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Chen PC, Chen CI. Exploring factors impacting patient decisions in hemorrhoid surgery: A questionnaire survey in Taiwan. Surg Open Sci 2024; 20:214-221. [PMID: 39156488 PMCID: PMC11327606 DOI: 10.1016/j.sopen.2024.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 07/05/2024] [Accepted: 07/19/2024] [Indexed: 08/20/2024] Open
Abstract
Background Minimally invasive hemorrhoid surgeries like Doppler-Guided Hemorrhoidal Artery Ligation (DGHAL) and Stapled Hemorrhoidopexy (PPH) offer benefits over traditional methods. This study investigated public perceptions and attitudes towards these surgeries, exploring awareness, preferences, and influencing factors. Methods A detailed questionnaire was disseminated to 2011 participants from various regions of Taiwan in December 2023, gathering data on demographics, understanding of minimally invasive surgery, and attitudes towards hemorrhoid surgery. Chi-square tests were used for analysis (p < 0.05). Results Hemorrhoid prevalence was similar across sexes and age groups. About 70 % preferred medical centers or district hospitals for surgery. Postoperative complications were a primary concern, with significant sex differences. Approximately 70 % preferred minimally invasive surgery if costs were below NT$50,000. Medical personnel showed higher awareness of minimally invasive surgery benefits. Most participants relied on personal networks and medical social media for information. Conclusions The study revealed generally positive perceptions of minimally invasive hemorrhoid surgery, with cost being a significant factor. Knowledge gaps exist, particularly among non-medical personnel. Future initiatives should aim to enhance public awareness of minimally invasive surgery benefits, and policy considerations should address financial aspects of healthcare decisions.
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Affiliation(s)
- Pin-Chun Chen
- Division of Colon and Rectal Surgery, Department of Surgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Chih-I Chen
- Division of Colon and Rectal Surgery, Department of Surgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
- Executive Master of Business Administration, National Sun Yat-sen University, Kaohsiung, Taiwan
- Division of General Surgery Medicine, Department of Surgery, E-Da hospital, I-Shou University, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
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Ahn E, LaDonna KA, Landreville JM, Mcheimech R, Cheung WJ. Only as Strong as the Weakest Link: Resident Perspectives on Entrustable Professional Activities and Their Impact on Learning. J Grad Med Educ 2023; 15:676-684. [PMID: 38045932 PMCID: PMC10686661 DOI: 10.4300/jgme-d-23-00204.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/20/2023] [Accepted: 08/20/2023] [Indexed: 12/05/2023] Open
Abstract
Background Core to competency-based medical education (CBME) is the use of frequent low-stakes workplace-based assessments. In the Canadian context, these observations of performance are framed around entrustable professional activities (EPAs). Objective We aimed to explore residents' real-world perspectives of EPAs and their perceived impact on learning, because assessments perceived to be "inauthentic," or not truly reflective of their lived experiences, may interfere with learning. Methods Using constructivist grounded theory, we conducted 18 semistructured interviews in 2021 with residents from all programs that had implemented CBME at one tertiary care academic center in Canada. Participants were recruited via email through respective program administrators. Data collection and analysis occurred iteratively, and categories were identified using constant comparative analysis. Results Residents were strikingly polarized, perceiving EPAs as either a valuable opportunity for professional growth or as an onerous requirement that interfered with learning. Regardless of what view participants held, all perspectives were informed by: (1) the program administration and the perceived messaging from program to residents; (2) faculty assessors and their perceived degree of engagement, or "buy-in" with the EPA system; and ultimately (3) learner behavior. We theorized from these findings that all 3 aspects must be working in tandem for the assessment system to function as intended. Conclusions From the learners' perspective, there exists a dynamic, interdependent relationship between the 3 CBME stakeholders. As such, the perceived value of the EPA assessment system can only be as strong as the weakest link in the chain.
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Affiliation(s)
- Eusang Ahn
- Eusang Ahn, MD, MS (MedEd), Dipl. KSEM, FRCPC, is Clinician Fellow, Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Kori A. LaDonna
- Kori A. LaDonna, PhD, is Associate Professor, Department of Innovation in Medical Education and Department of Medicine, Lead, Qualitative Education Research, and Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jeffrey M. Landreville
- Jeffrey M. Landreville, MD, MMed, FRCPC, is Program Director and Assistant Professor, Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Rawad Mcheimech
- Rawad Mcheimech, BA, is Research Coordinator, Department of Innovation in Medical Education, University of Ottawa, Ottawa, Ontario, Canada; and
| | - Warren J. Cheung
- Warren J. Cheung, MD, MMEd, FRCPC, DRCPSC, is Associate Director of Education Innovation, Director of Assessment, and Associate Professor, Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Bramley A, Forsyth A, McKenna L. Validity and Educational Impact of Clinical Entrustable Professional Activities Linked to the Nutrition Care Process for Work-Based Assessment of Entry-Level Dietetics Students: Evaluation of a 3-Year Implementation Study in Australia. J Acad Nutr Diet 2023; 123:614-625.e7. [PMID: 36089207 DOI: 10.1016/j.jand.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 08/30/2022] [Accepted: 09/05/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Entrustable professional activities (EPAs) describe key workplace activities and are increasingly being used for student work-based assessment. An EPA-based work-based assessment tool offers potential to increase understanding of dietetics student skill development and opportunity for standardised work-based student assessment. OBJECTIVE To determine construct validity and educational impact of an EPA work-based assessment tool for dietetics placement students in clinical settings. DESIGN Using a time series design, supervisor and student self-assessment data collected from an EPA-based assessment tool from three cohorts of dietetics students and supervisors from 2017-2019 was analyzed. PARTICIPANTS AND SETTING Dietetics students (n = 145) from an accredited dietetic training program in Australia and affiliated metropolitan and rural hospitals. MAIN OUTCOME MEASURES Construct validity was determined through analysis of supervisor evaluation of student performance against EPAs over time. Educational impact was determined through comparing student performance across EPAs to predicted milestones to identify areas of least entrustment. STATISTICAL ANALYSES PERFORMED Student performance over time and differences between student self-assessment and supervisor assessment for each EPA were investigated using Wilcoxon signed-rank tests and linear mixed-model analysis. Descriptive statistics summarised student performance against each EPA. RESULTS Performance significantly increased over time in 35 out of 37 EPAs. Significant differences between supervisor and student self-assessment were evident in 9 out of 37 EPAs. Dietetics student performance varied across EPAs with 88.2% of students achieving entrustment for nutrition management EPAs compared with 100% for professionalism EPAs. CONCLUSIONS The tool's construct validity was established. EPAs identified areas of Nutrition Care Process skills development requiring additional support. Data collected by the tool can inform teaching.
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Affiliation(s)
- Andrea Bramley
- School of Allied Health, Human Services, and Sport, La Trobe University, Bundoora, Victoria, Australia; Monash Health, Clayton, Victoria, Australia.
| | - Adrienne Forsyth
- School of Allied Health, Human Services, and Sport, La Trobe University, Bundoora, Victoria, Australia; Australian Catholic University, Melbourne, Victoria, Australia
| | - Lisa McKenna
- School of Nursing and Midwifery, College of Science, Health, and Engineering, La Trobe University, Bundoora, Victoria, Australia
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Valding B, Monti M, Junod Perron N, Frick S, Jaques C, Nendaz M, Gachoud D. Entrustable professional activities for residency in general internal medicine: a systematic review. Swiss Med Wkly 2022; 152:40002. [PMID: 36473152 DOI: 10.57187/smw.2022.40002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
CONTEXT Entrustable Professional Activities (EPAs) are observable tasks that are regular parts of a physician's daily clinical work. Before being permitted to accomplish these tasks independently, trainees must gain their supervisors' trust. Defining the list of EPAs that should be mastered by the end of a residency is critical to setting clear expectations about autonomous practice. OBJECTIVE To collect all the lists of EPAs defined for residencies in general internal medicine and synthesise them into a reference work useful for developing new lists of EPAs or improving existing ones. METHOD This systematic review searched five databases and relevant grey literature using keywords related to EPAs and postgraduate education, from 2005, when the first article on EPAs was published, to April 2022. Inclusion criteria were the availability of an EPAs list and a focus on general internal medicine. Two reviewers independently selected the studies, extracted data and performed a quality assessment using QATSDD and AACODS tools. Mean values and inter-rater reliability were calculated. RESULTS The review yielded 3292 records, with 16 articles meeting the inclusion criteria, mostly from North America. Synthesising their 16 lists generated 395 EPAs. The reviewers then inductively categoried those EPAs, 308 of which fell into 6 domains, 14 themes and 24 subthemes. The domains were: (1) care and management of the general adult population (n = 103 EPAs); (2) care and management of patients with specific needs (n = 67); (3) care coordination and communication (n = 52); (4) management and leadership (N = 21); (5) healthcare quality, education, and research (n = 41); and (6) miscellaneous (n = 24). The remaining 87 EPAs were disease-specific and did not fit into this categorisation. CONCLUSIONS Categorising EPAs created a unique synthesis of the existing lists of EPAs for educating residents in general internal medicine. This synthesis could be used as a reference for anyone tasked with developing new lists of EPAs or improving existing ones.
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Affiliation(s)
- Bastien Valding
- Department of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Matteo Monti
- Department of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland.,Medical Education Unit, University of Lausanne, Switzerland
| | - Noëlle Junod Perron
- Institute of Primary Care, Geneva University Hospitals, Geneva, Switzerland.,Unit for Development and Research in Medical Education, Faculty of Medicine, Geneva, Switzerland
| | - Sonia Frick
- Department of Internal Medicine, Lachen Hospital, Lachen, Switzerland.,School of Medicine, University of Zürich, Switzerland
| | - Cécile Jaques
- Medical Library, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Mathieu Nendaz
- Unit for Development and Research in Medical Education, Faculty of Medicine, Geneva, Switzerland.,Division of Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - David Gachoud
- Department of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland.,Medical Education Unit, University of Lausanne, Switzerland
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Bramley A, Forsyth A, McKenna L. Development and evaluation of Entrustable Professional Activities embedded in an e-portfolio for work-based assessment in community and public health dietetics. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5445-e5456. [PMID: 35942519 PMCID: PMC10087043 DOI: 10.1111/hsc.13967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 06/02/2022] [Accepted: 07/25/2022] [Indexed: 06/15/2023]
Abstract
Entrustable professional activities (EPAs) is a recent concept that helps operationalise competency-based education. In this paper, we report on the development of EPAs and incorporation into an e-portfolio for work-based assessment of final year dietetics students in a community and public health professional placement. We aimed to determine the utility of the EPAs for work-based assessment in this context. We used action research methodology to conduct broad consultation with students and supervisors using anonymous surveys and focus groups to understand their beliefs and attitudes towards work-based assessment. Consequently, 40 EPAs with an accompanying four-point entrustment scale were developed and mapped to the National Competency Standards for Dietitians in Australia. The EPAs and assessment tool were piloted and evaluated via an anonymous online user survey across three cohorts of students (n = 133) and supervisors (n = 67). Following mediocre pilot year evaluation results, EPAs were revised and reduced in number. While students positively evaluated the e-portfolio, their appraisal of the EPAs and entrustment scale was less positive compared to supervisors. Supervisor evaluation of the EPA-based e-portfolio supported the validity, feasibility and acceptability of this novel assessment method in a community and public health setting. Assessment using EPAs, and the resulting educational data collected by the tool, offers potential for individual learners to identify areas needing development during placement, as well as potential to inform curriculum improvements and increase understanding of learning opportunities and outcomes for dietetic students in community and public health settings.
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Affiliation(s)
- Andrea Bramley
- Department of Dietetics and Human NutritionLa Trobe UniversityBundooraVictoriaAustralia
- Monash HealthClayton RoadClaytonVictoriaAustralia
| | - Adrienne Forsyth
- Dietetics and Nutrition at Australian Catholic University, School of Allied Health, Human Services and SportLa Trobe UniversityBundooraVictoriaAustralia
| | - Lisa McKenna
- School of Nursing and Midwifery, College of Science, Health and EngineeringLa Trobe UniversityBundooraVictoriaAustralia
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Dunne D, Gielissen K, Slade M, Park YS, Green M. WBAs in UME-How Many Are Needed? A Reliability Analysis of 5 AAMC Core EPAs Implemented in the Internal Medicine Clerkship. J Gen Intern Med 2022; 37:2684-2690. [PMID: 34561828 PMCID: PMC9411433 DOI: 10.1007/s11606-021-07151-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 09/09/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Reliable assessments of clinical skills are important for undergraduate medical education, trustworthy handoffs to graduate medical programs, and safe, effective patient care. Entrustable professional activities (EPAs) for entering residency have been developed; research is needed to assess reliability of such assessments in authentic clinical workspaces. DESIGN A student-driven mobile assessment platform was developed and used for clinical supervisors to record ad hoc entrustment decisions using the modified Ottawa scale on 5 core EPAs in an 8-week internal medicine (IM) clerkship. After a 12-month period, generalizability (G) theory analysis was performed to estimate the reliability of entrustment scores and determine the proportion of variance attributable to the student and the other facets, including particular EPA, evaluator type (attending versus resident), or case complexity. Decision (D) theory analysis determined the expected reliability based on the number of hypothetical observations. A g-coefficient of 0.7 was used as a generally agreed upon minimum reliability threshold. KEY RESULTS A total of 1368 ratings over the 5 EPAs were completed on 94 students. Variance attributed to person (true variance) was high for all EPAs; EPA-5 had the lowest person variance (9.8% across cases and four blocks). Across cases, reliability ranged from 0.02 to 0.60. Applying this to the Decision study, the estimated number of observations needed to reach a reliability index of 0.7 ranged between 9 and 11 for all EPAs except EPA5 which was sensitive to case complexity. CONCLUSIONS Work place-based clinical skills in IM clerkship students were assessed and logged using a convenient mobile platform. Our analysis suggests that 9-11 observations are needed for these EPA workplace-based assessments (WBAs) to achieve a reliability index of 0.7. Note writing was very sensitive to case complexity. Further reliability analyses of core EPAs are needed before US medical schools consider wider adoption into summative entrustment processes and GME handoffs.
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Affiliation(s)
- Dana Dunne
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, 15 York Street LMP 1074, New Haven, CT, 065111, USA.
| | - Katherine Gielissen
- Department of Internal Medicine, Section of General Medicine, Yale School of Medicine, New Haven, CT, 06511, USA
| | - Martin Slade
- Occupational Medicine, Yale School of Medicine, New Haven, CT, 06511, USA
| | | | - Michael Green
- Department of Internal Medicine, Section of General Medicine, Yale School of Medicine, New Haven, CT, 06511, USA
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Penner JC, Hauer KE, Julian KA, Sheu L. How preceptors develop trust in continuity clinic residents and how trust influences supervision: A qualitative study. PERSPECTIVES ON MEDICAL EDUCATION 2022; 11:73-79. [PMID: 34914028 PMCID: PMC8941004 DOI: 10.1007/s40037-021-00694-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 09/25/2021] [Accepted: 09/29/2021] [Indexed: 05/21/2023]
Abstract
INTRODUCTION To advance in their clinical roles, residents must earn supervisors' trust. Research on supervisor trust in the inpatient setting has identified learner, supervisor, relationship, context, and task factors that influence trust. However, trust in the continuity clinic setting, where resident roles, relationships, and context differ, is not well understood. We aimed to explore how preceptors in the continuity clinic setting develop trust in internal medicine residents and how trust influences supervision. METHODS In this qualitative study, we conducted semi-structured interviews with faculty preceptors from two continuity clinic sites in an internal medicine residency program at an urban academic medical center in the United States from August 2018-June 2020. We analyzed transcripts using thematic analysis with sensitizing concepts related to the theoretical framework of the five factors of trust. RESULTS Sixteen preceptors participated. We identified four key drivers of trust and supervision in the continuity clinic setting: 1) longitudinal resident-preceptor-patient relationships, 2) direct observations of continuity clinic skills, 3) resident attitude towards their primary care physician role, and 4) challenging context and task factors influencing supervision. Preceptors shared challenges to determining trust stemming from incomplete knowledge about patients and limited opportunities to directly observe and supervise between-visit care. DISCUSSION The continuity clinic setting offers unique supports and challenges to trust development and trust-supervision alignment. Maximizing resident-preceptor-patient continuity, promoting direct observation, and improving preceptor supervision of residents' provision of between-visit care may improve resident continuity clinic learning and patient care.
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Affiliation(s)
- John C Penner
- Department of Medicine, School of Medicine, University of California, San Francisco, USA.
| | - Karen E Hauer
- Department of Medicine, School of Medicine, University of California, San Francisco, USA
| | - Katherine A Julian
- Department of Medicine, School of Medicine, University of California, San Francisco, USA
| | - Leslie Sheu
- Department of Medicine, School of Medicine, University of California, San Francisco, USA
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Bremer AE, van de Pol MHJ, Laan RFJM, Fluit CRMG. How an EPA-based curriculum supports professional identity formation. BMC MEDICAL EDUCATION 2022; 22:48. [PMID: 35057788 PMCID: PMC8781044 DOI: 10.1186/s12909-022-03116-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/07/2022] [Indexed: 05/16/2023]
Abstract
BACKGROUND Entrustable professional activities (EPAs) are widely used in medical education, and they might be an important incentive to stimulate professional identity formation (PIF) of medical students, by actively encouraging participation in the workplace. The goal of this study was to explore the effects of an EPA-based curriculum on the PIF of medical students in undergraduate curricula. METHODS In this study at the Radboud University Medical Center in Nijmegen, the Netherlands, the authors interviewed twenty-one medical students in three focus group interviews (November 2019), and conducted a thematic analysis based on both the synthesizing concepts PIF, communities of practice and EPAs, and newly defined themes. RESULTS Four central themes proved crucial for understanding the influence of EPAs on PIF: creating learning opportunities, managing feedback, dealing with supervision in context and developing confidence. EPAs helped students to create learning opportunities and to choose activities purposefully, and the use of EPAs stimulated their feedback-seeking behavior. The context and way of supervision had a great impact on their development, where some contexts offer better learning opportunities than others. EPAs helped them develop trust and self-confidence, but trust from supervisors hardly appears to result from using EPAs. CONCLUSIONS An EPA-based curriculum does stimulate PIF in the complex context of working and learning by supporting participation in the workplace and by encouraging feedback-seeking behavior. Striking the right balance between participation, feedback-seeking behavior and choosing learning activities is essential. TRIAL REGISTRATION This study was approved by the ethics committee of the Netherlands Association of Medical Education (NVMO, case number 2019.5.12).
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Affiliation(s)
- Anne E. Bremer
- Department of Radboudumc Health Academy, Postbus 9101, 6500 HB Nijmegen, The Netherlands
| | | | - Roland F. J. M. Laan
- Department of Radboudumc Health Academy, Postbus 9101, 6500 HB Nijmegen, The Netherlands
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Bramley A, Forsyth A, McKenna L. Design, implementation and evaluation of novel work-based clinical assessment tool: An e-portfolio with embedded Entrustable Professional Activities. NURSE EDUCATION TODAY 2021; 107:105101. [PMID: 34488192 DOI: 10.1016/j.nedt.2021.105101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 07/07/2021] [Accepted: 08/13/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND A new concept in work-based assessment, Entrustable Professional Activities (EPAs) describe key activities a work-ready practitioner can perform independently. EPAs are widely used in medicine to support competency-based education and are gaining acceptance in other professions such as nursing, pharmacy and dietetics. There is currently no widely accepted work-based assessment tool for student clinical placement assessment in dietetics and EPAs offer potential to address this gap. OBJECTIVES To design, implement and evaluate a work-based assessment tool using EPAs embedded in an e-portfolio for use in clinical dietetics. SETTING An accredited dietetic training program in Australian university and affiliated metropolitan and rural hospitals. PARTICIPANTS Three consecutive cohorts of final year dietetic students (n = 126) and their professional placement supervisors (n = 101). METHODS A working party consisting of dietetic academics with experience in clinical dietetics and education developed clinical dietetic EPAs and milestones that were mapped to the National Competency Standards for Dietitians in Australia. A design model incorporating multiple rounds of user feedback was used to create an e-portfolio with the EPAs embedded. Students and supervisors were invited to complete anonymous on-line surveys with Likert responses (1 = highly dissatisfied, 5 = highly satisfied) to evaluate the face validity, acceptability and feasibility of the tool. RESULTS A total of 37 EPAs were developed with an accompanying four-point entrustment scale to measure performance. Evaluation survey response rates were high and ranged from 35 to 45% for students and 57-83% for supervisors across the study period. Both students and supervisors evaluated the tool positively with a mean overall satisfaction of 4.12 ± 0.69 and 4.03 ± 0.68, respectively. Survey items evaluating face validity, feasibility and acceptability scored >3.75 for both groups of users. CONCLUSIONS The EPA based e-portfolio demonstrated face validity, feasibility and acceptability and offers potential for a widely accepted tool for work-based assessment of clinical dietetic students.
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Affiliation(s)
- Andrea Bramley
- Department of Dietetics & Human Nutrition, School of Allied Health, Human Services and Sport, La Trobe University; Department of Workforce, Innovation, Strategy, Education and Research, Monash Health, Australia.
| | - Adrienne Forsyth
- Department of Dietetics & Human Nutrition, School of Allied Health, Human Services and Sport, La Trobe University
| | - Lisa McKenna
- School of Nursing and Midwifery, College of Science, Health and Engineering, La Trobe University, Australia
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van Loon KA, Bonnie LHA, van Dijk N, Scheele F. Benefits of EPAs at risk? The influence of the workplace environment on the uptake of EPAs in EPA-based curricula. PERSPECTIVES ON MEDICAL EDUCATION 2021; 10:200-206. [PMID: 33788161 PMCID: PMC8368760 DOI: 10.1007/s40037-021-00658-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 02/18/2021] [Accepted: 02/25/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Entrustable Professional Activities (EPAs) have been applied differently in many postgraduate medical education (PGME) programmes, but the reasons for and the consequences of this variation are not well known. Our objective was to investigate how the uptake of EPAs is influenced by the workplace environment and to what extent the benefits of working with EPAs are at risk when the uptake of EPAs is influenced. This knowledge can be used by curriculum developers who intend to apply EPAs in their curricula. METHOD For this qualitative study, we selected four PGME programmes: General Practice, Clinical Geriatrics, Obstetrics & Gynaecology, and Radiology & Nuclear Medicine. A document analysis was performed on the national training plans, supported by the AMEE Guide for developing EPA-based curricula and relevant EPA-based literature. Interviews were undertaken with medical specialists who had specific involvement in the development of the curricula. Content analysis was employed and illuminated the possible reasons for variation in the uptake of EPAs. RESULTS An important part of the variation in the uptake of EPAs can be explained by environmental factors, such as patient population, the role of the physician in the health-care system, and the setup of local medical care institutions where the training programme takes place. The variation in uptake of EPAs is specifically reflected in the number and breadth of the EPAs, and in the way the entrustment decision is executed within the PGME programme. DISCUSSION Due to variation in uptake of EPAs, the opportunities for trainees to work independently during the training programme might be challenging. EPAs can be implemented in the curriculum of PGME programmes in a meaningful way, but only if the quality of an EPA is assessed, future users are involved in the development, and the key feature of EPAs (the entrustment decision) is retained.
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Affiliation(s)
- Karsten Arthur van Loon
- School of Medical Sciences of the Amsterdam University Medical Center, Amsterdam, The Netherlands.
| | | | - Nynke van Dijk
- Department of General Practice of the Academic Medical Centre, Amsterdam, The Netherlands
| | - Fedde Scheele
- Health Systems Innovation and Education at the VU University in Amsterdam and Amsterdam UMC, OLVG, Amsterdam, The Netherlands
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Burr KL, Stump AA, Bladen RC, O'Brien PR, Lemon BJ, Tearl DK, Roby M, Daley LM, Brown JM, Hertzog JH. Twice-Daily Huddles Improves Collaborative Problem Solving in the Respiratory Care Department. Respir Care 2021; 66:822-828. [PMID: 33531358 PMCID: PMC9994132 DOI: 10.4187/respcare.07717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Lean Six Sigma processes are used in health care systems to increase safety and efficiency. Daily huddles, one tool of the Lean Six Sigma process, have been used to increase patient safety, facilitate efficiency in problem solving, promote optimal patient outcomes, and reduce poor communication. Huddle utilization by respiratory care departments has not been previously reported. We describe our process of implementing daily huddles and the impact on departmental problem solving. METHOD A descriptive study of a quality improvement intervention and a retrospective study of prospectively collected data were performed. The respiratory care department was trained in the utilization of a daily huddle process to resolve issues and identify process improvement opportunities. Huddles were performed at the beginning of each shift. Process improvement opportunities were raised by the respiratory therapy staff using the following categories: Safety/Service, Methods, Equipment, Supplies, and Associates. Opportunities were placed within 3 categories; quick hits (resolution in 1-3 d), complex problems (resolution in 3-7 d), and projects (resolution in > 7 d). All opportunities included a problem statement, an immediate countermeasure, a problem leader, and a due date. Items requiring interdisciplinary support were escalated to the organizational patient care services huddle. We evaluated the number and nature of process improvement opportunities raised in huddles from January 1 through December 31, 2018, to better understand the impact of daily huddles. RESULTS A total of 366 process improvement opportunities were raised during huddles. Of those, 245 (67%) were quick hits, 77 (21%) were complex, and 44 (12%) were projects. Resolution of 174 (47.5%) opportunities was completed using only the resources of the respiratory care department, and 157 (43%) were resolved with additional interdisciplinary involvement. A small portion 35 (9.5%) of opportunities required escalation to the organizational multidisciplinary huddle for resolution. All process improvement opportunities were resolved at the end of the study period (mean ± SD of 30.5 ± 7.7 per month). CONCLUSIONS Twice-daily huddles implemented by our respiratory care department allowed for identification and timely resolution of process improvement opportunities.
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Affiliation(s)
- Katlyn L Burr
- Respiratory Care Services, Nemours Alfred I. duPont Hospital for Children, Wilmington, Delaware.
| | - Angela A Stump
- Respiratory Care Services, Nemours Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Rustin C Bladen
- Respiratory Care Services, Nemours Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Paul R O'Brien
- Respiratory Care Services, Nemours Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Brenda J Lemon
- Respiratory Care Services, Nemours Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Donna K Tearl
- Respiratory Care Services, Nemours Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Maureen Roby
- Respiratory Care Services, Nemours Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Lauren M Daley
- Nursing Administration, Nemours Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Joel M Brown
- Respiratory Care Services, Nemours Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - James H Hertzog
- Respiratory Care Services, Nemours Alfred I. duPont Hospital for Children, Wilmington, Delaware
- Department of Pediatrics, Division of Critical Care Medicine, Nemours Alfred I. duPont Hospital for Children, Wilmington, Delaware
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12
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Watson A, Leroux T, Ogilvie-Harris D, Nousiainen M, Ferguson PC, Murnahan L, Dwyer T. Entrustable Professional Activities in Orthopaedics. JB JS Open Access 2021; 6:JBJSOA-D-20-00010. [PMID: 34056510 PMCID: PMC8154482 DOI: 10.2106/jbjs.oa.20.00010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background An entrustable professional activity (EPA) is defined as a core task of a specialty that is entrusted to a trainee once sufficient competence has been reached. A group of EPAs reflects the activities that clinicians commonly do on a day-to-day basis. Lists of EPAs have been created for most medical subspecialties, but not orthopaedic surgery. The aim of this study was to create a peer-reviewed list of essential EPAs that a resident must perform independently before completing orthopaedic residency training. Methods A focus group of 7 orthopaedic surgeons from the University of Toronto developed a comprehensive list of 285 EPAs. For each subspecialty group, the opinions of at least 15 academic and nonacademic surgeons, as well as subspecialty-trained and non-subspecialty-trained surgeons, were used. The modified Delphi method was used to rank EPAs on a five-point scale from not important to mandatory for a resident to competent before exiting training. Two Delphi rounds were used, using a threshold of >50% of surgeons considering the EPA as mandatory before being considered for the next round. A final list of EPAs was ratified using the focus group of academic surgeons involved in the study. Results Seventy-five (75) of 107 (70%) surgeons invited responded to the survey. Nearly half (129) of the 285 EPAs were discarded after the first round of Delphi. A further 118 EPAs were discarded after the second Delphi round, leaving 49 final EPAs, across 9 subspecialties in orthopaedic surgery. Conclusions Expert consensus was used to create a list of EPAs considered mandatory for completion of resident training in orthopaedics in our province. The final 49 peer-reviewed EPAs will be a valuable benchmark in curriculum design and assessment in orthopaedic surgery in the competency-based era for other programs.
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Affiliation(s)
- Adam Watson
- Royal Hobart Hospital, Hobart, Tasmania, Australia.,Women's College Hospital, Toronto, Ontario, Canada
| | - Timothy Leroux
- Women's College Hospital, Toronto, Ontario, Canada.,Toronto Western Hospital, Toronto, Ontario, Canada
| | - Darrell Ogilvie-Harris
- Women's College Hospital, Toronto, Ontario, Canada.,Toronto Western Hospital, Toronto, Ontario, Canada
| | - Markku Nousiainen
- Women's College Hospital, Toronto, Ontario, Canada.,Sunnybrook Health Science Centre, Toronto, Ontario, Canada
| | | | - Lucas Murnahan
- Women's College Hospital, Toronto, Ontario, Canada.,Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Tim Dwyer
- Women's College Hospital, Toronto, Ontario, Canada.,Mount Sinai Hospital, Toronto, Ontario, Canada
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13
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Dehghani Poudeh M, Mohammadi A, Mojtahedzadeh R, Yamani N. Entrustability levels of general internal medicine residents. BMC MEDICAL EDUCATION 2021; 21:185. [PMID: 33766005 PMCID: PMC7995576 DOI: 10.1186/s12909-021-02624-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 03/19/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Entrustable professional activities (EPAs) are those activities that a health professional can perform without direct supervision in a defined environment. Bridging the gap between competencies and learning objectives, EPAs have made assessing the performances of health professional more realistic. The main objective of the present study was developing and customizing EPAs for Iranian Internal Medicine Residency Programs. RESULTS After reviewing the publications, residency curricula and logbooks, and collecting experts' ideas, the initial list of EPAs was developed. Then, in a focus group, the list was refined, the entrustability level of each residency year was determined, and finally, the EPA-competency cross-tab was established, and in the next step, through a one- round Delphi, the results were validated. Twenty-eight EPAs were developed. Some of them were definitely suitable for the higher levels of residency, such that they had to be accomplished under direct supervision until the end of the program. On the other hand, some of EPAs were those that residents, even from the first year, are expected to perform independently or under indirect supervision. Most of the EPAs cover a wide range of competencies. CONCLUSION Determining the entrustability level of each residency year in each EPA as well as the competency- EPA matrix has crucial effect on the quality of the graduates. It seems that our findings are applicable in developing countries like Iran.
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Affiliation(s)
- Mostafa Dehghani Poudeh
- Department of Medical Education, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Aeen Mohammadi
- Department of E-learning in Medical Education, Virtual School, Center for Excellence in E-learning in Medical Education, Tehran University of Medical Sciences, Tehran, Iran
| | - Rita Mojtahedzadeh
- Department of E-learning in Medical Education, Virtual School, Center for Excellence in E-learning in Medical Education, Tehran University of Medical Sciences, Tehran, Iran
| | - Nikoo Yamani
- Department of Medical Education, Isfahan University of Medical Sciences, Isfahan, Iran
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14
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Experiences of patients with haemorrhoidal disease – a qualitative study. JOURNAL OF COLOPROCTOLOGY 2021. [DOI: 10.1016/j.jcol.2018.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Abstract
Purpose To obtain a better understanding of the patients’ experiences with haemorrhoidal disease’ impact on their daily life and results of treatment by performing a qualitative study.
Method Individually interviews were conducted among patients with haemorrhoidal disease between 2016 and 2017. Each interview was recorded using an audio recorder and transcribed verbatim. A semi-structured interview guide was used with pre-specified topics, based on a previous conducted literature review. Transcripts were coded and the analysis consisted highlighting passages in the text and assigning each passage a code representing the predefined themes from the interview guide. This resulted in a three-level theme hierarchy: overarching theme, mid-level sub-theme and issues.
Results Fifteen participants underwent individual interviews of whom thirteen were conducted by telephone. The mean age was 60.7 years (35–78); five of them were female (33.3%). Pain and blood loss were the most frequently reported symptoms. Participants indicated that these symptoms were directly associated with emotional burden, daily adjustments and social impact. Before diagnosis with haemorrhoidal disease blood loss resulted in feelings of fear and next in embarrassment during social activities. In daily life participants needed to get up early, used sanitary pads for blood loss and anal ice sticks to reduce pain. Participants were often not completely satisfied with the process and outcome of treatment.
Conclusion This first qualitative study provides detailed insight into the patients’ experiences with haemorrhoidal disease, impact on daily life and results of treatment. This information may be used in daily practice to create awareness among clinicians.
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15
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Fuller KA, Donahue B, Kruse A. Examining student
self‐awareness
of performance on entrustable professional activities given context of preceptor evaluations. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Kathryn A. Fuller
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | - Brian Donahue
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | - Abbey Kruse
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
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16
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Taylor N, Defenbaugh N, Mira AE, Bendas E. What's new in academic medicine? Focus on evolving models of competence in Graduate Medical Education. INTERNATIONAL JOURNAL OF ACADEMIC MEDICINE 2021. [DOI: 10.4103/ijam.ijam_30_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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17
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Block L, Petersen C, Coletti DJ, Yalakkishettar P, LaVine N. Access and Continuity: A Multidisciplinary Education Workshop to Teach Patient-Centered Medical Home (PCMH) Principles. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:10974. [PMID: 33083534 PMCID: PMC7549388 DOI: 10.15766/mep_2374-8265.10974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 03/26/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION As more practices move to patient-centered medical home (PCMH) models, future health care professionals must train to work in collaborative settings. We implemented a 3-hour workshop for multidisciplinary trainees on the PCMH principles of access and continuity based on the EFECT framework (eliciting a patient-centered narrative, facilitating an interprofessional team discussion, evaluating the clinical evidence, creating a shared care plan, and tracking outcomes). METHODS Participants included internal medicine residents and medical, physician assistant (PA), and clinical psychology students. The workshop incorporated reflective activities identifying patient and provider health care delivery priorities, plus a PCMH presentation and group activities focusing on access and continuity. Evaluations were analyzed qualitatively and quantitatively. RESULTS The workshop had 39 participants (seven physicians, one PA, one educator, one psychologist, three staff, nine residents, one PA student, one psychology extern, and 15 medical students). On a 0-10 Likert scale (0 = don't agree at all, 10 = completely agree), learners reported higher knowledge of PCMH principles (M = 8.8), feeling better prepared for PCMH work (M = 8.6), and having obtained real-world skills (M = 8.3). Open-ended responses describing the workshop's take-home message included the role of patient-centeredness in clinical redesign, the value of the multidisciplinary team in optimizing access and continuity, and how to use a quality improvement approach for access and continuity. DISCUSSION This workshop increased PCMH-related knowledge and encouraged discussion of professional roles within the team. Learners recognized the benefits of team-based rather than provider-centric approaches to access and continuity.
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Affiliation(s)
- Lauren Block
- Associate Professor, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
| | - Christopher Petersen
- Medical Student, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
| | - Daniel J. Coletti
- Assistant Professor, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
| | | | - Nancy LaVine
- Assistant Professor, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
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18
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Batt AM, Tavares W, Williams B. The development of competency frameworks in healthcare professions: a scoping review. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2020; 25:913-987. [PMID: 31797195 DOI: 10.1007/s10459-019-09946-w] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 11/23/2019] [Indexed: 05/27/2023]
Abstract
Competency frameworks serve various roles including outlining characteristics of a competent workforce, facilitating mobility, and analysing or assessing expertise. Given these roles and their relevance in the health professions, we sought to understand the methods and strategies used in the development of existing competency frameworks. We applied the Arksey and O'Malley framework to undertake this scoping review. We searched six electronic databases (MEDLINE, CINAHL, PsycINFO, EMBASE, Scopus, and ERIC) and three grey literature sources (greylit.org, Trove and Google Scholar) using keywords related to competency frameworks. We screened studies for inclusion by title and abstract, and we included studies of any type that described the development of a competency framework in a healthcare profession. Two reviewers independently extracted data including study characteristics. Data synthesis was both quantitative and qualitative. Among 5710 citations, we selected 190 for analysis. The majority of studies were conducted in medicine and nursing professions. Literature reviews and group techniques were conducted in 116 studies each (61%), and 85 (45%) outlined some form of stakeholder deliberation. We observed a significant degree of diversity in methodological strategies, inconsistent adherence to existing guidance on the selection of methods, who was involved, and based on the variation we observed in timeframes, combination, function, application and reporting of methods and strategies, there is no apparent gold standard or standardised approach to competency framework development. We observed significant variation within the conduct and reporting of the competency framework development process. While some variation can be expected given the differences across and within professions, our results suggest there is some difficulty in determining whether methods were fit-for-purpose, and therefore in making determinations regarding the appropriateness of the development process. This uncertainty may unwillingly create and legitimise uncertain or artificial outcomes. There is a need for improved guidance in the process for developing and reporting competency frameworks.
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Affiliation(s)
- Alan M Batt
- Department of Paramedicine, Monash University, Building H, McMahons Road, Frankston, VIC, 3199, Australia.
- Fanshawe College, 1001 Fanshawe College Blvd., London, ON, N5Y 5R6, Canada.
| | - Walter Tavares
- The Wilson Centre, Department of Medicine, University of Toronto/University Health Network, 200 Elizabeth Street, 1ES‑565, Toronto, ON, M5G 2C4, Canada
- Post‑MD Education (Post‑Graduate Medical Education/Continued Professional Development), University of Toronto, Toronto, ON, Canada
| | - Brett Williams
- Department of Paramedicine, Monash University, Building H, McMahons Road, Frankston, VIC, 3199, Australia
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Al-Moteri M. Entrustable professional activities in nursing: A concept analysis. Int J Nurs Sci 2020; 7:277-284. [PMID: 32817849 PMCID: PMC7424159 DOI: 10.1016/j.ijnss.2020.06.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 06/13/2020] [Accepted: 06/17/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Entrustable professional activities (EPAs) is a newly emerging concept. This paper aims at analyzing the concept of "EPAs" to clarify the meaning and to identify its components for optimum understanding of the concept for use in nursing education and future research. METHOD Three databases - ProQuest, Ovid, and PubMed- were retrieved, and Walker and Avant's concept analysis approach was used to analyze the concept of EPAs. RESULTS Based on the analysis, three attributes of EPAs were defined, namely 1) EPAs should be restricted to a limited number of tasks; 2)reflect the experience curve; and 3) include acceptance of responsibility and accountability. The antecedent of EPAs is a holistic and integrated assessment approach. This will eventually lead to anticipated consequences such as a mastery of core competencies and an increase in the level of autonomy. CONCLUSION The study may contribute to a reduction in the ambiguity of this concept to better apply it in nursing practice.
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Affiliation(s)
- Modi Al-Moteri
- Nursing Department, College of Applied Medical Science, University of Al-Taif, Western Region, Saudi Arabia
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20
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Soran C, Laponis R, Summerville S, Thompson V, Eastburn A, O'Sullivan P, Julian KA. Identifying Entrustable Professional Activities for Internal Medicine Residents in Ambulatory Continuity Practice. J Gen Intern Med 2020; 35:1917-1919. [PMID: 31637647 PMCID: PMC7280367 DOI: 10.1007/s11606-019-05430-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 08/27/2019] [Accepted: 09/24/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Christine Soran
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA.
| | - Ryan Laponis
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA.,Internal Medicine Residency Program, University of California San Francisco, San Francisco, CA, USA
| | - Sarah Summerville
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Vanessa Thompson
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA.,Internal Medicine Residency Program, University of California San Francisco, San Francisco, CA, USA
| | - Abigail Eastburn
- Division of General Internal Medicine, San Francisco Veterans Affairs Medical Center, University of California San Francisco, San Francisco, CA, USA
| | - Patricia O'Sullivan
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA.,Department of Surgery, University of California San Francisco, San Francisco, CA, USA.,Research and Development in Medical Education, University of California San Francisco, San Francisco, CA, USA
| | - Katherine A Julian
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA.,Internal Medicine Residency Program, University of California San Francisco, San Francisco, CA, USA
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21
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Lau ST, Ang E, Samarasekera DD, Shorey S. Development of undergraduate nursing entrustable professional activities to enhance clinical care and practice. NURSE EDUCATION TODAY 2020; 87:104347. [PMID: 32004948 DOI: 10.1016/j.nedt.2020.104347] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 11/22/2019] [Accepted: 01/20/2020] [Indexed: 05/22/2023]
Abstract
BACKGROUND Nursing education adopts a time-based approach to assess the multifaceted competencies of student nurses. The competency-based approach is preferred historically as it is practical and ensures that individuals deliver effective healthcare practice. However, there remains a gap on how these competencies are actually applied in nursing practice. To facilitate the connection between competencies, competency-based education, and nursing practice, entrustable professional activities (EPAs) can be utilized to translate competencies into clinical practice. EPAs have shown promising results across multiple healthcare specialties and have become the current driving force to facilitate nursing care and practice. Given the limited information of EPAs in nursing education, it is an opportune time to develop EPAs specific to nursing care and practice. OBJECTIVES To provide a detailed breakdown on the development of EPAs in nursing education to inform clinical care and practice. METHODS The development stages of EPAs included: i) the formation of a team, ii) the development of the conceptual framework, and iii) the pooling, reviewing, and revising of core EPAs. RESULTS A total of ten core EPAs were developed, with sub-EPAs nested within these core EPAs. The EPAs include: 1) patient engagement, 2) patient care and practice, 3) care management, 4) common procedures, 5) safety, 6) urgent care, 7) transition care, 8) patient education, 9) interprofessional collaboration, and 10) palliative care. CONCLUSION The development of EPAs specific to nursing care and practice may offer nursing programs a guide to assist with curricula planning and a basis for developing entrustment assessment tools. The unfamiliarity of EPAs in nursing education may pose as implementation challenges to EPAs. Future research is warranted to evaluate and improve the developed EPAs.
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Affiliation(s)
- Siew Tiang Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, Singapore 117597, Singapore.
| | - Emily Ang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, Singapore 117597, Singapore.
| | - Dujeepa D Samarasekera
- Centre for Medical Education, National University of Singapore, Level 5, Clinical Research Centre, 10 Medical Drive, Singapore 117597, Singapore.
| | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, Singapore 117597, Singapore.
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22
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Boeckxstaens P, Brown JB, Reichert SM, Smith CNC, Stewart M, Fortin M. Perspectives of specialists and family physicians in interprofessional teams in caring for patients with multimorbidity: a qualitative study. CMAJ Open 2020; 8:E251-E256. [PMID: 32253205 PMCID: PMC7144580 DOI: 10.9778/cmajo.20190222] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Patients with multimorbidity often require services across different health care settings, yet team processes among settings are rarely implemented. We explored perceptions of specialists and family physicians collaborating in a telemedicine interprofessional consultation for patients with multimorbidity to better understand the value of bringing physicians together across the boundaries of health care settings. METHODS This was a descriptive qualitative, interview-based study. Physicians who had previously participated in the Telemedicine Interprofessional Model of Practice for Aging and Complex Treatments (Telemedicine IMPACT Plus [TIP] Program) were invited to participate and asked to describe their experience of being a member of the program. Interviews were conducted from March to May 2016. We conducted an iterative and interpretive process using both individual and team analysis to identify themes. RESULTS There were 15 participants, 9 specialists and 6 family physicians. Three themes emerged in the analysis: creating new perspectives on care for patients with multimorbidity by sharing knowledge, skills and attitudes; the shift from a consultant model to an interprofessional team model (allowing a window into the community, extending discussions beyond the medical model and focusing on the patient's health in context); and opportunities for learners, including learning about interprofessional collaboration and gaining exposure to a real-world model for caring for people with multimorbidity in outpatient settings. INTERPRETATION Family physicians and specialists participating in a TIP Program believed the program improved their knowledge and skills, while also serving as an effective care delivery strategy. The findings also support that learners require more exposure to nontraditional consultant models in order to care for patients with multimorbidity effectively.
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Affiliation(s)
- Pauline Boeckxstaens
- Department of Family Medicine and Primary Healthcare (Boeckxstaens), Ghent University, Ghent, Belgium; Centre for Studies in Family Medicine (Brown, Reichert, Stewart), Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Medicine (Smith), Toronto East Health Network, Michael Garron Hospital, Toronto, Ont.; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que.
| | - Judith Belle Brown
- Department of Family Medicine and Primary Healthcare (Boeckxstaens), Ghent University, Ghent, Belgium; Centre for Studies in Family Medicine (Brown, Reichert, Stewart), Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Medicine (Smith), Toronto East Health Network, Michael Garron Hospital, Toronto, Ont.; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que
| | - Sonja M Reichert
- Department of Family Medicine and Primary Healthcare (Boeckxstaens), Ghent University, Ghent, Belgium; Centre for Studies in Family Medicine (Brown, Reichert, Stewart), Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Medicine (Smith), Toronto East Health Network, Michael Garron Hospital, Toronto, Ont.; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que
| | - Christopher N C Smith
- Department of Family Medicine and Primary Healthcare (Boeckxstaens), Ghent University, Ghent, Belgium; Centre for Studies in Family Medicine (Brown, Reichert, Stewart), Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Medicine (Smith), Toronto East Health Network, Michael Garron Hospital, Toronto, Ont.; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que
| | - Moira Stewart
- Department of Family Medicine and Primary Healthcare (Boeckxstaens), Ghent University, Ghent, Belgium; Centre for Studies in Family Medicine (Brown, Reichert, Stewart), Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Medicine (Smith), Toronto East Health Network, Michael Garron Hospital, Toronto, Ont.; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que
| | - Martin Fortin
- Department of Family Medicine and Primary Healthcare (Boeckxstaens), Ghent University, Ghent, Belgium; Centre for Studies in Family Medicine (Brown, Reichert, Stewart), Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Medicine (Smith), Toronto East Health Network, Michael Garron Hospital, Toronto, Ont.; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que
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Abstract
INTRODUCTION The simulation fellowship training community has commenced efforts toward the development of core curricular elements for healthcare simulation fellowships but has not deployed the same effort to create evaluation strategies to monitor fellows' progress. The authors present a current view of simulation fellowship assessment strategies, their relative validity evidence using Kane's theoretical framework, and consider new approaches for defining expertise after training. METHODS Fellowship directors in North America were surveyed to identify what competencies are being used by the simulation fellowship community to monitor fellows' progress. A follow-up survey was sent to further clarify which tools with published validity evidence were being applied by current programs. RESULTS Of the 61 programs contacted, 44 (72.1%) responded and completed the first survey. Of the 44 programs, 32 (72.7%) reported using some formal assessment of their fellows. The most commonly assessed skill was debriefing. Twenty-three (37.7%) of the 61 programs contacted responded to the secondary survey. These reported that the most common published tool used was the Debriefing Assessment for Simulation in Healthcare, with only a few other tools mentioned. CONCLUSIONS There is a paucity of tools with published validity evidence being used to monitor a fellow's progression. The authors agree that further research needs to focus on creating validated assessment tools to assist in refining fellowship training.
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Design of an entrustable professional activity for adult extracorporeal membrane oxygenation. Surg Open Sci 2019; 2:42-45. [PMID: 33981980 PMCID: PMC8083009 DOI: 10.1016/j.sopen.2019.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 08/30/2019] [Accepted: 09/09/2019] [Indexed: 12/04/2022] Open
Abstract
Background Extracorporeal membrane oxygenation supports severe cardiac or pulmonary failure. There are currently no competency-based standards for extracorporeal membrane oxygenation training. Methods Extracorporeal membrane oxygenation experts were interviewed using a structured interview. Responses were audio recorded, transcribed, and validated by respondents. Interviews were coded using grounded theory with a constant comparison method. Themes were developed and used to construct the entrustable professional activity, which was reviewed by the extracorporeal membrane oxygenation experts. Results Nine experts were interviewed; all had experience with trainees. Interview themes identified include patient selection, circuit and medical management, multidisciplinary communication, problem-based learning and simulation, and entrustment decisions. Essential functions of the entrustable professional activity were patient selection, circuit management, cannula selection, responding to circuit emergencies/complications, anticoagulation management, weaning, and family/team communication. Conclusions Essential functions of an extracorporeal membrane oxygenation entrustable professional activity were defined using data from structured interviews. The resultant entrustable professional activity could be implemented by critical-care programs as a scaffolding for competency-based fellow training. A structured interview is an effective method for an EPA creation. Nine experts with a median 14 years of ECMO experience were interviewed. The essential functions for ECMO care were defined. The ECMO EPA could be used for competency-based critical care education.
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25
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Lyons A, Walker RJ, Prigmore HL, Muntz M. Multidisciplinary Team Meetings-a Venue to Improve Team Engagement and Quality in Resident Continuity Clinic. J Gen Intern Med 2019; 34:2001-2002. [PMID: 31197731 PMCID: PMC6816636 DOI: 10.1007/s11606-019-05084-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Amalia Lyons
- Division of General Internal Medicine, Department of Medicine, Froedtert & The Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Rebekah J Walker
- Division of General Internal Medicine, Department of Medicine, Froedtert & The Medical College of Wisconsin, Milwaukee, WI, USA.,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Heather L Prigmore
- Division of General Internal Medicine, Department of Medicine, Froedtert & The Medical College of Wisconsin, Milwaukee, WI, USA.,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Marty Muntz
- Division of General Internal Medicine, Department of Medicine, Froedtert & The Medical College of Wisconsin, Milwaukee, WI, USA.,Kern Institute for the Transformation of Medical Education, Medical College of Wisconsin, Milwaukee, WI, USA
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26
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Goodell KH, Ticku S, Fazio SB, Riedy CA. Entrustable Professional Activities in Oral Health for Primary Care Providers Based on a Scoping Review. J Dent Educ 2019; 83:1370-1381. [PMID: 31501254 DOI: 10.21815/jde.019.152] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 07/22/2019] [Indexed: 11/20/2022]
Abstract
Despite advances in oral health care, inequalities in oral health outcomes persist due to problems in access. With proper training, primary care providers can mitigate this inequality by providing oral health education, screening, and referral to advanced dental treatment. Diverging sets of oral health competencies and guidelines have been released or endorsed by multiple primary care disciplines. The aim of this study was to transform multiple sets of competencies into Entrustable Professional Activities (EPAs) for oral health integration into primary care training. A scoping review of the literature between January 2000 and December 2016 was conducted according to PRISMA methodology to identify all existing sets of competencies. The following primary care disciplines were included in the search: allopathic/osteopathic medical schools and residency programs in family medicine, internal medicine, and pediatrics; physician assistant programs; and nurse practitioner programs. Competencies were compared using the Health Resources and Services Administration Integration of Oral Health and Primary Care Practice competencies as the foundational set and translated into EPAs. The resulting EPAs were tested with a reactor panel. The scoping review produced 1,466 references, of which 114 were selected for full text review. Fourteen competencies were identified as being central to the integration of oral health into primary care. These were converted to seven EPAs for oral health integration into primary care and were mapped onto Accreditation Council for Graduate Medical Education residency competency domains as well to the Association of American Medical Colleges EPAs for graduating medical students. The resulting EPAs delineate the essential, observable work required of primary care providers to ensure that oral health is treated as a critical determinant of overall health.
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Affiliation(s)
- Kristen H Goodell
- Kristen H. Goodell, MD, is Associate Dean of Admissions and Assistant Professor of Family Medicine, Boston University School of Medicine; Shenam Ticku, BDS, MPH, is Instructor, Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine; Sara B. Fazio, MD, is Associate Professor of Medicine, Harvard Medical School, and Associate Director of Medical Education, Harvard Medical School Center for Primary Care; and Christine A. Riedy, PhD, MPH, is Chair, Department of Oral Health Policy and Epidemiology, and Delta Dental of Massachusetts Associate Professor in Oral Public Health and Epidemiology, Harvard School of Dental Medicine.
| | - Shenam Ticku
- Kristen H. Goodell, MD, is Associate Dean of Admissions and Assistant Professor of Family Medicine, Boston University School of Medicine; Shenam Ticku, BDS, MPH, is Instructor, Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine; Sara B. Fazio, MD, is Associate Professor of Medicine, Harvard Medical School, and Associate Director of Medical Education, Harvard Medical School Center for Primary Care; and Christine A. Riedy, PhD, MPH, is Chair, Department of Oral Health Policy and Epidemiology, and Delta Dental of Massachusetts Associate Professor in Oral Public Health and Epidemiology, Harvard School of Dental Medicine
| | - Sara B Fazio
- Kristen H. Goodell, MD, is Associate Dean of Admissions and Assistant Professor of Family Medicine, Boston University School of Medicine; Shenam Ticku, BDS, MPH, is Instructor, Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine; Sara B. Fazio, MD, is Associate Professor of Medicine, Harvard Medical School, and Associate Director of Medical Education, Harvard Medical School Center for Primary Care; and Christine A. Riedy, PhD, MPH, is Chair, Department of Oral Health Policy and Epidemiology, and Delta Dental of Massachusetts Associate Professor in Oral Public Health and Epidemiology, Harvard School of Dental Medicine
| | - Christine A Riedy
- Kristen H. Goodell, MD, is Associate Dean of Admissions and Assistant Professor of Family Medicine, Boston University School of Medicine; Shenam Ticku, BDS, MPH, is Instructor, Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine; Sara B. Fazio, MD, is Associate Professor of Medicine, Harvard Medical School, and Associate Director of Medical Education, Harvard Medical School Center for Primary Care; and Christine A. Riedy, PhD, MPH, is Chair, Department of Oral Health Policy and Epidemiology, and Delta Dental of Massachusetts Associate Professor in Oral Public Health and Epidemiology, Harvard School of Dental Medicine
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Shorey S, Lau TC, Lau ST, Ang E. Entrustable professional activities in health care education: a scoping review. MEDICAL EDUCATION 2019; 53:766-777. [PMID: 30945329 DOI: 10.1111/medu.13879] [Citation(s) in RCA: 114] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 11/30/2018] [Accepted: 02/22/2019] [Indexed: 05/13/2023]
Abstract
CONTEXT The shift in medical education from time-based learning to outcome-based learning has drawn much attention to entrustable professional activities (EPAs) as an ideal assessment framework to translate competencies into clinical practice. Given the relative novelty of EPAs, this review aims to highlight research gaps and explore and consolidate available evidence pertaining to the development and implementation of EPAs in health care. METHOD Arksey and O'Malley's scoping review framework was used to present the findings. The authors performed a systematic search of PubMed, Embase, CINAHL, Scopus, MedNar, OpenGrey and ProQuest Dissertation and Theses for English articles published from the inception of each database to May 2018. A manual search of the reference lists of the included studies was conducted and an expert panel was consulted. Two reviewers screened the articles for eligibility using the inclusion criteria. All authors extracted key data and analysed the data descriptively. Thematic analysis was used to categorise the results into themes. RESULTS Eighty articles were included in the review. All articles were published between 2010 and 2018. Three major themes and eight sub-themes were generated: (i) development of EPAs (frameworks for EPA development and implementation, identifying core or specialty-specific EPAs, and EPAs for faculty development), (ii) evaluation of EPAs and EPA entrustment factors (revised curriculum, entrustment decisions for professional activities, and feedback on implemented EPAs and the development process), and (iii) future directions and recommendations for EPAs (implementation of EPAs in undergraduate medical education and specific disciplines, and other criticisms and recommendations for EPAs). CONCLUSIONS Entrustable professional activities are an essential means to translate competencies into observable and measurable clinical practice. However, high-level evidence-based research on the efficacy, development and implementation of EPAs for specific target groups (i.e. undergraduates and staff) and geographical regions (i.e. Asia and Africa) is still lacking, which suggests a direction for future research.
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Affiliation(s)
- Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, Singapore, Singapore
| | | | - Siew Tiang Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Emily Ang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, Singapore, Singapore
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Perez Jolles M, Lengnick-Hall R, Mittman BS. Core Functions and Forms of Complex Health Interventions: a Patient-Centered Medical Home Illustration. J Gen Intern Med 2019; 34:1032-1038. [PMID: 30623387 PMCID: PMC6544719 DOI: 10.1007/s11606-018-4818-7] [Citation(s) in RCA: 129] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 12/14/2018] [Accepted: 12/14/2018] [Indexed: 02/03/2023]
Abstract
Despite policy and practice support to develop and test interventions designed to increase access to quality care among high-need patients, many of these interventions fail to meet expectations once deployed in real-life clinical settings. One example is the Patient-Centered Medical Home (PCMH) model, designed to deliver coordinated care. A meta-analysis of PCMH initiatives found mixed evidence of impacts on service access, quality, and costs. Conceptualizing PCMH as a complex health intervention can generate insights into the mechanisms by which this model achieves its effects. It can also address heterogeneity by distinguishing PCMH core functions (the intervention's basic purposes) from forms (the strategies used to meet each function). We conducted a scoping review to identify core functions and forms documented in published PCMH models from 2007 to 2017. We analyzed and summarized the data to develop a PCMH Function and Form Matrix. The matrix contributes to the development of an explicit theory-based depiction of how an intervention achieves its effects, and can guide decision-support tools in the field. This innovative approach can support transformations of clinical settings and implementation efforts by building on a clear understanding of the intervention's standard core functions and the forms adapted to local contexts' characteristics.
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Affiliation(s)
- Mónica Perez Jolles
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 1150 South Olive Street, Suite 1421, Los Angeles, CA 90015 USA
| | - Rebecca Lengnick-Hall
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 1150 South Olive Street, Suite 1421, Los Angeles, CA 90015 USA
| | - Brian S. Mittman
- Health Services Research & Implementation Science, Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA USA
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O'Dowd E, Lydon S, O'Connor P, Madden C, Byrne D. A systematic review of 7 years of research on entrustable professional activities in graduate medical education, 2011-2018. MEDICAL EDUCATION 2019; 53:234-249. [PMID: 30609093 DOI: 10.1111/medu.13792] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 11/05/2018] [Accepted: 11/20/2018] [Indexed: 05/13/2023]
Abstract
PURPOSE This review aimed to synthesise some of the extant work on the use of entrustable professional activities (EPAs) for postgraduate physicians, to assess the quality of the work and provide direction for future research and practice. METHOD Systematic searches were conducted within five electronic databases (Medline, Scopus, Web of Science, PsycINFO and CINAHL) in September 2018. Reference lists, Google Scholar and Google were also searched. Methodological quality was assessed using the Quality Assessment Tool for Studies with Diverse Designs (QATSDD). RESULTS In total, 49 studies were included, classified as Development of EPAs (n = 37; 76% of total included), Implementation and/or assessment of EPAs (n = 10; 20%), or both (n = 2; 4%). EPAs were described for numerous specialties, including internal medicine (n = 14; 36%), paediatrics (n = 8; 21%) and psychiatry (n = 4; 10%). Of the development studies, 92% utilised more than one method to generate EPAs. The two most commonly used methods were developing initial EPAs in a working group, (n = 27; 69%) and revising through deliberation (n = 21; 54%). Development papers were of variable quality (mean QATSDD score = 20, range 6-41). Implementation and assessment studies utilised methods that included observing trainee performance (n = 6; 50%) and enrolling trainees in competency-based curricula, which included EPAs (n = 4; 33%). The methodological quality of these implementation studies varied (mean QATSDD score = 19.5, range = 6-32). CONCLUSIONS This review highlighted a need for: (i) consideration of best practice guidelines for EPA development; (ii) focus on the methodological quality of research on EPA development and of EPAs, and (iii) further work investigating the implementation of EPAs in the curriculum.
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Affiliation(s)
- Emily O'Dowd
- Irish Centre for Applied Patient Safety and Simulation, National University of Ireland, Galway, Ireland
- Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Ireland
| | - Sinéad Lydon
- Irish Centre for Applied Patient Safety and Simulation, National University of Ireland, Galway, Ireland
- School of Medicine, National University of Ireland, Galway, Ireland
| | - Paul O'Connor
- Irish Centre for Applied Patient Safety and Simulation, National University of Ireland, Galway, Ireland
- Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Ireland
| | - Caoimhe Madden
- Irish Centre for Applied Patient Safety and Simulation, National University of Ireland, Galway, Ireland
- Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Ireland
| | - Dara Byrne
- Irish Centre for Applied Patient Safety and Simulation, National University of Ireland, Galway, Ireland
- School of Medicine, National University of Ireland, Galway, Ireland
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Patient-Centered Medical Home Graduate Internship, Benefits to a Practice Manager: Case Study. Health Care Manag (Frederick) 2019; 38:50-60. [PMID: 30640243 DOI: 10.1097/hcm.0000000000000248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Graduate Health Information Management students can and should be involved in collaborations with the Patient-Centered Medical Home at primary care clinics. In this case, the student is not from a Health Services Management background as it was in the first internship article, but rather from a Health Information Management background. This case study is the second of 2 Patient-Centered Medical Home internship studies where the value of an intern to a practice manager is demonstrated.
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Hart D, Franzen D, Beeson M, Bhat R, Kulkarni M, Thibodeau L, Weizberg M, Promes S. Integration of Entrustable Professional Activities with the Milestones for Emergency Medicine Residents. West J Emerg Med 2019; 20:35-42. [PMID: 30643599 PMCID: PMC6324698 DOI: 10.5811/westjem.2018.11.38912] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 10/29/2018] [Accepted: 11/12/2018] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Medical education is moving toward a competency-based framework with a focus on assessment using the Accreditation Council for Graduate Medical Education Milestones. Assessment of individual competencies through milestones can be challenging. While competencies describe characteristics of the person, the entrustable professional activities (EPAs) concept refers to work-related activities. EPAs would not replace the milestones but would be linked to them, integrating these frameworks. Many core specialties have already defined EPAs for resident trainees, but EPAs have not yet been created for emergency medicine (EM). This paper describes the development of milestone-linked EPAs for EM. METHODS Ten EM educators from across North America formed a consensus working group to draft EM EPAs, using a modified Glaser state-of-the-art approach. A reactor panel with EPA experts from the United States, Canada and the Netherlands was created, and an iterative process with multiple revisions was performed based on reactor panel input. Following this, the EPAs were sent to the Council of Residency Directors for EM (CORD-EM) listserv for additional feedback. RESULTS The product was 11 core EPAs that every trainee from every EM program should be able to perform independently by the time of graduation. Each EPA has associated knowledge, skills, attitudes and behaviors (KSAB), which are either milestones themselves or KSABs linked to individual milestones. We recognize that individual programs may have additional focus areas or work-based activities they want their trainees to achieve by graduation; therefore, programs are also encouraged to create additional program-specific EPAs. CONCLUSION This set of 11 core, EM-resident EPAs can be used as an assessment tool by EM residency programs, allowing supervising physicians to document the multiple entrustment decisions they are already making during clinical shifts with trainees. The KSAB list within each EPA could assist supervisors in giving specific, actionable feedback to trainees and allow trainees to use this list as an assessment-for-learning tool. Linking each KSAB to individual EM milestones allows EPAs to directly inform milestone assessment for clinical competency committees. These EPAs serve as another option for workplace-based assessment, and are linked to the milestones to create an integrated framework.
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Affiliation(s)
- Danielle Hart
- Hennepin County Medical Center, Department of Emergency Medicine, Minneapolis, Minnesota
| | - Douglas Franzen
- University of Washington, Department of Emergency Medicine, Seattle, Washington
| | - Michael Beeson
- Akron General, Department of Emergency Medicine, Akron, Ohio
| | - Rahul Bhat
- MedStar Georgetown University Hospital, Washington Hospital Center, Department of Emergency Medicine, Washington, District of Columbia
| | - Miriam Kulkarni
- St John’s Riverside Hospital, Department of Emergency Medicine, Yonkers, New York
| | - Lorraine Thibodeau
- Albany Medical Center, Department of Emergency Medicine, Albany, New York
| | - Moshe Weizberg
- Northwell Health, Department of Emergency Medicine, New York City, New York
| | - Susan Promes
- Penn State Health, Department of Emergency Medicine, Hershey, Pennsylvania
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Gardner AL, Shunk R, Dulay M, Strewler A, O'Brien B. Huddling for High-Performing Teams. Fed Pract 2018; 35:16-22. [PMID: 30766382 PMCID: PMC6366795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In short team huddles, trainees and PACT teamlets meet to coordinate care and identify ways to improve team processes under the guidance of faculty members who reinforce collaborative practice and continuous improvement.
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Affiliation(s)
- Annette L Gardner
- is an Assistant Professor at the Philip R. Lee Institute for Health Policy Studies and the Department of Social and Behavioral Sciences, University of California, San Francisco (UCSF). is the Codirector of the San Francisco VA Center of Excellence in Primary Care Education (CoEPCE) and Associate Chief of Staff for Education at the San Francisco VA Healthcare System (SFVAHCS), and an Associate Professor, Department of Medicine at UCSF. is an Associate Professor at UCSF and Associate Director of the SFVAHCS CoEPCE Center of Excellence in Primary Care Education, and is Codirector of the SFVAHCS CoEPCE and Assistant Clinical Professor at UCSF. is Director of Evaluation and Scholarship, SFVAHCS CoEPCE and an Associate Professor at UCSF
| | - Rebecca Shunk
- is an Assistant Professor at the Philip R. Lee Institute for Health Policy Studies and the Department of Social and Behavioral Sciences, University of California, San Francisco (UCSF). is the Codirector of the San Francisco VA Center of Excellence in Primary Care Education (CoEPCE) and Associate Chief of Staff for Education at the San Francisco VA Healthcare System (SFVAHCS), and an Associate Professor, Department of Medicine at UCSF. is an Associate Professor at UCSF and Associate Director of the SFVAHCS CoEPCE Center of Excellence in Primary Care Education, and is Codirector of the SFVAHCS CoEPCE and Assistant Clinical Professor at UCSF. is Director of Evaluation and Scholarship, SFVAHCS CoEPCE and an Associate Professor at UCSF
| | - Maya Dulay
- is an Assistant Professor at the Philip R. Lee Institute for Health Policy Studies and the Department of Social and Behavioral Sciences, University of California, San Francisco (UCSF). is the Codirector of the San Francisco VA Center of Excellence in Primary Care Education (CoEPCE) and Associate Chief of Staff for Education at the San Francisco VA Healthcare System (SFVAHCS), and an Associate Professor, Department of Medicine at UCSF. is an Associate Professor at UCSF and Associate Director of the SFVAHCS CoEPCE Center of Excellence in Primary Care Education, and is Codirector of the SFVAHCS CoEPCE and Assistant Clinical Professor at UCSF. is Director of Evaluation and Scholarship, SFVAHCS CoEPCE and an Associate Professor at UCSF
| | - Anna Strewler
- is an Assistant Professor at the Philip R. Lee Institute for Health Policy Studies and the Department of Social and Behavioral Sciences, University of California, San Francisco (UCSF). is the Codirector of the San Francisco VA Center of Excellence in Primary Care Education (CoEPCE) and Associate Chief of Staff for Education at the San Francisco VA Healthcare System (SFVAHCS), and an Associate Professor, Department of Medicine at UCSF. is an Associate Professor at UCSF and Associate Director of the SFVAHCS CoEPCE Center of Excellence in Primary Care Education, and is Codirector of the SFVAHCS CoEPCE and Assistant Clinical Professor at UCSF. is Director of Evaluation and Scholarship, SFVAHCS CoEPCE and an Associate Professor at UCSF
| | - Bridget O'Brien
- is an Assistant Professor at the Philip R. Lee Institute for Health Policy Studies and the Department of Social and Behavioral Sciences, University of California, San Francisco (UCSF). is the Codirector of the San Francisco VA Center of Excellence in Primary Care Education (CoEPCE) and Associate Chief of Staff for Education at the San Francisco VA Healthcare System (SFVAHCS), and an Associate Professor, Department of Medicine at UCSF. is an Associate Professor at UCSF and Associate Director of the SFVAHCS CoEPCE Center of Excellence in Primary Care Education, and is Codirector of the SFVAHCS CoEPCE and Assistant Clinical Professor at UCSF. is Director of Evaluation and Scholarship, SFVAHCS CoEPCE and an Associate Professor at UCSF
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Young JQ, Hasser C, Hung EK, Kusz M, O'Sullivan PS, Stewart C, Weiss A, Williams N. Developing End-of-Training Entrustable Professional Activities for Psychiatry: Results and Methodological Lessons. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:1048-1054. [PMID: 29166349 DOI: 10.1097/acm.0000000000002058] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE To develop entrustable professional activities (EPAs) for psychiatry and to demonstrate an innovative, validity-enhancing methodology that may be relevant to other specialties. METHOD A national task force employed a three-stage process from May 2014 to February 2017 to develop EPAs for psychiatry. In stage 1, the task force used an iterative consensus-driven process to construct proposed EPAs. Each included a title, full description, and relevant competencies. In stage 2, the task force interviewed four nonpsychiatric experts in EPAs and further revised the EPAs. In stage 3, the task force performed a Delphi study of national experts in psychiatric education and assessment. All survey participants completed a brief training program on EPAs. Quantitative and qualitative analysis led to further modifications. Essentialness was measured on a five-point scale. EPAs were included if the content validity index was at least 0.8 and the lower end of the asymmetric confidence interval was not lower than 4.0. RESULTS Stages 1 and 2 yielded 24 and 14 EPAs, respectively. In stage 3, 31 of the 39 invited experts participated in both rounds of the Delphi study. Round 1 reduced the proposed EPAs to 13. Ten EPAs met the inclusion criteria in Round 2. CONCLUSIONS The final EPAs provide a strong foundation for competency-based assessment in psychiatry. Methodological features such as critique by nonpsychiatry experts, a national Delphi study with frame-of-reference training, and stringent inclusion criteria strengthen the content validity of the findings and may serve as a model for future efforts in other specialties.
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Affiliation(s)
- John Q Young
- J.Q. Young is professor, Department of Psychiatry, Zucker School of Medicine at Hofstra/Northwell, New York, New York. C. Hasser is assistant professor, Department of Psychiatry, UCSF School of Medicine, San Francisco, California. E.K. Hung is associate professor, Department of Psychiatry, UCSF School of Medicine, San Francisco, California. M. Kusz is research assistant, Department of Psychiatry, Hofstra Northwell School of Medicine, New York, New York. P.S. O'Sullivan is professor, Department of Medicine and Surgery, UCSF School of Medicine, San Francisco, California. C. Stewart is assistant professor, Department of Psychiatry, Georgetown School of Medicine, Washington, DC. A. Weiss is associate professor, Department of Psychiatry and Behavioral Sciences, Albert Einstein School of Medicine, New York, New York. N. Williams is professor, Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, Iowa
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Henrickson Parker S, Schmutz JB, Manser T. Training Needs for Adaptive Coordination: Utilizing Task Analysis to Identify Coordination Requirements in Three Different Clinical Settings. GROUP & ORGANIZATION MANAGEMENT 2018. [DOI: 10.1177/1059601118768022] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A team’s ability to coordinate and adapt their performance to meet situational demands is critical to excellent patient care. The goal of this article is to identify common coordination characteristics that enable health care action teams to ensure effective patient care and to discuss specific examples of adaptive coordination within the health care setting. Task analyses were conducted to identify situational demands, in three different clinical settings: cardiac anesthesia, pediatric sepsis simulation, and trauma resuscitation. Each task analysis identified specific coordination requirements for pertinent tasks. The research team compared these task analyses, identified emerging themes, and agreed on core coordination characteristics common across all three environments by consensus through iterative abductive analysis. Findings across these diverse clinical settings showed that expert action teams (a) continually appraise their dynamic environment, (b) identify and define points of coordination, and (c) respond to the demands of nonroutine events by making coordination highly explicit. Specific examples of adaptive coordination within the health care setting are discussed, and implications for training are articulated. Findings are also pertinent outside of health care and may contribute to the understanding of coordination behaviors within action teams across multiple settings.
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Affiliation(s)
| | | | - Tanja Manser
- University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland
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Junod Perron N, Audetat MC, Mazouri S, Schindler M, Haller DM, Sommer J. How well are Swiss French physicians prepared for future practice in primary care? BMC MEDICAL EDUCATION 2018; 18:65. [PMID: 29615038 PMCID: PMC5883275 DOI: 10.1186/s12909-018-1168-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 03/19/2018] [Indexed: 05/28/2023]
Abstract
BACKGROUND Moving from postgraduate training into independent practice represents a major transition in physicians' professional life. Little is known about how Swiss primary care graduates experience such a transition. The aim of this study was to explore the extent to which primary care physicians who recently set up private practice felt prepared to work as independent practitioners. METHODS We conducted 7 focus groups among recently established (≤ 5 years) primary care physicians in Switzerland. Questions focused on positive and negative aspects of setting up a practice, and degree of preparedness. Transcripts were analysed according to organisational socialisation and work role transition frameworks. RESULTS Participants felt relatively well prepared for most medical tasks except for some rheumatologic, minor traumatology, ENR, skin and psychiatric aspects. They felt unprepared for non clinical tasks such as office, insurance and medico-legal management issues and did not anticipate that the professional networking outside the hospital would be so important to their daily work. They faced dilemmas opposing professional values to the reality of practice which forced them to clarify their professional roles and expectations. Adjustment strategies were mainly informal. CONCLUSION Although the postgraduate primary care curriculum is longer in Switzerland than in most European countries, it remains insufficiently connected with the reality of transitioning into independent practice, especially regarding role development and management tasks. A greater proportion of postgraduate training, with special emphasis on these issues, should take place directly in primary care.
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Affiliation(s)
- N. Junod Perron
- Institute of Primary Care, Geneva University Hospitals, 22 av Beau-Séjour, 1211 Genève 4, Switzerland
- Unit of Development and Research in Medical Education, Geneva Faculty of Medicine, Geneva, Switzerland
| | - M. C. Audetat
- Unit of Development and Research in Medical Education, Geneva Faculty of Medicine, Geneva, Switzerland
- Unit of Primary Care, Geneva Faculty of Medicine, Geneva, Switzerland
| | - S. Mazouri
- Division of Primary Care, Geneva University Hospitals, Geneva University Hospitals, Geneva, Switzerland
| | - M. Schindler
- Division of Primary Care, Geneva University Hospitals, Geneva University Hospitals, Geneva, Switzerland
| | - D. M. Haller
- Unit of Primary Care, Geneva Faculty of Medicine, Geneva, Switzerland
| | - J. Sommer
- Unit of Primary Care, Geneva Faculty of Medicine, Geneva, Switzerland
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Chesbro SB, Jensen GM, Boissonnault WG. Entrustable Professional Activities as a Framework for Continued Professional Competence: Is Now the Time? Phys Ther 2018; 98:3-7. [PMID: 29088388 DOI: 10.1093/ptj/pzx100] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
| | - Gail M Jensen
- Department of Physical Therapy, School of Pharmacy and Health Professions, Creighton University, Omaha, Nebraska
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Kaminetzky CP, Beste LA, Poppe AP, Doan DB, Mun HK, Woods NF, Wipf JE. Implementation of a novel population panel management curriculum among interprofessional health care trainees. BMC MEDICAL EDUCATION 2017; 17:264. [PMID: 29273028 PMCID: PMC5741920 DOI: 10.1186/s12909-017-1093-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 12/04/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Gaps in chronic disease management have led to calls for novel methods of interprofessional, team-based care. Population panel management (PPM), the process of continuous quality improvement across groups of patients, is rarely included in health professions training for physicians, nurses, or pharmacists. The feasibility and acceptance of such training across different healthcare professions is unknown. We developed and implemented a novel, interprofessional PPM curriculum targeted to diverse health professions trainees. METHODS The curriculum was implemented annually among internal medicine residents, nurse practitioner students and residents, and pharmacy residents co-located in a large, academic primary care site. Small groups of interprofessional trainees participated in supervised quarterly seminars focusing on chronic disease management (e.g., diabetes mellitus, hypertension, or chronic obstructive pulmonary disease) or processes of care (e.g., emergency department utilization for nonacute conditions or chronic opioid management). Following brief didactic presentations, trainees self-assessed their clinic performance using patient-level chart review, presented individual cases to interprofessional staff and faculty, and implemented subsequent feedback with their clinic team. We report data from 2011 to 2015. Program evaluation included post-session participant surveys regarding attitudes, knowledge and confidence towards PPM, ability to identify patients for referral to interprofessional team members, and major learning points from the session. Directed content analysis was performed on an open-ended survey question. RESULTS Trainees (n = 168) completed 122 evaluation assessments. Trainees overwhelmingly reported increased confidence in using PPM and increased knowledge about managing their patient panel. Trainees reported improved ability to identify patients who would benefit from multidisciplinary care or referral to another team member. Directed content analysis revealed that trainees viewed team members as important system resources (n = 82). CONCLUSIONS Structured interprofessional training in PPM is both feasible and acceptable to trainees across multiple professions. Curriculum participants reported improved panel management skills, increased confidence in using PPM, and increased confidence in identifying candidates for interprofessional care. The curriculum could be readily exported to other programs and contexts.
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Affiliation(s)
- Catherine P. Kaminetzky
- VA Puget Sound Health Care System, Seattle, WA USA
- Division of General Internal Medicine, University of Washington, Seattle, WA USA
| | - Lauren A. Beste
- VA Puget Sound Health Care System, Seattle, WA USA
- Division of General Internal Medicine, University of Washington, Seattle, WA USA
| | - Anne P. Poppe
- VA Puget Sound Health Care System, Seattle, WA USA
- Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, Seattle, WA USA
| | - Daniel B. Doan
- VA Puget Sound Health Care System, Seattle, WA USA
- Division of General Internal Medicine, University of Washington, Seattle, WA USA
| | | | - Nancy Fugate Woods
- Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, Seattle, WA USA
- de Tornyay Center for Healthy Aging, University of Washington School of Nursing, Seattle, WA USA
| | - Joyce E. Wipf
- VA Puget Sound Health Care System, Seattle, WA USA
- Division of General Internal Medicine, University of Washington, Seattle, WA USA
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Wagner LM, Dolansky MA, Englander R. Entrustable professional activities for quality and patient safety. Nurs Outlook 2017; 66:237-243. [PMID: 29544650 DOI: 10.1016/j.outlook.2017.11.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 11/14/2017] [Accepted: 11/15/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Further efforts are warranted to identify innovative approaches to best implement competencies in nursing education. To bridge the gap between competency-based education, practice, and implementation of knowledge, skills, and attitudes, one emerging approach is entrustable professional activities (EPAs). PURPOSE The objective of this study was to introduce the concept of EPAs as a framework for curriculum and assessment in graduate nursing education and training. METHODS Seven steps are provided to develop EPAs for nurses through the example of a quality and safety EPA. The example incorporates the Quality and Safety Education for Nurses (QSEN) patient safety competencies and evidence-based literature. FINDINGS EPAs provide a practical approach to integrating competencies in nursing as quality and safety are the cornerstones of nursing practice, education, and research. DISCUSSION Introducing the EPA concept in nursing is timely as we look to identify opportunities to enhance nurse practitioner (NP) training models and implement nurse residency programs.
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Affiliation(s)
- Laura M Wagner
- University of California, San Francisco, School of Nursing, San Francisco, CA.
| | - Mary A Dolansky
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH
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Brown CR, Criscione-Schreiber L, O'Rourke KS, Fuchs HA, Putterman C, Tan IJ, Valeriano-Marcet J, Hsieh E, Zirkle S, Bolster MB. What Is a Rheumatologist and How Do We Make One? Arthritis Care Res (Hoboken) 2017; 68:1166-72. [PMID: 26663526 DOI: 10.1002/acr.22817] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 11/17/2015] [Accepted: 12/08/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Graduate medical education is a critical time in the training of a rheumatologist, and purposeful evaluation of abilities during this time is essential for long-term success as an independent practitioner. The internal medicine subspecialties collectively developed a uniform set of reporting milestones by which trainees can be assessed and receive formative feedback, providing clarity of accomplishment as well as areas for improvement in training. Furthermore, the reporting milestones provide a schema for assessment and evaluation of fellows by supervisors. The internal medicine subspecialties were also tasked with considering entrustable professional activities (EPAs), which define the abilities of a subspecialty physician who has attained sufficient mastery of the field to be accountable to stakeholders and participate in independent practice. Although EPAs have been established for a few specialties, they had not yet been described for rheumatology. EPAs have value as descriptors of the comprehensive abilities, knowledge, and skills of a practicing rheumatologist. The rheumatology EPAs have a role in defining a specialist in rheumatology upon completion of training, and also represent the ways our specialty defines our abilities that are enduring throughout practice. METHODS We describe the collaborative process of the development of both the subspecialty reporting milestones and the rheumatology EPAs. The reporting milestones evolved through discussions and collaborations among representatives from the Association of Specialty Professors, the Alliance for Academic Internal Medicine, the American Board of Internal Medicine, and the Accreditation Council for Graduate Medical Education. The EPAs were a product of deliberations by the Next Accreditation System (NAS) working group of the American College of Rheumatology (ACR) Committee on Rheumatology Training and Workforce Issues. RESULTS Twenty-three subspecialty reporting milestones and 14 rheumatology EPAs were advanced and refined over the course of 3 subspecialty reporting milestone development summits and 3 ACR NAS working group meetings, respectively. CONCLUSION The subspecialty reporting milestones and rheumatology EPAs presented here stipulate reasonable and measurable expectations for rheumatologists-in-training. Together, these tools aim to promote enrichment and greater accountability in the training of fellows. Additionally, the EPAs define, for all stakeholders, the expertise of a rheumatologist in practice.
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Affiliation(s)
- Calvin R Brown
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | | | - Howard A Fuchs
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Chaim Putterman
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Irene J Tan
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | | | | | - Sarah Zirkle
- American College of Rheumatology, Atlanta, Georgia
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Giannitrapani KF, Ahluwalia SC, Day RT, Pisciotta M, Dobscha S, Lorenz K. Challenges to teaming for pain in primary care. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2017; 6:23-27. [PMID: 28711504 DOI: 10.1016/j.hjdsi.2017.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 01/24/2017] [Accepted: 06/28/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Karleen F Giannitrapani
- Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025, USA.
| | | | - R Thomas Day
- Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025, USA
| | - Maura Pisciotta
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, USA
| | - Steven Dobscha
- Department of Psychiatry, Oregon Health & Science University, USA
| | - Karl Lorenz
- Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025, USA; The RAND Corporation, USA; Stanford School of Medicine, USA
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Raslau D, Kasten MJ, Kebede E, Mohabbat A, Ratrout B, Mikhail M. Developing a Comprehensive Perioperative Education Curriculum for Internal Medicine Residency Training. THE JOURNAL OF EDUCATION IN PERIOPERATIVE MEDICINE : JEPM 2017; 19:E608. [PMID: 29600257 PMCID: PMC5868371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Background Patients undergoing surgery are becoming increasingly complex and internists are becoming more involved in their perioperative care. Therefore, new requirements from the ACGME/ABIM necessitate education in this area. We aim to discuss how our institution adapted a perioperative curriculum to fill this need. Methods Perioperative education is primarily given to the residents during their one month rotation through the General Internal Medicine Consult Service rotation. This is an inpatient rotation that provides perioperative expertise to surgical teams, medicine consultation to medical subspecialty teams, and outpatient preoperative evaluations. Results Our implementation complies with ACGME/ABIM requirements and ensures that the educational and clinical needs of our institution are met. Conclusions Developing a new curriculum can be daunting. We hope that this explanation of our approach will aid others who are working to develop an effective perioperative curriculum at their institutions.
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Veinot P, Lin W, Woods N, Ng S. Faculty and resident perspectives on ambulatory care education: A collective case study of family medicine, psychiatry, and surgery. CANADIAN MEDICAL EDUCATION JOURNAL 2017; 8:e37-e48. [PMID: 29098047 PMCID: PMC5661737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Ambulatory care (AC) experiences within medical education are garnering increasing attention. We sought to understand how faculty and residents' describe their experiences of AC and ambulatory care education (ACEduc) within, between, and across disciplinary contexts. METHODS We designed a Stakian collective case study, applying constructivist grounded theory analytic methods. Using purposive and snowball sampling, we interviewed 17 faculty and residents across three instrumental cases: family medicine, psychiatry, surgery. Through constant comparative analysis, we identified patterns within, between, and across cases. RESULTS Family medicine and psychiatry saw AC as an inherent part of continuous, longitudinal care; surgery equated AC with episodic experiences in clinic, differentiating it from operating. Across cases, faculty and residents cautiously valued ACEduc, and in particular, considered it important to develop non-medical expert competencies (e.g., communication). However, surgery residents described AC and ACEduc as less interesting and a lower priority than operating. Educational structures mediated these views. CONCLUSION Differences between cases highlight a need for further study, as universal assumptions about ACEduc's purposes and approaches may need to be tempered by situated, contextually-rich perspectives. How disciplinary culture, program structure, and systemic structure influence ACEduc warrant further consideration as does the educational potential for explicitly framing learners' perspectives.
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Affiliation(s)
- Paula Veinot
- Centre for Ambulatory Care Education, Women’s College Hospital, University of Toronto, Ontario, Canada
| | - William Lin
- Centre for Ambulatory Care Education, Women’s College Hospital, University of Toronto, Ontario, Canada
| | - Nicole Woods
- Centre for Ambulatory Care Education, Women’s College Hospital, University of Toronto, Ontario, Canada
- The Wilson Centre, University of Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Ontario, Canada
| | - Stella Ng
- Centre for Ambulatory Care Education, Women’s College Hospital, University of Toronto, Ontario, Canada
- Centre for Faculty Development, University of Toronto, Ontario, Canada
- Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
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Holzhausen Y, Maaz A, Cianciolo AT, Ten Cate O, Peters H. Applying occupational and organizational psychology theory to entrustment decision-making about trainees in health care: a conceptual model. PERSPECTIVES ON MEDICAL EDUCATION 2017; 6:119-126. [PMID: 28284011 PMCID: PMC5383570 DOI: 10.1007/s40037-017-0336-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
In medical contexts around the world, supervising physicians continuously decide what degree of supervision to apply as trainees carry out professional activities. Although the implications for patients can be far-reaching, little is known about how these entrustment decisions are formed. The concept of 'Entrustable Professional Activities' has initiated interest and valuable research on factors that may influence the entrustment decision process.The aim of the current article is to link models of entrustment developed in the fields of occupational and organizational psychology and military psychology to medical education studies that have explored the factors influencing physicians' entrustment decisions. We provide a conceptual framework of the entrustment decision-making process, which we suggest will contribute to the understanding of how supervising physicians arrive at the decision to entrust a medical trainee with a professional activity.
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Affiliation(s)
- Ylva Holzhausen
- Dieter Scheffner Center for Medical Education and Educational Research, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Asja Maaz
- Dieter Scheffner Center for Medical Education and Educational Research, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Anna T Cianciolo
- Department of Medical Education, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Olle Ten Cate
- Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Harm Peters
- Dieter Scheffner Center for Medical Education and Educational Research, Charité-Universitätsmedizin Berlin, Berlin, Germany.
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Block L, LaVine N, Verbsky J, Sagar A, Smith MA, Lane S, Conigliaro J, Chaudhry SA. Do medical residents perform patient-centered medical home tasks? A mixed-methods study. MEDICAL EDUCATION ONLINE 2017; 22:1352434. [PMID: 28758564 PMCID: PMC5653944 DOI: 10.1080/10872981.2017.1352434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 06/29/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Increasingly, residents are being trained in Patient-centered Medical Home (PCMH) settings. A set of PCMH entrustable professional activities (EPAs) for residents has been defined but not evaluated in practice. OBJECTIVE To understand whether residents trained at PCMH sites reported higher likelihood of engaging in PCMH tasks than those training in non-PCMH sites. DESIGN Survey and nominal group data from post-graduate trainees at three residency programs. RESULTS A total of 179 residents responded (80% response). Over half (52%) cared for patients at PCMH sites. Residents at PCMH sites were more likely to report engaging in tasks in the NCQA domains of enhancing access and continuity (p < 0.01 for 4/11 tasks), planning and managing care (p < 0.01 for 3/4 tasks), providing self-care and community support (p < 0.01 for 3/5 tasks), and identifying and managing patient populations (p < 0.01 for 1/6 tasks), but were not more likely to report tracking and coordinating care or measuring and improving performance. Residents at PCMH sites were more likely to report working with medical assistants (p < 0.01), but not other healthcare professionals. Qualitative data showed staff teamwork and continuity of care as facilitators of patient-centered care, and technological problems and office inefficiencies as barriers to care. CONCLUSIONS Residents trained at PCMH sites were more likely to engage in tasks in several NCQA domains, but not care coordination and quality assessment. Similar facilitators and barriers to trainee provision of patient-centered care were cited regardless of PCMH status. Curricula on PCMH principles and workflows that foster continuity and communication may help to inform residents on PCMH tenets and incorporate residents into team-based care. ABBREVIATIONS EPA: Entrustable professional activity; GIM: General Internal Medicine; NCQA: National Center for Quality Assurance; PCMH: Patient-centered medical home.
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Affiliation(s)
- Lauren Block
- Department of Medicine, Northwell Health, Lake Success, NY, USA
| | - Nancy LaVine
- Department of Medicine, Northwell Health, Lake Success, NY, USA
| | | | - Ankita Sagar
- Department of Medicine, Northwell Health, Lake Success, NY, USA
| | - Miriam A. Smith
- Department of Medicine, Northwell Health, Lake Success, NY, USA
| | - Susan Lane
- Department of Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA
| | | | - Saima A. Chaudhry
- Office of Academic Affairs, Memorial Healthcare System, Hollywood, FL, USA
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Long T, Chaiyachati K, Bosu O, Sircar S, Richards B, Garg M, McGarry K, Solomon S, Berman R, Curry L, Moriarty J, Huot S. Why Aren't More Primary Care Residents Going into Primary Care? A Qualitative Study. J Gen Intern Med 2016; 31:1452-1459. [PMID: 27488970 PMCID: PMC5130953 DOI: 10.1007/s11606-016-3825-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 05/25/2016] [Accepted: 07/14/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Workforce projections indicate a potential shortage of up to 31,000 adult primary care providers by the year 2025. Approximately 80 % of internal medicine residents and nearly two-thirds of primary care internal medicine residents do not plan to have a career in primary care or general internal medicine. OBJECTIVE We aimed to explore contextual and programmatic factors within primary care residency training environments that may influence career choices. DESIGN This was a qualitative study based on semi-structured, in-person interviews. PARTICIPANTS Three primary care internal medicine residency programs were purposefully selected to represent a diversity of training environments. Second and third year residents were interviewed. APPROACH We used a survey guide developed from pilot interviews and existing literature. Three members of the research team independently coded the transcripts and developed the code structure based on the constant comparative method. The research team identified emerging themes and refined codes. ATLAS.ti was used for the analysis. KEY RESULTS We completed 24 interviews (12 second-year residents, and 12 third-year residents). The age range was 27-39 years. Four recurrent themes characterized contextual and programmatic factors contributing to residents' decision-making: resident expectations of a career in primary care, navigation of the boundary between social needs and medical needs, mentorship and perceptions of primary care, and structural features of the training program. CONCLUSIONS Addressing aspects of training that may discourage residents from careers in primary care such as lack of diversity in outpatient experiences and resident frustration with their inability to address social needs of patients, and strengthening aspects of training that may encourage interests in careers in primary care such as mentorship and protected time away from inpatient responsibilities during primary care rotations, may increase the proportion of residents enrolled in primary care training programs who pursue a career in primary care.
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Affiliation(s)
- Theodore Long
- Robert Wood Johnson Clinical Scholars Program, Yale School of Medicine, 333 Cedar Street, SHM IE-61, PO Box 208088, New Haven, CT, 06520, USA. .,Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
| | - Krisda Chaiyachati
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | | | | | - Bradley Richards
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Megha Garg
- Department of Internal Medicine, Medical School of Brown University, Providence, RI, USA
| | - Kelly McGarry
- Department of Internal Medicine, Medical School of Brown University, Providence, RI, USA
| | - Sonja Solomon
- Division of General Internal Medicine & Primary Care, Brigham and Women's Hospital, Boston, MA, USA
| | - Rebecca Berman
- Division of General Internal Medicine & Primary Care, Brigham and Women's Hospital, Boston, MA, USA
| | - Leslie Curry
- Robert Wood Johnson Clinical Scholars Program, Yale School of Medicine, 333 Cedar Street, SHM IE-61, PO Box 208088, New Haven, CT, 06520, USA.,Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.,Yale School of Public Health, New Haven, CT, USA
| | - John Moriarty
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Stephen Huot
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
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Weiss A, Ozdoba A, Carroll V, DeJesus F. Entrustable Professional Activities: Enhancing Meaningful Use of Evaluations and Milestones in a Psychiatry Residency Program. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2016; 40:850-854. [PMID: 26976398 DOI: 10.1007/s40596-016-0530-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 02/23/2016] [Indexed: 06/05/2023]
Affiliation(s)
- Andrea Weiss
- Montefiore Medical Center-Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Ana Ozdoba
- Montefiore Medical Center-Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Felicia DeJesus
- T.W. Ponessa and Associates Counseling Services, Inc, Lancaster, PA, USA
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Gerhard-Szep S, Güntsch A, Pospiech P, Söhnel A, Scheutzel P, Wassmann T, Zahn T. Assessment formats in dental medicine: An overview. GMS JOURNAL FOR MEDICAL EDUCATION 2016; 33:Doc65. [PMID: 27579365 PMCID: PMC5003142 DOI: 10.3205/zma001064] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 03/24/2016] [Accepted: 05/09/2016] [Indexed: 05/25/2023]
Abstract
AIM At the annual meeting of German dentists in Frankfurt am Main in 2013, the Working Group for the Advancement of Dental Education (AKWLZ) initiated an interdisciplinary working group to address assessments in dental education. This paper presents an overview of the current work being done by this working group, some of whose members are also actively involved in the German Association for Medical Education's (GMA) working group for dental education. The aim is to present a summary of the current state of research on this topic for all those who participate in the design, administration and evaluation of university-specific assessments in dentistry. METHOD Based on systematic literature research, the testing scenarios listed in the National Competency-based Catalogue of Learning Objectives (NKLZ) have been compiled and presented in tables according to assessment value. RESULTS Different assessment scenarios are described briefly in table form addressing validity (V), reliability (R), acceptance (A), cost (C), feasibility (F), and the influence on teaching and learning (EI) as presented in the current literature. Infoboxes were deliberately chosen to allow readers quick access to the information and to facilitate comparisons between the various assessment formats. Following each description is a list summarizing the uses in dental and medical education. CONCLUSION This overview provides a summary of competency-based testing formats. It is meant to have a formative effect on dental and medical schools and provide support for developing workplace-based strategies in dental education for learning, teaching and testing in the future.
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Affiliation(s)
- Susanne Gerhard-Szep
- Goethe-Universität, Carolinum Zahnärztliches Universitäts-Institut gGmbH, Poliklinik Zahnerhaltungskunde, Frankfurt am Main, Deutschland
| | - Arndt Güntsch
- Marquette University School of Dentistry, Department of Surgical Sciences, Milwaukee, USA und Universitätsklinikum Jena, Zentrum für Zahn-, Mund- und Kieferheilkunde, Jena, Deutschland
| | - Peter Pospiech
- Universität Würzburg, Poliklinik für Zahnärztliche Prothetik, Würzburg, Deutschland
| | - Andreas Söhnel
- Universitätsmedizin Greifswald, Poliklinik für Zahnärztliche Prothetik, Alterszahnheilkunde und medizinischer Werkstoffkunde, Greifswald, Deutschland
| | - Petra Scheutzel
- Universitätsklinikum Münster, Poliklinik für Prothetische Zahnmedizin & Biomaterialien, Münster, Deutschland
| | - Torsten Wassmann
- Universitätsmedizin Göttingen, Poliklinik für Zahnärztliche Prothetik, Göttingen, Deutschland
| | - Tugba Zahn
- Goethe-Universität, Carolinum Zahnärztliches Universitäts-Institut gGmbH, Poliklinik für Zahnärztliche Prothetik, Frankfurt am Main, Deutschland
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Anandarajah G, Furey C, Chandran R, Goldberg A, El Rayess F, Ashley D, Goldman RE. Effects of adding a new PCMH block rotation and resident team to existing longitudinal training within a certified PCMH: primary care residents' attitudes, knowledge, and experience. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2016; 7:457-466. [PMID: 27536169 PMCID: PMC4978166 DOI: 10.2147/amep.s110215] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Although the patient-centered medical home (PCMH) model is considered important for the future of primary care in the USA, it remains unclear how best to prepare trainees for PCMH practice and leadership. Following a baseline study, the authors added a new required PCMH block rotation and resident team to an existing longitudinal PCMH immersion and didactic curriculum within a Level 3-certified PCMH, aiming for "enhanced situated learning". All 39 residents enrolled in a USA family medicine residency program during the first year of curricular implementation completed this new 4-week rotation. This study examines the effects of this rotation after 1 year. METHODS A total of 39 intervention and 13 comparison residents were eligible participants. This multimethod study included: 1) individual interviews of postgraduate year (PGY) 3 intervention vs PGY3 comparison residents, assessing residents' PCMH attitudes, knowledge, and clinical experience, and 2) routine rotation evaluations. Interviews were audiorecorded, transcribed, and analyzed using immersion/crystallization. Rotation evaluations were analyzed using descriptive statistics and qualitative analysis of free text responses. RESULTS Authors analyzed 23 interviews (88%) and 26 rotation evaluations (67%). Intervention PGY3s' interviews revealed more nuanced understanding of PCMH concepts and more experience with system-level PCMH tasks than those of comparison PGY3s. More intervention PGY3s rated themselves "extremely prepared" to implement PCMH than comparison PGY3s; however, most self-rated "somewhat prepared". Their reflections demonstrated deeper understanding of PCMH implementation and challenges than comparison PGY3s but inadequate experience to directly see the results of successful solutions. Rotation evaluations from PGY1, PGY2, and PGY3s revealed strengths and several areas for improvement. CONCLUSION Adding one 4-week block rotation to existing longitudinal training appears to improve residents' PCMH knowledge, skills, and experience from "basic" to "intermediate". However, this training level appears inadequate for PCMH leadership or for teaching junior learners. Further study is needed to determine the optimum training for different settings.
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Affiliation(s)
- Gowri Anandarajah
- Department of Family Medicine
- Department of Medical Science, Warren Alpert Medical School of Brown University, Providence, RI
| | | | | | - Arnold Goldberg
- Department of Family Medicine, University of South Florida Morsani College of Medicine, Tampa, FL
- Department of Family Medicine, Leigh Valley Family Health Network, Allentown, PA
| | | | | | - Roberta E Goldman
- Department of Family Medicine
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Wisman-Zwarter N, van der Schaaf M, Ten Cate O, Jonker G, van Klei WA, Hoff RG. Transforming the learning outcomes of anaesthesiology training into entrustable professional activities: A Delphi study. Eur J Anaesthesiol 2016; 33:559-67. [PMID: 27270884 DOI: 10.1097/eja.0000000000000474] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND True competency-based medical education should produce graduates meeting fixed standards of competence. Current postgraduate programmes are usually based on a pre-determined length of time in training making them poorly suited for an individual approach. The concept of entrustable professional activities (EPAs) enables a more flexible, personalised and less time-dependent approach to training programmes. An EPA is a unit of professional practice, to be entrusted to a trainee to execute without supervision once they demonstrate sufficient competence. As EPAs relate competencies to clinical practice, they structure training and assessment more logically according to the way clinicians actually work. A first step in building an EPA-based curriculum is to identify the core EPAs of the profession. OBJECTIVES The aim of this study was to identify EPAs for postgraduate training in anaesthesiology and to provide an example of how an existing curriculum can be transformed into an EPA-based curriculum. DESIGN A modified Delphi method was used as a consensus approach applying three Delphi rounds. SETTING Postgraduate specialty training in anaesthesiology in the Netherlands. PARTICIPANTS All programme directors in anaesthesiology in the Netherlands except for a single programme director who was involved as a researcher in this study and could not participate. MAIN OUTCOME MEASURES Agreement among participants on a list of EPAs. Agreement was specified as a consensus rate of more than 80%. RESULTS In this study, 27 programme directors (69% overall response rate) reached consensus on a set of 45 EPAs that describe a curriculum in anaesthesiology for the Netherlands. CONCLUSION This study is a first step toward a more contemporary curriculum in competency-based postgraduate anaesthesiology training.
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Affiliation(s)
- Nienke Wisman-Zwarter
- From the Department of Anaesthesiology, University Medical Centre Utrecht, (NW-Z, GJ, WAvK, RGH); Department of Education, University of Utrecht (MvdS); and Center for Research and Development of Education, University Medical Centre Utrecht, Utrecht, The Netherlands (OtC)
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Rugen KW, Speroff E, Zapatka SA, Brienza R. Veterans Affairs Interprofessional Nurse Practitioner Residency in Primary Care: A Competency-based Program. J Nurse Pract 2016. [DOI: 10.1016/j.nurpra.2016.02.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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