Trust, entrustment decisions and a few things we shouldn’t forget

For many decades, medical educators have been struggling with assessment, as illustrated by the predominance of assessment in medical education research as well as the ongoing profound and sometimes heated discussions about how to best assess trainees’ competence and development [1–3]. In any event, efforts to change assessment systems are oriented towards the goal of improving health care quality by improving medical education, assessment and trainee learning. The rise of outcome-based models of education and increasing pressures for educational and professional accountability resulted in a growing emphasis on assessments that provide more direct evidence of the ultimate proficiencies of interest, i. e. performance in practice. As a consequence, medical education has witnessed radical changes in assessment approaches, including development and implementation of competency frameworks and, more recently, the concept of Entrustable Professional Activities (EPAs). In workaday reality of medical training EPAs, trust and entrustment seem to emerge as concepts that are more intuitive and meaningful than competencies. They are readily embraced by clinicians and medical educators as well, suggesting we may finally have found the Holy Grail in assessment [4, 5]. Part of the appeal of the entrustment concept appears to lie in the fact that entrustment decisions and the inherent ‘willingness to take risk’ align with the reality of medical practice: this is what clinicians do, day after day [4]. However, as persuasively argued by Holmboe and Batalden, achieving the desired transformation in medical