Entrustable professional activities framework for assessment in predoctoral dental education, developed using a modified Delphi process

Developing and Validating Entrustable Professional Activities (EPAs) for Rheumatology Fellowship Training Programs in Saudi Arabia: A Delphi Study

Background

Entrustable professional activities (EPAs) define the core tasks that a graduating rheumatologist needs to perform independently in practice. The objective of this study was to develop and validate EPAs for rheumatology fellowship training programs in Saudi Arabia.

Methods

Experts met to develop an initial set of potential end-of-training EPAs by conducting a comprehensive literature review of EPAs and studying the Saudi rheumatology fellowship curriculum. Then, to validate the EPAs, we conducted two rounds of the modified Delphi technique among rheumatology experts in Saudi Arabia. A response rate of 80% was considered and the minimum number of experts needed to be 25 to 30. Descriptive statistics were utilized to describe participants' demographic characteristics and group responses to each statement in all rounds. The experts were asked to rate the relevancy of each EPA using a 5-point Likert scale in both Delphi rounds.

Results

In the preliminary phase, four rheumatologists developed an initial set of 36 core EPAs for rheumatology training program in Saudi Arabia. For the two-rounds Delphi techniques, 32 experts were invited to complete the study. The response rate of the first and second round were, 78.12% (25) and 93.75% (30), respectively. The first-round Delphi resulted in a robust consensus on 31 EPAs for rheumatology training. Five EPAs were excluded, and one new EPA was proposed. In the subsequent round, all 32 EPAs achieved strong consensus. The eliminated EPAs likely fell short in one or more of the following areas: relevance to rheumatology practice in Saudi Arabia, overlapping with other EPAs, or practical challenges in the implementation.

Conclusion

We have developed and validated a core set of EPAs for rheumatology fellowship training programs in Saudi Arabia. Mapping and identifying milestones for these EPAs are essential steps to follow to enhance workplace curriculum development.

Structure, governance and delivery of specialist training programs in periodontology and implant dentistry

AIM

To update the competences and learning outcomes and their evaluation, educational methods and education quality assurance for the training of contemporary specialists in periodontology, including the impact of the 2018 Classification of Periodontal and Peri-implant Diseases and Conditions (2018 Classification hereafter) and the European Federation of Periodontology (EFP) Clinical Practice Guidelines (CPGs).

METHODS

Evidence was gathered through scientific databases and by searching for European policies on higher education. In addition, two surveys were designed and sent to program directors and graduates.

RESULTS

Program directors reported that curricula were periodically adapted to incorporate advances in diagnosis, classification, treatment guidelines and clinical techniques, including the 2018 Classification and the EFP CPGs. Graduates evaluated their overall training positively, although satisfaction was limited for training in mucogingival and surgical procedures related to dental implants. Traditional educational methods, such as didactic lectures, are still commonly employed, but they are now often associated with more interactive methods such as case-based seminars and problem-based and simulation-based learning. The evaluation of competences/learning outcomes should employ multiple methods of assessment.

CONCLUSION

An update of competences and learning outcomes of specialist training in periodontology is proposed, including knowledge and practical application of the 2018 Classification and CPGs. Harmonizing specialist training in periodontology is a critical issue at the European level.

Gaps in Access to Medically Necessary Dental Care for Patients Living With and Beyond Cancer: We Must Do Better

Delivery of high-quality, evidence-based oral care for those living with and beyond cancer needed!

Developing an entrustable professional activity for providing health education and consultation in occupational therapy and examining its validity

BACKGROUND

Entrustable Professional Activities (EPA)-based assessment is easily and intuitively used in evaluating the learning outcomes of competency-based medical education (CBME). This study aimed to develop an EPA for occupational therapy focused on providing health education and consultation (TP-EPA3) and examine its validity.

METHODS

Nineteen occupational therapists who had completed online training on the EQual rubric evaluation participated in this study. An expert committee identified six core EPAs for pediatric occupational therapy. TP-EPA3 was developed following the EPA template and refined through consensus meetings. The EQual rubric, a 14-item, five-point criterion-based anchor system, encompassing discrete units of work (DU), entrustable, essential, and important tasks of the profession (EEIT), and curricular role (CR), was used to evaluate the quality of TP-EPA3. Overall scores below 4.07, or scores for DU, EEIT, and CR domains below 4.17. 4.00, and 4.00, respectively, indicate the need for modifications.

RESULTS

The TP-EPA3 demonstrated good validity, surpassing the required cut-off score with an average overall EQual score of 4.21 (SD = 0.41). Specific domain scores for DU, EEIT, and CR were 3.90 (SD = 0.69), 4.46 (SD = 0.44), and 4.42 (SD = 0.45), respectively. Subsequent revisions clarified observation contexts, enhancing specificity and focus. Further validation of the revised TP-EPA3 and a thorough examination of its reliability and validity are needed.

CONCLUSION

The successful validation of TP-EPA3 suggests its potential as a valid assessment tool in occupational therapy education, offering a structured approach for developing competency in providing health education and consultation. This process model for EPA development and validation can guide occupational therapists in creating tailored EPAs for diverse specialties and settings.

American Dental Education Association Compendium Entrustable Professional Activities Workgroup report

PURPOSE

Entrustable professional activities (EPAs) are discrete clinical tasks that can be evaluated to help define readiness for independent practice in the health professions and are intended to increase trust in the dental graduate. EPAs provide a framework that bridges competencies to clinical practice. This report describes the work of the American Dental Education Association (ADEA) Compendium EPA Workgroup to develop a list of EPAs for dental education and supportive resources, including specifications and a glossary.

METHODS

Preliminary work including literature and resource review, mapping of existing competencies, and review of other health professions' EPAs informed the development of our EPAs list. Workgroup members achieved consensus using a modified Delphi process. A Qualtrics survey using a validated rubric for the assessment of EPAs as described in peer-reviewed literature was used. Dental educators, including academic deans, were surveyed for feedback on the content and format of the EPAs.

RESULTS

Based on findings in the literature analysis of existing EPAs and competencies in health professions, a list of EPAs was developed along with a description of specifications. The EPA workgroup (nine members from multiple institutions) used the Delphi process in receiving feedback from various experts. A list of 11 core EPAs was vetted by dental educators including academic deans (n = ∼23), and the process of development was reviewed by EPAs experts outside dental education. A glossary was developed to align language.

CONCLUSION

These EPAs define the scope of dental practice. This report represents Phase 1 of the EPA framework development and vetting process. Future directions will include a broader vetting of the EPA list, faculty development, and national standardized technology that support this work to optimize implementation.

Exploring and describing current behavioral and social sciences curricula in predoctoral dental programs

PURPOSE

To maintain accreditation status, predoctoral dental programs in the United States and Canada are required to train future dentists in the fundamentals of behavioral sciences. Each program independently determines how to fulfill this task, and little information exists on the consistency of training across programs. The purpose of this study was to identify the range of topics currently taught in predoctoral dental programs in the United States and Canada, who teaches them, and the modes of instruction and assessment.

METHODS

Invitations to complete an online survey were emailed to faculty responsible for, or familiar with, the behavioral sciences curricula at 75 predoctoral dental programs in the United States and Canada. Questions elicited information on behavioral sciences education at each program, including instructor background, topics taught, instructional and assessment methods, and sources of content.

RESULTS

Of those invited, 27 (36%) completed surveys. Per the responses, prototypical behavioral sciences programs usually consist of didactic/lecture format teaching, mostly during the first 2 years of the predoctoral program, by a dentist who assesses students using multiple-choice or true/false exams. The results indicated, however, substantial variation in what is taught, how it is taught, who teaches it, and how it is assessed.

CONCLUSIONS

While being a requirement for accreditation, this study demonstrated how behavioral and social sciences topics, teaching strategies, and assessments, along with the individuals teaching those topics varied across predoctoral programs. Consistency, coordination, and clinical integration are possible ways of enhancing behavioral science instruction.

Entrustable professional activities in undergraduate dental education: A practical model for development and validation

OBJECTIVE

Entrustable professional activities (EPAs) are tasks that a person who is qualified or is in the process to be credentialed are allowed to engage. There are several levels of entrustment based on degrees of supervision assigned to each EPA. This paper aims to describe the process and outcome of creating EPAs; validate EPAs relevant to undergraduate dental training.

METHODS

A draft set of EPA statements was developed based on the consensus of an expert panel. These were then mapped to the nationally determined minimum experience thresholds (clinical and procedural experiences/competencies) and aligned to task-based instructional strategy. The EPAs were validated to improve the relevance by using a criterion-based rubric.

RESULTS

An end-to-end process workflow led to the development of an EPA-based educational framework to bridge the gaps in the curriculum. The process identified a total of 41 EPAs and out of which, 10 EPAs were notated as core EPAs and will be subjected to structured workplace-based assessment complying to the national standards. The validation exercise rated core EPAs with an overall score matching close to the cut-off of 4.07 (Equal rubric).

CONCLUSION

The end-to-end process workflow provided the opportunity to elaborate a structured process for the development of EPAs for undergraduate dental education. As validation is a continuous process, feedback from implementation will inform the next steps.

Entrustable professional activities in dental education: a scoping review

Background Competency-based education has led to the introduction of entrustable professional activities (EPAs) in health sciences education. EPAs are assessment tools that serve to certify a trainee's preparedness to conduct a given clinical activity. Objective Given its modest introduction into dental education, we sought to examine the current situation of EPAs in our field and identify possible barriers and facilitators. This review aimed to summarise evidence about EPA introduction in dental education programmes.Data sources A review of articles published between January 2005 and December 2021 was conducted using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews methodology in three databases (PubMed, Cochrane and Embase).Data selection Keywords were 'entrustable professional activity' OR 'entrustable professional activities' AND 'dentistry' OR 'dental education'.Data extraction Eligibility criteria targeted papers published in English describing dental education EPA.Data synthesis Ten publications were selected: six reported on new EPAs, three discussed their relevance for dental education and one article described a process for developing validated EPAs. EPAs focused on clinical examination, health promotion, treatment planning, pain and/or anxiety control and topics related to a specific discipline or care procedures.Conclusion Topics covered by EPAs described in our study adequately reflect the specificities of today's dental professional. The benefits of EPAs will ensure tomorrow's dentists consistently meet societal expectations.

Entrustable professional activities in nursing education: a scoping review protocol

INTRODUCTION

Entrustable professional activities were introduced in medical education more than 15 years ago. EPAs define units of professional practice that can be fully entrusted to sufficiently competent professionals. Today, EPAs have been developed and implemented in many health professions, as the concept is useful in bridging the gap between competency-based education and the daily tasks health professions have to deal with in the workplace. While some evidence exists in medical education, the role of EPAs in nursing education is not yet fully understood. Therefore, the overall aim of this scoping review is to describe the current body of evidence regarding EPA implementation in nursing education.

METHODS AND ANALYSIS

A two-stage screening process will be used during the search phase, in order to screen retrieved abstracts and titles that focus primarily on the discussion of EPA in nursing education in all languages within the last two decades. The electronic databases, OVID (Embase and PubMed combined) and EBSCOhost (CINHAL and ERIC combined), as well as grey literature will be searched. The search period ranges from 1 January 1995 to 31 December 2021. Data will be extracted according to study design, context (geographical location and type of nursing programme), details of EPAs mentioned (title, specifications, limitations and competency domains), as well as evidence of implementation, outcomes and effect sizes.

ETHICS AND DISSEMINATION

Ethical approval is not required as this review will be using previously collected data. Review findings will be published in a peer-reviewed journal and presented at scientific conferences.

Entrustable professional activities framework for assessment of patient handoffs in dentistry

PURPOSE/OBJECTIVES

The aim of this study is to report data on the lack of a proper patient handoff system in dentistry and dental education and to present a possible solution to integrate this into curriculum using the "entrustable professional activities" (EPAs) framework.

METHODS

Delphi participants from seven US dental schools provided feedback on a preliminary definition of handoff, a mnemonic and an assessment rubric. 2019 American Dental Education Association Commission on Change and Innovation in Dental Education (ADEA CCI) participants further evaluated the handoff EPA using the EQual rubric for EPA quality and structure.

RESULTS

Delphi participants identified points of transition in dentistry, selected the D-PASS as a mnemonic, and agreed with the evaluation rubric. The ADEA CCI participants agreed the handoff EPA describes work that is essential for the profession and suitable for entrustment.

CONCLUSION

The D-PASS rubric is an effective way to assess patient handoffs.