ des e´chelles de confiance dans le cadre de la re´sidence en anesthe´siologie . Alexander J. Lingley, MSc . Julie Ghatalia, Med . Daniel G. Dubois, MD Meghan M. McConnell, PhD Received: 9 October 2019 / Revised: 9 July 2020 / Accepted: 12 July 2020 Ó Canadian Anesthesiologists’ Society 2020
Abstract Introduction Competency-based medical education requires robust assessment in authentic clinical environments. Using work-based assessments, entrustment scales have emerged as a means of describing a trainee’s ability to perform competently. Nevertheless, psychometric properties of entrustment-based assessment are relatively unknown, particularly in anesthesiology. This study assessed the generalizability and extrapolation evidence for entrustment scales within a program of assessment during anesthesiology training. Methods Entrustment scores were collected during the first seven blocks of training for three resident cohorts. Entrustment scores were assessed during daily evaluations using a Clinical Case Assessment Tool (CCAT) within the preoperative, intraoperative, and postoperative setting. The reliability of the entrustment scale was estimated using generalizability theory. Spearman’s correlations measured the relationship between median entrustment scores and percentiles scores on the Anesthesia Knowledge Test
D. G. Dubois, MD (&) J. Ghatalia, Med Department of Anesthesiology and Pain Medicine, University of Ottawa, 1053 Carling Ave, Room B311, Ottawa, ON K1Y 4E9, Canada e-mail: [email protected] A. J. Lingley, MSc Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada M. M. McConnell, PhD Department of Anesthesiology and Pain Medicine, University of Ottawa, 1053 Carling Ave, Room B311, Ottawa, ON K1Y 4E9, Canada Department of Innovation in Medical Innovation, University of Ottawa, Ottawa, ON, Canada
(AKT)-1 and AKT-6, mean Objective Structured Clinical Examination (OSCE) scores, and rankings of performance by the Clinical Competence Committee (CCC). Results Analyses were derived from 2,309 CCATs from 35 residents. The reliability or generalizability (G) coefficient of the entrustment scale was 0.73 (95% confidence interval [CI], 0.70 to 0.76), and the internal consistency was 0.86 (95% CI, 0.84 to 0.88). Intraoperative entrustment scores significantly correlated with the AKT-6 (rho = 0.51, P = 0.01), mean OSCE (rho = 0.45, P = 0.04), and CCC performance rankings (rho = 0.52, P = 0.006). Conclusion As part of an assessment program, entrustment scales used early during anesthesiology training showed evidence of validity. Intraoperative entrustment scores had good reliability and showed acceptable internal consistency. Interpreting entrustment scores in this setting may constitute a valuable adjunct complementing traditional summative evaluations. Re´sume´ Introduction La formation me´dicale fonde´e sur les compe´tences ne´cessite une e´valuation rigoureuse dans des environnements cliniques
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