Weighing Entrustment Decisions with Patient Care during Residency Training

The landscape of surgical training is changing. Challenges, including work hour mandates, legal restrictions, institutional policies, patient expectations, and advances in surgical care, have resulted in an increased pursuit of fellowship training and have raised concerns about trainee readiness to enter independent practice. Residents at any stage of training may find themselves in situations where they demonstrate the ability to work with increasingly more autonomy yet continue to be relegated to the assistant’s role. Perhaps more concerning is a scenario where these same residents nearing the end of training are not comfortable in the resident surgeon’s role. Entrustment refers to the degree of autonomy a supervising physician confides in the trainee and is conspicuously lacking in the scenarios above. As physicians, we accept that patient care is paramount, but we cannot deny a simultaneous obligation to train our future surgeons. Does patient care suffer at the expense of trainee entrustment and vice versa? Herein, we weigh the importance of ensuring trainee competence for future patient care against providing the best possible care for patients treated in the present.