Theoretical foundations of trust and entrustment in health professions education

Abstract

The purpose of this chapter is to conceptualize trust within the context of entrustment in clinical education-to clarify what its purpose is, what its components are, how decisions about it are made, and what other forms of trust it relates to. In a general context, trust is a ubiquitous and intuitive construct that emerges within relationships, enabling individuals to cooperate and collaborate to perform tasks that they might not otherwise be able to perform alone. The trust specific to entrustment emerges from the interdependent goals of patient care and trainee learning, creating reciprocity between supervisor and trainee. Starting from a definition of trust in which risk assessment is central, proposed by Mayer et al. in 1995, additional details are added to conceptualize entrustment's unique form of trust. Considerations include contrasting the trustworthiness of clinical trainees with that of general trustworthiness, and consolidating the factors that influence entrustment decision-making. The connections between entrustment and other forms of trust within the patient-supervisor-trainee triad are also considered: trainee trust in their supervisors, and patient trust in trainees-including entrustment's role in ensuring patients' presumptive trust in trainees is justified. A unified model of entrustment is presented that incorporates these dimensions of trust and their theoretical conceptualizations.