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Purpose: Entrustment has mainly been conceptualized as delegating discrete professional tasks. Because residents provide most of their patient care independently, not all resident performance is visible to supervisors; the entrustment process involves more than granting discrete tasks. This study explored how supervisors made entrustment decisions based on residents' performance in a long-term family medicine training program., Method: A qualitative nonparticipant observational study was conducted in 2014-2015 at competency-based family medicine residency programs in the Netherlands. Seven supervisor-resident pairs participated. During two days, one researcher observed first-year residents' patient encounters, debriefing sessions, and supervisor-resident educational meetings and interviewed them separately afterwards. Data were collected and analyzed using iterative, phenomenological inductive research methodology., Results: The entrustment process developed over three phases. Supervisors based their initial entrustment on prior knowledge about the resident. In the ensuing two weeks, entrustment decisions regarding independent patient care were derived from residents' observed general competencies necessary for a range of health problems (clinical reasoning, decision making, relating to patients); medical knowledge and skills; and supervisors' intuition. Supervisors provided supervision during and after encounters. Once residents performed independently, supervisors kept reevaluating their decisions, informed by residents' overall growth in competencies rather than by adhering to a predefined set of tasks., Conclusions: Supervisors in family medicine residency training took a holistic approach to trust, based on general competencies, knowledge, skills, and intuition. Entrustment started before training and developed over time. Building trust is a mutual process between supervisor and resident, requiring a good working relationship.

Objective: To investigate differences between medical faculties in the proportion of graduates entering general practice (GP) training, and to analyse whether this is related to the degree of orientation towards general practice of Dutch medical undergraduate curricula., Design: Retrospective cohort study., Methods: Several databases were used to investigate which percentage of medical graduates per faculty entered the GP training programme between 1989 and 2001. The coordinators of general practice education in the undergraduate curriculum of the eight Dutch faculties of medicine filled in a questionnaire about the degree of orientation toward general practice of their curriculum and the extent to which medical students came into contact with primary care., Results: The number of medical graduates per faculty in the period 1989-2001 varied between 1682 and 2443. On average, 23.5% of the students entered GP training. The medical faculties of Maastricht University, Radboud University Nijmegen and VU University Amsterdam showed the strongest orientation towards general practice. Leiden University, the University of Amsterdam and University of Groningen were the least oriented, and Utrecht University and Erasmus University Rotterdam were in between. There was no clear correlation between the orientation of the curriculum towards general practice and the percentage of medical graduates entering general practice training., Conclusion: There were small differences between faculties in the proportion of graduates entering a GP training programme during a 10-year period. Although there were differences between curricula in the degree of orientation towards general practice, this had little effect on the number of medical graduates entering general practice training. Presumably, other factors such as personal preferences and the employment situation are more important.