A question of risk: how do undergraduate GP teachers experience entrustment decision-making in primary care?

The decision to trust a learner to actively participate in care is a fundamental part of clinical training. However, concerns about patient safety mean that clinical practice often presents newly qualified doctors with situations they are unable to manage independently. 'Entrustable professional activities' (EPAs) have been proposed as a possible solution to this unpreparedness. Understanding how undergraduate GP teachers make entrustment decisions, which is a gap in the existing literature, may be an appropriate first step towards understanding whether EPAs can be applied to undergraduate primary care. To explore teachers' experiences of entrustment decision-making in an undergraduate primary care context. This is an interpretive phenomenological study. Data were collected through semi-structured interviews with final year GP teachers. Interviews were audio recorded, transcribed and subjected to thematic analysis. Five GP teachers were interviewed. Five themes and twenty-four subthemes were produced. These captured participants' experiences of entrustment decision-making, as well as the factors influencing these decisions. The teacher's personal approach to risk was a key consideration. The experience of GP teachers is also shaped by their context and challenges such as managing complexity and uncertainty that are inherent to the GP role. Entrustment decision-making is complex and is experienced individually by different teachers, resulting in a range of approaches to supervision. Despite these differences there are various common factors that impact the decision of whether to entrust. This study allows several recommendations to be made that may enable us to move towards entrustment of undergraduate students in a primary care context.