Modes of trust and decision-making processes: A real-world exploration of entrustment decision-making in clinical supervision

INTRODUCTION: This study aimed to conceptualize how individual clinical supervisors make prospective entrustment decisions when considering trainee and supervisor factors. We sought to explore how supervisors operationalized different modes of trust (presumptive, initial, and grounded) when navigating the complexities of entrustment decision-making. METHODS: Between July and August 2024, experienced pharmacist supervisors across Australia participated in focus group interviews exploring how they make entrustment decisions and enact modes of trust when supervising trainees. The interview guide, informed by prior entrustment literature, explored prospective entrustment decision-making through the lens of individual supervisors. Thematic analysis was conducted using Braun and Clarke's reflexive approach to identify themes and to interpret how supervisors' decision-making processes aligned with different modes of trust. RESULTS: Seven focus group interviews involving 28 supervisors were conducted. Three key themes were evident: (1) Trainee trustworthiness is primarily defined by the ability of the trainee to recognize their limitations, demonstrate self-awareness, and show insight; (2) Supervisors' entrustment decision-making is informed by their trust propensity, risk tolerance, and professional experiences and standards; and (3) The nature of the supervisor-trainee relationship shapes the act of entrustment. Supervisors emphasized the importance of direct observation and evidence accumulation in informing conscious, analytical entrustment decisions, even when prior entrustment decisions had been made by other supervisors. DISCUSSION: Entrustment decisions made by individual supervisors are grounded by accumulated evidence and establishing familiarity with the trainee. Supervisor characteristics and the supervisor-trainee relationship further influence how prospective entrustment decisions are made. Rather than relying on initial trust processes, supervisors described developing grounded trust through direct observation of the trainee and accumulation of multisource evidence to inform conscious, analytical entrustment decisions. This study offers an empirically grounded conceptual framework that deepens our understanding of how trust is enacted and developed in real-world entrustment decision-making.