Entrusting “Attitudes” in the K/S/A of Bedside Cardiac Assessment

Abstract

ABSTRACTProblemIn the competency-based medical education literature, investigators have typically discussed notions of trust in the context of entrustment decision-making rather than as attitudes within competency frameworks. Complementarity between concepts of entrustable professional activities and of competencies created an opportunity to infuse the latter with notions of trust.Bedside cardiac assessment (BCA) exemplified one such competency. Traditional approaches to teaching and learning BCA addressed relevant knowledge and skills but not attitudes. We conceptualized entrustability as part of an attitudinal approach to teaching and learning BCA more holistically and effectively. The purpose of this thematic analysis was to explore students’ experience, in a medicine clerkship at one U.S. medical school, of participating in a newly developed BCA curriculum that aimed to foster attitudinal growth and a holistic approach to clinical learning.ApproachBuilding upon Teaching for Understanding and conceptual change frameworks, the authors developed a flipped class curriculum utilizing pre-class short online videos and practice exercises followed by in-class activities and reflective discussions. Using a combination of content analysis and thematic analysis methodology of open-ended questionnaires administered from November 2017 to June 2018, the authors analyzed the experiences of medical students at one of the schools at which the curriculum was implemented.OutcomesThematic analysis suggested learning strategies were effective and that peer encounters, skills practice, and encounters with educators were meaningful. The analysis also revealed opportunities to improve the original instructional design.Next StepsThe authors will incorporate feedback into future iterations of the curriculum and make it widely available to better study its impact on learners’ abilities; entrustability as a construct; and transfer of learning from the classroom to the workplace. Further work is needed to clarify the value of incorporating notions of trust into competency frameworks. The authors intend this exploratory work to stimulate conversations around expanded roles of trustworthiness and entrustability in medical education.