Validity theory applied to entrustment as an approach to assessment

In adopting entrustment-based assessments, the construct has shifted from assessing learners' capability to provide competent care to their readiness for the responsibility for the welfare of patients and permission to perform clinical care with appropriate autonomy. Competence committees charged with making entrustment-based decisions must make decisions that are valid, fit for purpose, and interpreted appropriately. However, entrustment as a construct is complex and warrants a discussion regarding its relation to validity. While many different validity questions may be asked in the context of entrustable professional activities (EPAs), this chapter focuses on what we believe is the most salient and novel feature of EPA-based programs, which is the introduction of entrustment decisionmaking as an approach to assessment of health professionals in training. Validity theory, with reference to the models of Messick and Kane, is discussed in the context of entrustment. This leads to reflections on how some assumptions regarding validity may need to be reconceptualized, how sources of evidence and validity arguments can support defensible decisions, and how threats to validity must be considered and minimized.