What levels of supervision are required for physician trainees? This month’s #MedEdPearl focuses on faculty supervision levels using a prospective, summative entrustment scale that fosters physician trainee progression toward autonomy.  As trusting propensity is an important component in supervision and entrustment, ten Cate and colleagues have developed an easily understood model for communicating aspects of entrustment through level of supervision for trainee assessment. The model describes elements of progression and decision-making that can foster autonomy in the learner.  As a complement to ten Cate's model, the #MedEdPearls team offers the following questions to quickly assess the required level of supervision for a learner while encouraging learner growth.

  1. What is your plan for …?  (This could address the learner’s plan for managing a patient and this question transfers ownership to the learner)
  2. How many times have you done …? (This is a proxy for skill development if direct observation of skill set has not been made)
  3. How comfortable are you...? (Combined with the above questions this self-assessment can help determine level of supervision)
  4. How would you teach a peer to...? (This question assesses the learner’s readiness to supervise others)

Entrustable Professional Activities (EPAs) levels quick guide:

What questions do you use to encourage trainee autonomy?  Share them via twitter with the hashtag at #MedEdPearls 


ten Cate, O., (2013) Nuts and Bolts of Entrustable Professional Activities JGME, 5(1): 157-158. doi: 10.4300/JGME-D-12-00380.1

ten Cate, O., (2018) A Primer on Entrustable Professional Activities KJME, 30(1): 1 – 10. doi: 10.3946/kjme.2018.76


Megan M. Haak, MA, is the Program Manager for Graduate Medical Education with the Medical College of Wisconsin Affiliated Hospitals (MCWAH), Inc. Ms. Haak works with programs to ensure continued compliance for over 90 ACGME-accredited training programs. Ms. Haak believes cultivating an intentional growth mindset opens the doors to many pathways in this journey of life. Ms. Haak is professionally interested in faculty development, teaching and learning, measurement and evaluation, and survey design. Follow Ms. Haak on Twitter @MeganHaak or connect via email: mhaak@mcw.edu  




#MedEdPearls Team:
Jean Bailey, PhD – Virginia Commonwealth University School of Medicine
Carrie Bowler, EdD, MS, MLSCM (ASCP) – Mayo Clinic
Kristina Dzara, PhD, MMSc (Educators ’16; Assessment ’16; HCE 2.0 ’17) – Saint Louis University School of Medicine
Shanu Gupta, MD – University of South Florida and Tampa General Hospital
Jennifer Hillyer, PhD – Northeast Ohio Medical University College of Medicine
Larry Hurtubise, PhD (HCE 2.0 '16) – The Ohio State University
Anna Lama, EdD – West Virginia University School of Medicine
Machelle Linsenmeyer, EdD, NAOME (Assessment ’07) – West Virginia School of Osteopathic Medicine
Rachel Moquin, EdD, MA – Washington University School of Medicine in St. Louis
Stacey Pylman, PhD – Michigan State University College of Human Medicine
Leah Sheridan, PhD – The Ohio University Heritage College of Osteopathic Medicine
Lonika Sood, MBBS, MHPE – Elson S. Floyd College of Medicine, Washington State University
Mark Terrell, EdD – Lake Erie College of Osteopathic Medicine
Stacey Wahl, PhD – Virginia Commonwealth University School of Medicine