Factors Leading to Trainee Entrustment in EGD and Colonoscopy: A Prospective Multicenter Study Evaluating Endoscopy Competence in the Era of the Next Accreditation System (NAS): Presidential Poster Award

Introduction: The decision to trust a trainee to independently care for a patient, known as entrustment, is a critical developmental stage in training. With the transition to a competency-based medical education framework, there is an increasing need to understand how and when entrustment decisions are made by physicians supervising gastroenterology fellows (GIFs) performing endoscopic procedures. We aimed to describe the trainee factors influencing trainer entrustment decisions in EGD and Colonoscopy. Methods: All accredited GI fellowship programs (GIFPs) were invited to participate. After every 25 colonoscopies or EGDs, GIFs were evaluated on the next 5 of each procedure. Trainers were asked whether or not they would entrust GIFs with remote supervision (supervisor not in the room but readily available) or independent practice (performing procedure independently) and delineate which 3 factors, of 6 total - trainee confidence, communication skills, recognition of limitations, truthfulness, reliability, and procedural competence - led to that entrustment decision (Table 1).These factors were assessed for EGD and colonoscopy and were compared across the years of training. Results: In total, 14 GIFPs agreed to participate; over the study period, a total of 1385 EGDs and 1293 colonoscopies performed by 146 GIFs were evaluated. For colonoscopy, the 3 factors most influencing entrustment were procedural competence (71.9%), trainee reliability (44.4%), and recognition of limitations (40.7%). The frequency of factors associated with entrustment based on the year of training is highlighted in Table 2 and Figure. For EGD, the 3 most important factors for entrustment were procedural competency (71.8%), reliability (43.4%), and recognition of limitations (34.9%). The variability in the importance of these factors associated with entrustment based on the year of training is highlighted in Table 2 and Figure. Conclusion: Entrustment decisions of GIFs in EGD and colonoscopy appear to be primarily built on factors of trainee procedural competence, reliability, and a sense of recognizing one’s limitations. Identification of these factors may play a critical role in training GIFs especially in GIFPs where remote supervision is practiced.521_A Figure 1. Entrustment Questionnaire521_B Figure 2. Entrustment Comparison by year of fellowship521_C Figure 3. Entrustment Factors by year of fellowship