title: OpTrust: Validity of a Tool Assessing Intraoperative Entrustment Behaviors.
abstract: The aim of this study is to establish evidence to support the validity of a novel faculty-resident intraoperative assessment tool for entrustment known as OpTrust.
  
  
  
  Recently, the landscape of surgical training has been altered, in part, because of resident work-hour changes and increased supervision requirements. To address these concerns, a new model for assessment of teaching and learning in surgical residencies must be anchored on progression through milestones and entrustment.
  
  
  
  OpTrust was designed to assess the faculty-resident dyad in the operating room and measure the entrustment exhibited during intraoperative interactions across 5 domains: (i) types of questions asked, (ii) operative plan, (iii) instruction, (iv) problem solving, and (v) leadership by the surgical resident. After initial pilot testing and refinement of OpTrust, 5 individual raters underwent rater training sessions; 49 individual operating room observations were completed based on 28 cases.
  
  
  
  OpTrust, as a tool for assessing intraoperative entrustment, is supported by strong validity evidence. In part, it demonstrates strong interrater reliability across all faculty domains as measured by intraclass correlation 1 (ICC1) (0.81-0.93). For resident domains the results were similar with ICC1 (0.84-0.94). Cronbach alpha was 0.89 and 0.87 for faculty and resident entrustment respectively, signifying the 5 domains could be combined into a single construct of entrustment. A high correlation existed between faculty and resident scores (Pearson r = 0.94, P < 0.001) indicating a strong positive linear relationship between faculty and resident mean entrustment scores across all scale domains.
  
  
  
  OpTrust successfully assesses behaviors associated with entrustment during intraoperative faculty-resident interactions, and has the potential to be adopted across other procedural-based specialties to promote autonomous training progression.
authors.affiliation: Department of Surgery, University of Michigan, Ann Arbor, MI.|Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI.
authors.forename: Gurjit
authors.initials: G
authors.lastname: Sandhu
authors.affiliation: Department of Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Vahagn C
authors.initials: VC
authors.lastname: Nikolian
authors.affiliation: Department of Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Magas
authors.affiliation: Wayne State University School of Medicine, Graduate Medical Education office, Troy, MI.
authors.forename: Robert B
authors.initials: RB
authors.lastname: Stansfield
authors.affiliation: Department of Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Danielle C
authors.initials: DC
authors.lastname: Sutzko
authors.affiliation: University of Michigan Medical School, Ann Arbor, MI.
authors.forename: Kaustubh
authors.initials: K
authors.lastname: Prabhu
authors.affiliation: Department of Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Niki
authors.initials: N
authors.lastname: Matusko
authors.affiliation: Section of Hepatopancreatobiliary Surgery, Division of Surgical Oncology, UT Southwestern Medical Center, Dallas, TX.
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Minter
mesh_terms: D002983:Clinical Competence; D004521:Educational Measurement / Q000379:methods*; D005180:Faculty, Medical / Q000523:psychology*; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency / Q000592:standards*; D007432:Intraoperative Period; D017009:Professional Autonomy; D015203:Reproducibility of Results; D035502:Trust