Point-of-care assessment of medical trainee competence for independent clinical work.

BACKGROUND Clinical supervisors make frequent assessments of medical trainees' competence so they can provide appropriate opportunities for trainees to experience clinical independence. This study explored context-specific assessments of trainees' competence for independent clinical work. METHOD In Phase One, 88 teaching team members from internal and emergency medicine were observed during clinical activities (216 hours), and 65 participants completed brief interviews. In Phase Two, 36 in-depth interviews were conducted using video vignettes. Data collection and analysis employed grounded theory methodology. RESULTS Supervisors' assessments of trainee trustworthiness for independent clinical work involved consideration of four dimensions: knowledge/skill, discernment of limitations, truthfulness, and conscientiousness. Supervisors' reliance on language cues as a source of trustworthiness data was revealed. CONCLUSIONS This study provides an initial exploration of context-specific competence assessments, which affect both patient safety and education, and provides a novel framework for study of the links between language use and competence.