Procedural Entrustment Alignment Between Pediatric Residents and Their Preceptors in the Pediatric Emergency Department

Objective: Entrustment describes the balance of supervision and autonomy between resident and preceptor to complete doctoring tasks like procedures. Entrustment alignment between resident and preceptor facilitates safe, successful outcomes, and promotes learning. Study objectives describe procedural entrustment alignment between senior pediatric residents and their preceptors and report the impact of a simulation-based formative assessment (SFA) on entrustment alignment.

Methods: This prospective observational study enrolled a convenience sample of senior pediatric residents in 2023. The SFA was videoed, consisted of obtaining informed consent and performing simulated procedures (laceration [LAC] and lumbar puncture [LP]). Residents self-assessed their entrustability pre/post-SFA. A PEM preceptor panel individually rated videos of the residents. PEM panel's scores were compared to residents' scores on both an 8-point scale and the dichotomized variable of needing "in versus out" of the room entrustment.

Results: Twenty-four residents' SFAs were rated by 9 panelists. Before the SFA, entrustment alignments on the 8-point scale were as follows: resident LAC 4.08 vs PEM panel 4.97 (P < 0.001), and resident LP 4.75 vs PEM panel 5.31 (P = 0.15). After the SFA, entrustment alignments were as follows: resident LAC 5.21 vs PEM panel 4.97 (P = 0.32), and resident LP 5.54 vs PEM panel 5.31 (P = 0.52). The dichotomized analyses revealed improved alignment post-SFA: LAC-pre-kappa = 0.03 vs LAC-post 0.46, and LP-pre-kappa = (-0.03) vs LP-post = 0.24.

Conclusions: Our findings indicate senior pediatric residents desire less entrustment (more supervision) for procedures but better align with preceptors after an SFA. This work offers insight into procedural entrustment decision making and the potential of SFA's to facilitate procedural learning.