Entrustment in Action: Factors that Contribute to Entrustment Decision-Making Through the Lens of the Supervisor and the Intern

Abstract

ObjectiveTo explore what factors are considered in making an entrustment decision about a provisionally registered (intern) pharmacist from the perspectives of registered and intern pharmacists. MethodsRegistered and intern pharmacists in Australia were invited to participate in an anonymous online survey. The survey included open-ended, free-text questions exploring the factors influencing entrustment decisions for three Entrustable Professional Activities developed by the Australian Pharmacy Council for use in workplace-based assessments of intern pharmacists: dispensing medicines, compounding pharmaceutical products, and providing medication counselling. Qualitative data were analyzed using Braun and Clarke’s reflexive thematic analysis approach to identify key themes and subthemes influencing entrustment decisions. ResultsOf the 302 respondents (220 registered pharmacists and 82 interns), 215 participants provided qualitative responses. Analysis revealed four major themes: (1) Intern’s competency and skill proficiency, with emphasis on technical knowledge, task execution, and interpersonal skills; (2) Intern’s self-awareness and metacognition, including receptiveness to feedback and reflective practice; (3) Entrustment process dynamics, highlighting task complexity, contextual risk, and supervisor trust propensity; and (4) Barriers to and opportunities for establishing entrustment practices that guide entrustment decisions. Supervisors reported relying on team-based perspectives to inform entrustment decisions. ConclusionEntrustment decision-making is a multifaceted process shaped by intern characteristics, task complexity, and contextual dynamics. In addition to technical competence, metacognitive capabilities and reflective practice were identified as critical to fostering more autonomy in practice. Variability in supervisors’ trust propensity and entrustment practices highlights the need to strengthen entrustment practices to enhance consistency in how decisions are made and to support effective use of Entrustable Professional Activities in workplace-based pharmacy education.