OpTrust Entrustment Education

Dr. Gurjit Sandhu, Associate Professor of Surgery and Learning Health Sciences, discusses the impressive work of the Education Research Scientist Collaborative team and their contributions to the conversation on entrustment in the operating room.

Purpose of the OpTrust Educational Bundle:

Surgical training programs are orienting to a competency-based educational model with an entrustable professional activities (EPAs) assessment framework. A successful transition to this new model will require significant faculty and resident development.

OpTrust is a novel faculty and resident educational bundle focused on the development of intraoperative behaviors to optimize entrustment in the operating room and to further resident autonomy. This effective educational initiative will better prepare faculty and residents for competency-based teaching, learning, and assessment.

What does the OpTrust Educational Bundle entail?

The OpTrust Educational Bundle consists of a faculty and resident development module, goal attainment and motivation style identification, and a validated tool for intraoperative entrustment measurement. The development module consists of an 1-hour interactive lecture with group discussion, strategic questioning, and written take-away educational materials.  The module provides an introduction to entrustment behaviors, shared mental models, learning theory, and regulatory focus motivational styles.

  1. Entrustment Behaviors

Entrustment and entrustability each represent part of a dual educational responsibility between faculty and residents. Faculty entrustment describes actions that impart trust and responsibility for patient care to residents while providing appropriate supervision. Resident entrustability demonstrates behaviors and decision making that warrant entrustment, as residents actively participate in driving their own learning. OpTrust education enables faculty and residents to identify intraoperative behaviors that advance entrustment and entrustability.

2. Shared Mental Models

Shared mental models among team members are required for effective coordination. Shared mental models enable team members to anticipate and predict each other’s needs, adapt to task demands, and coordinate their activities. When rapid adaptive performance is required, team members that utilize shared mental models develop accurate expectations for their own performance and for the performance of teammates. These expectations allow team members to coordinate effectively without the need for extensive overt strategizing.

3. Learning Theory

Vygotsky’s social development theory and educational concept, the zone of proximal development (ZPD), serves as a useful framework for resident surgical education.1 ZPD emphasizes that optimal learning and skill acquisition occurs when a trainee is functioning at the edge of their ability rather than by repeatedly performing tasks they have already mastered.2 Using the principles of social development theory and ZPD, faculty can foster an educational environment in which continual feedback strengthens a trainee’s surgical skills as the resident advances to their ZPD. Promoting these educational practices can aid faculty in becoming more confident when assessing the risk of a resident performing new tasks under their supervision. Purposeful teaching and learning can safely and appropriately advance a trainee’s operative limitations.

4. Regulatory Focus Theory

The OpTrust Bundle utilizes personality type assessment to effectively leverage individual behavioral styles to advance intraoperative education. Developed in the Higgins Lab at Columbia University, the Regulatory Focus Theory identifies how individuals with promotion-focused and prevention-focused mindsets approach goal achievement. Faculty and residents will assess their goal attainment style using the Regulatory Focus Questionnaire (RFQ), a validated psychosocial measurement instrument. RFQ styles are then discussed and contextualized in terms of how they could influence faculty-resident interactions in the operating room.

  1. Chaiklin S. The zone of proximal development in Vygotsky’s analysis of learning and instruction. Vygotsky’s educational theory in cultural context. 2003;1:39-64.

2. Jaramillo JA. Vygotsky’s sociocultural theory and contributions to the development of constructivist curricula. Education. 1996;117(1):133-141.