Scales, numbers, and words to support entrustment decisions about trainees

This chapter focuses on reporting trainee performance in workplace-based assessment programs. Tools that translate observations into assessment documentation typically include several components of observed activities, or competencies, and rating scales with multiple gradations of proficiency. Over the past two decades, introduction of the concept of entrustment and entrustable professional activities has led educators to create scales that focus on the amount of supervision, support, or help trainees need to complete a workplace-based activity. More recently, entrustment-supervision (ES) scales have shifted the focus to reporting readiness for future activities, using specified levels of supervision to be recommended for trainees. This chapter describes the use of these scales for ad hoc and summative entrustment decision-making, including adaptations for profession-specific or context-specific circumstances and variable levels of trainee proficiency. Scales for entrustment and supervision are more holistic than those for reporting observed behavior, and include both specific and general trainee features. Expert supervisor judgment includes an inherent subjective element, because experts show legitimate differences, but unwanted bias must be excluded. Narrative feedback comments can supplement and explain scale scores providing a holistic picture, guided by tools such as the 'A RICH' framework. Entrustment decisions are crucial in an EPA-based curriculum, and ES scale values must be embedded in a program of assessment in which feedback conversations with trainees remain essential.