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Kitto S, Fantaye AW, Zevin B, Fowler A, Sachdeva AK, Raiche I. A Scoping Review of the Literature on Entrustable Professional Activities in Surgery Residency Programs. JOURNAL OF SURGICAL EDUCATION 2024; 81:823-840. [PMID: 38679495 DOI: 10.1016/j.jsurg.2024.02.011] [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: 12/08/2023] [Accepted: 02/20/2024] [Indexed: 05/01/2024]
Abstract
OBJECTIVE Entrustable professional activities (EPAs) are a crucial component of contemporary postgraduate medical education with many surgery residency programs having implemented EPAs as a competency assessment framework to assess and provide feedback on the performance of their residents. Despite broad implementation of EPAs, there is a paucity of evidence regarding the impact of EPAs on the learners and learning environments. A first step in improving understanding of the use and impact of EPAs is by mapping the rising number of EPA-related publications from the field of surgery. The primary objective of this scoping review is to examine the nature, extent, and range of articles on the development, implementation, and assessment of EPAs. The second objective is to identify the experiences and factors that influence EPA implementation and use in practice in surgical specialties. DESIGN Scoping review. Four electronic databases (Medline, Embase, Education Source, and ERIC) were searched on January 20, 2022, and then again on July 19, 2023. A quasi-statistical content analysis was employed to quantify and draw meaning from the information related to the development, implementation, assessment, validity, reliability, and experiences with EPAs in the workplace. PARTICIPANTS A total of 42 empirical and nonempirical articles were included. RESULTS Four thematic categories describe the topic areas in included articles related to: 1) the development and refinement of EPAs, including the multiple steps taken to develop and refine unique EPAs for surgery residency programs; 2) the methods for implementing EPAs; 3) outcomes of EPA use in practice; 4) barriers, facilitators, and areas for improvement for the implementation and use of EPAs in surgical education. CONCLUSIONS This scoping review highlights the key trends and gaps from the rapidly increasing number of publications on EPAs in surgery residency, from development to their use in the workplace. Existing EPA studies lack a theoretical and/or conceptual basis; future development and implementation studies should adopt implementation science frameworks to better structure and operationalize EPAs within surgery residency programs.
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Affiliation(s)
- Simon Kitto
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Arone W Fantaye
- Office of Continuing Professional Development, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Boris Zevin
- Department of Surgery, Queen's University, Kingston, Canada
| | - Amanda Fowler
- Department of Surgery, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Ajit K Sachdeva
- Division of Education, American College of Surgeons, Chicago, Illinios
| | - Isabelle Raiche
- Department of Surgery, University of Ottawa, Ottawa, Canada.
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Yan F, Yang X, Zhang L, Cheng H, Bai L, Yang F. Establishing entrustable professional activities for psychiatry residents in China. BMC MEDICAL EDUCATION 2023; 23:623. [PMID: 37658351 PMCID: PMC10474625 DOI: 10.1186/s12909-023-04583-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 08/11/2023] [Indexed: 09/03/2023]
Abstract
PURPOSE The authors established entrustable professional activities for psychiatry residents in China. METHODS The authors conducted a literature research and two expert consultation rounds following the Delphi method in 2022 to screen and optimize entrustable professional activities for psychiatry residents. RESULTS The effective questionnaire recovery rate in the two consultation rounds was 100% (44/44). The expert authority coefficients of the first and second consultation rounds were 0.861 and 0.881, respectively. The Kendall harmony coefficients of the first and second expert consultation rounds were 0.279 (χ2 = 405.43, P < .001) and 0.389 (χ2 = 3456.83, P < .001), respectively. The arithmetic means of the various indicators' evaluation results in the two consultation rounds ranged between 3.61 and 4.93, and the full score rates were between 13.6% and 93.2%. The authors established 17 entrustable professional activities for psychiatry residents and their contents with phase-based modularization and formulated the entrustable level of each at various stages. CONCLUSIONS Combined with standardized psychiatry training characteristics, the authors preliminarily established phase-specific and modular entrustable professional activities for psychiatry residents. The formulated entrustable professional activities are suitable for the practice and clinical environment of standardized psychiatry training in China. The devised system has good observability and measurability and provides a simple and feasible competency evaluation method for standardized psychiatry resident training.
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Affiliation(s)
- Feng Yan
- Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Xu Yang
- Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Ligang Zhang
- Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Huaqin Cheng
- Institute of Medical Education &National center for Health Professions Education Development, PeKing University, Beijing, 100083, China
| | - Luyuan Bai
- Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Fude Yang
- Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, China.
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Stephan A, Cheung G, van der Vleuten C. Entrustable Professional Activities and Learning: The Postgraduate Trainee Perspective. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2023; 47:134-142. [PMID: 36224504 PMCID: PMC10060374 DOI: 10.1007/s40596-022-01712-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 09/16/2022] [Indexed: 05/25/2023]
Abstract
OBJECTIVE Entrustable professional activities (EPAs) are used as clinical activities in postgraduate psychiatry training in Australasia. This study aimed to explore psychiatry trainees' perceptions of the impact of EPAs on their motivation and learning. METHODS A constructivist grounded theory approach was used to conceptualize the impact of EPAs on trainees' motivation and learning. A purposive sample of trainees was recruited from across New Zealand. Semi-structured individual interviews were used for data collection and continued until theoretical saturation was reached. RESULTS The impact of EPAs on learning was mediated by the trainee's appraisals of subjective control, value, and the costs of engaging with EPAs. When appraisals were positive, EPAs encouraged a focus on particular learning needs and structured learning with the supervisor. However, when appraisals were negative, EPAs encouraged a superficial approach to learning. Trainee appraisals and their subsequent impact on motivation and learning were most affected by EPA granularity, alignment of EPAs with clinical practice, and the supervisor's conscientiousness in their approach to EPAs. CONCLUSIONS To stimulate learning, EPAs must be valued by both trainees and supervisors as constituting a coherent work-based curriculum that encompasses the key fellowship competencies. If EPAs are to be effective as clinical tasks for learning, ongoing faculty development must be the leading priority.
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Affiliation(s)
- Alice Stephan
- Mental Health and Addictions Service, Waikato District Health Board, Hamilton, New Zealand
| | - Gary Cheung
- School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
| | - Cees van der Vleuten
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, University of Maastricht, Maastricht, Netherlands
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Ehlinger C, Fernandez N, Strub M. Entrustable professional activities in dental education: a scoping review. Br Dent J 2023; 234:171-176. [PMID: 36765231 DOI: 10.1038/s41415-023-5503-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/28/2022] [Accepted: 12/09/2022] [Indexed: 02/12/2023]
Abstract
Background Competency-based education has led to the introduction of entrustable professional activities (EPAs) in health sciences education. EPAs are assessment tools that serve to certify a trainee's preparedness to conduct a given clinical activity. Objective Given its modest introduction into dental education, we sought to examine the current situation of EPAs in our field and identify possible barriers and facilitators. This review aimed to summarise evidence about EPA introduction in dental education programmes.Data sources A review of articles published between January 2005 and December 2021 was conducted using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews methodology in three databases (PubMed, Cochrane and Embase).Data selection Keywords were 'entrustable professional activity' OR 'entrustable professional activities' AND 'dentistry' OR 'dental education'.Data extraction Eligibility criteria targeted papers published in English describing dental education EPA.Data synthesis Ten publications were selected: six reported on new EPAs, three discussed their relevance for dental education and one article described a process for developing validated EPAs. EPAs focused on clinical examination, health promotion, treatment planning, pain and/or anxiety control and topics related to a specific discipline or care procedures.Conclusion Topics covered by EPAs described in our study adequately reflect the specificities of today's dental professional. The benefits of EPAs will ensure tomorrow's dentists consistently meet societal expectations.
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Affiliation(s)
- Claire Ehlinger
- Université de Strasbourg, Faculté de Chirurgie Dentaire, 8 Rue Sainte Elisabeth, 67000 Strasbourg, France; Hôpitaux Universitaires de Strasbourg, Pôle de Médecine et Chirurgie Bucco-Dentaires, 1 Place de l'Hôpital, 67000 Strasbourg, France
| | - Nicolas Fernandez
- Département de Médecine de Famille et Médecine D'urgence, Faculty of Medicine, Université de Montréal, 2900 Boulevard Édouard-Montpetit, Montréal, Québec, H3C 1J7, Canada
| | - Marion Strub
- Université de Strasbourg, Faculté de Chirurgie Dentaire, 8 Rue Sainte Elisabeth, 67000 Strasbourg, France; Hôpitaux Universitaires de Strasbourg, Pôle de Médecine et Chirurgie Bucco-Dentaires, 1 Place de l'Hôpital, 67000 Strasbourg, France.
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Zaeri R, Gandomkar R. Developing entrustable professional activities for doctoral graduates in health professions education: obtaining a national consensus in Iran. BMC MEDICAL EDUCATION 2022; 22:424. [PMID: 35655194 PMCID: PMC9164418 DOI: 10.1186/s12909-022-03469-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 05/17/2022] [Indexed: 05/31/2023]
Abstract
BACKGROUND The number of doctoral programs in health professions education (HPE) is expanding. Entrustable professional activities (EPAs) can be a mechanism to define the expected activities of the HPE doctorate to inform training and assessment processes. The purpose of this study was to develop and reach a consensus on EPAs for HPE doctoral graduates. METHODS We used a modified Nominal Group Technique (NGT) to elicit EPA titles followed by two rounds of a modified Delphi survey to seek consensus on the EPAs among groups of experts (HPE doctoral graduates and Board of HPE Examiners members) at the national level in Iran between July 2019 and July 2020. RESULTS A total number of 92 initial EPA titles, which emerged from brainstorming in the NGT meeting, was reduced to 27 titles during the clarification process. The final EPA framework consisted of 24 EPA titles with descriptions, arranged in three categories: Research and scholarship (6 EPAs), Educational development (11 EPAs) and Educational management (7 EPAs). All final EPAs scored ≥80% agreement at the national level. CONCLUSIONS The proposed EPAs framework can be used to improve the HPE doctorate training and to inform employment decisions. A future international consensus procedure could use these EPA outcomes as a starting point.
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Affiliation(s)
- Reza Zaeri
- Department of Medical Education, School of Medicine, Tehran University of Medical Sciences, No. 57, Hojjatdust Alley, Naderi St., Keshavarz Blvd, Tehran, 141663591, Iran
| | - Roghayeh Gandomkar
- Department of Medical Education, School of Medicine, Tehran University of Medical Sciences, No. 57, Hojjatdust Alley, Naderi St., Keshavarz Blvd, Tehran, 141663591, Iran.
- Health Professions Education Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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Bonnie LHA, Cremers GR, Nasori M, Kramer AWM, van Dijk N. Longitudinal training models for entrusting students with independent patient care?: A systematic review. MEDICAL EDUCATION 2022; 56:159-169. [PMID: 34383965 PMCID: PMC9292729 DOI: 10.1111/medu.14607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/21/2021] [Accepted: 08/04/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The participation of students from both undergraduate medical education (UGME) and postgraduate medical education (PGME) in independent patient care contributes to the development of knowledge, skills and the professional identity of students. A continuing collaboration between students and their preceptor might contribute to opportunities for students to independently provide patient care. In this systematic review, we aim to evaluate whether longitudinal training models facilitate the independent practice of students and what characteristics of longitudinal training models contribute to this process. METHOD This systematic review was performed according to the PRISMA guidelines. In May 2020, we performed a search in three databases. Articles evaluating the impact of longitudinal training models on the independent practice of students from both UGME and PGME programmes were eligible for the study. A total of 68 articles were included in the study. Quality of the included studies was assessed using the Quality Assessment Tool for Studies with Diverse Designs (QATSDD). RESULTS Both UGME and PGME students in longitudinal training models are more frequently allowed to provide patient care independently when compared with their block model peers, and they also feel better prepared for independent practice at the end of their training programme. Several factors related to longitudinal training models stimulate opportunities for students to work independently. The most important factors in this process are the longitudinal relationships with preceptors and with the health care team. CONCLUSION Due to the ongoing collaboration between students and their preceptor, they develop an intensive and supportive mutual relationship, allowing for the development of a safe learning environment. As a result, the professional development of students is fostered, and students gradually become part of the health care team, allowing them the opportunity to engage in independent patient care.
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Affiliation(s)
- Linda H. A. Bonnie
- Department of General PracticeAmsterdam UMC Location AMCAmsterdamThe Netherlands
| | - Gaston R. Cremers
- Department of General PracticeAmsterdam UMC Location AMCAmsterdamThe Netherlands
| | - Mana Nasori
- Department of General PracticeAmsterdam UMC Location AMCAmsterdamThe Netherlands
| | - Anneke W. M. Kramer
- Department of Public Health and Primary Care MedicineLeiden UniversityLeidenThe Netherlands
| | - Nynke van Dijk
- Department of General PracticeAmsterdam UMC Location AMCAmsterdamThe Netherlands
- Faculty of Health and the Faculty of Sports and NutritionAmsterdam University of Applied SciencesAmsterdamThe Netherlands
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Kerth JL, van Treel L, Bosse HM. The Use of Entrustable Professional Activities in Pediatric Postgraduate Medical Education: A Systematic Review. Acad Pediatr 2022; 22:21-28. [PMID: 34256178 DOI: 10.1016/j.acap.2021.07.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 05/28/2021] [Accepted: 07/01/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Entrustable Professional Activities (EPAs) provide a framework to make judgments of trainees' abilities in several settings including postgraduate medical education. No systematic review of the role of EPAs in pediatrics has yet been performed. OBJECTIVES In our systematic review, we sought to determine the use of EPAs in pediatrics to identify research gaps, summarize and discuss evidence relating to the development, implementation, and assessment. DATA SOURCES Medline, Scopus, PsycINFO, MedEdPortal, and Web of Science. STUDY ELIGIBILITY CRITERIA Two independent reviewers used a structured screening protocol in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and Association for Medical Education in Europe's guide for systematic reviews to include all articles reporting on EPAs in postgraduate medical education and pediatrics in particular. There were no restrictions due to language, study design, or participants. STUDY APPRAISAL AND SYNTHESIS METHODS Data on development, implementation, feasibility, acceptance, and assessment of EPAs were extracted and analyzed by the 2 independent researchers. RESULTS Twenty-eight articles published between 2014 and 2020 were included in the review. We found an increase in publications and a notable shift from descriptions of development processes toward aspects beyond development, ie, implementation, feasibility, acceptance/perception, and assessment. LIMITATIONS Studies from non-English-speaking countries are scarce which might lead to an inaccurate representation of actual international practice. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS We provide a comprehensive overview of EPAs in pediatrics to guide future curriculum developers in collaborative development, implementation and assessment of EPAs in pediatric postgraduate medical education.
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Affiliation(s)
- Janna-Lina Kerth
- Department of General Pediatrics, Pediatric Cardiology, and Neonatology, University Children's Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany.
| | - Lena van Treel
- Department of General Pediatrics, Pediatric Cardiology, and Neonatology, University Children's Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - Hans Martin Bosse
- Department of General Pediatrics, Pediatric Cardiology, and Neonatology, University Children's Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
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Chauhan VS, Chatterjee K, Prakash J, Singh YM, Dangi A, Dubey A, Chail A, Sharma R. Identifying entrustable professional activities for postgraduation in psychiatry: What should a psychiatrist be able to do? Ind Psychiatry J 2022; 31:49-55. [PMID: 35800858 PMCID: PMC9255628 DOI: 10.4103/ipj.ipj_124_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/23/2021] [Accepted: 07/02/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Competency-based medical education (CBME) has been the mandate by regulatory bodies of medical education in India, and implementation is an evolving process. This study aimed to identify and propose a set of entrustable professional activities (EPAs) for a master's degree in psychiatry. An attempt has been made to present it in the form of a portfolio. METHODOLOGY Faculty experts in psychiatry went through phases of review to select appropriate EPAs for postgraduate residents from divergent thinking to development of portfolio. RESULTS One hundred and sixty-seven EPAs were identified and are presented. These were divided according to expertise required. Of these, 54% were considered vital, 30% essential, and 16% desirable. CONCLUSION It is envisaged that the use of EPAs and portfolios will be instrumental in implementation and success of CBME in psychiatry. It is expected that medical universities will incorporate them in their curricula. It is also expected that data will be generated to identify challenges, which shall guide future refinement of the EPAs.
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Affiliation(s)
- Vinay Singh Chauhan
- Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India
| | - Kaushik Chatterjee
- Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India
| | - Jyoti Prakash
- Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India
| | - Yujal Man Singh
- Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India
| | - Ankit Dangi
- Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India
| | - Amresh Dubey
- Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India
| | - Amit Chail
- Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India
| | - Rachit Sharma
- Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India
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Bramley AL, McKenna L. Entrustable professional activities in entry-level health professional education: A scoping review. MEDICAL EDUCATION 2021; 55:1011-1032. [PMID: 33884655 DOI: 10.1111/medu.14539] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/25/2021] [Accepted: 04/01/2021] [Indexed: 06/12/2023]
Abstract
Entrustable professional activities (EPAs) are a recent enhancement to competency-based health professional education that describe the observable work done by a competent health professional. Through defining education outcomes in a work-based context, EPAs offer potential to identify skill gaps in individual or student cohorts and focus improvements. Entrustable professional activities have been pioneered and gained rapid acceptance in postgraduate medical education; however, less is known about their application and use in undergraduate or entry-level health professional education. The Joanna Briggs Institute scoping review methodology was used to explore how and in what context EPAs are being used in entry-level health professional education. Databases searched include CINAHL, EMBASE, MEDLINE, Web of Science and PsycINFO. A total of 748 abstracts were returned after duplicates removed, and 127 full-text articles were screened with 30 included for data extraction. Publications in this area have recently accelerated with disciplines of professions of medicine, pharmacy, dietetics and physician assistants reporting on EPA development, implementation and evaluation. EPA use has been reported in the United States, Canada, Europe Australia and Central America. Major motivation reported for EPA use is to improve patient safety by aligning performance and expectations and to improve student assessment. Several studies report on the use of EPAs to evaluate different curriculum models or identify curriculum gaps representing potential application in education research.
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Affiliation(s)
- Andrea Louise Bramley
- Department of Nutrition and Dietetics, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, Australia
| | - Lisa McKenna
- School of Nursing and Midwifery, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, Australia
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Pinilla S, Cantisani A, Klöppel S, Strik W, Nissen C, Huwendiek S. Introducing a Psychiatry Clerkship Curriculum Based on Entrustable Professional Activities: an Explorative Pilot Study. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2021; 45:354-359. [PMID: 33598804 PMCID: PMC8116264 DOI: 10.1007/s40596-021-01417-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 02/04/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The authors evaluated a reformed psychiatry clerkship curriculum based on entrustable professional activities (EPAs). METHODS The authors conducted an exploratory pilot study of a reformed clerkship curriculum based on EPAs. A novel workplace-based assessment format including an entrustment-supervision scale and curricular adaptations were introduced. The Kirkpatrick model was used to evaluate outcomes of the reformed clerkship curriculum on three levels (1 = acceptance, 2 = learning, 3 = change of behavior). RESULTS The pilot student cohort (n = 10) completed a questionnaire, 180 self-assessments (18 per student) on need for supervision, and 63 workplace-based assessments (6.3 per student, in 4 weeks). Level 1: high overall satisfaction with the clerkship (five-point Likert item: average, 4.9; range: 4.0-5.0). Level 2: the overall significant decrease in self-assessed need for supervision before and after the clerkship was two supervision levels (direct to indirect supervision; p < 0.05). The most frequently documented admissions included schizophrenic disorders (n = 11; 28%), affective disorders (n = 10; 25%), substance abuse disorders (n = 5; 13%), and anxiety and stress-related disorders (n = 5; 13%). Level 3: clinical supervisors used history taking, assessing the mental status, and documentation and presentation for workplace-based assessments. According to supervisors' ratings, there was a decreasing need for supervision from the first to last week of the clerkship. CONCLUSIONS Students reacted positively to the reformed clerkship curriculum. The workplace-based assessments with entrustment ratings appeared to support achievement of competency-based learning objectives. Better understanding of how to cover assessment of all core EPAs in the psychiatry clerkship is needed.
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Affiliation(s)
- Severin Pinilla
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
- Institute for Medical Education, University of Bern, Bern, Switzerland.
| | - Andrea Cantisani
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Stefan Klöppel
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Werner Strik
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Christoph Nissen
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Sören Huwendiek
- Institute for Medical Education, University of Bern, Bern, Switzerland
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Young JQ, Holmboe ES, Frank JR. Competency-Based Assessment in Psychiatric Education: A Systems Approach. Psychiatr Clin North Am 2021; 44:217-235. [PMID: 34049645 DOI: 10.1016/j.psc.2020.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Medical education programs are failing to meet the health needs of patients and communities. Misalignments exist on multiple levels, including content (what trainees learn), pedagogy (how trainees learn), and culture (why trainees learn). To address these challenges effectively, competency-based assessment (CBA) for psychiatric medical education must simultaneously produce life-long learners who can self-regulate their own growth and trustworthy processes that determine and accelerate readiness for independent practice. The key to effectively doing so is situating assessment within a carefully designed system with several, critical, interacting components: workplace-based assessment, ongoing faculty development, learning analytics, longitudinal coaching, and fit-for-purpose clinical competency committees.
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Affiliation(s)
- John Q Young
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell and the Zucker Hillside Hospital at Northwell Health, Glen Oaks, NY, USA.
| | - Eric S Holmboe
- Accreditation Council for Graduate Medical Education, 401 North Michigan Avenue, Chicago, IL 60611, USA
| | - Jason R Frank
- Royal College of Physicians and Surgeons of Canada, 774 Echo Drive, Ottawa, Ontario K15 5NB, Canada; Education, Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Young JQ, Frank JR, Holmboe ES. Advancing Workplace-Based Assessment in Psychiatric Education: Key Design and Implementation Issues. Psychiatr Clin North Am 2021; 44:317-332. [PMID: 34049652 DOI: 10.1016/j.psc.2021.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
With the adoption of competency-based medical education, assessment has shifted from traditional classroom domains of knows and knows how to the workplace domain of doing. This workplace-based assessment has 2 purposes; assessment of learning (summative feedback) and the assessment for learning (formative feedback). What the trainee does becomes the basis for identifying growth edges and determining readiness for advancement and ultimately independent practice. High-quality workplace-based assessment programs require thoughtful choices about the framework of assessment, the tools themselves, the platforms used, and the contexts in which the assessments take place, with an emphasis on direct observation.
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Affiliation(s)
- John Q Young
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell and, Zucker Hillside Hospital at Northwell Health, 75-59 263rd Street, Kaufman Building, Glen Oaks, NY 11004, USA.
| | - Jason R Frank
- Department of Emergency Medicine, University of Ottawa, Royal College of Physicians and Surgeons of Canada, 774 Echo Drive, Ottawa, Ontario K15 5NB, Canada
| | - Eric S Holmboe
- Accreditation Council for Graduate Medical Education, ACGME, 401 North Michigan Avenue, Chicago, IL 60611, USA
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Pinilla S, Kyrou A, Klöppel S, Strik W, Nissen C, Huwendiek S. Workplace-based assessments of entrustable professional activities in a psychiatry core clerkship: an observational study. BMC MEDICAL EDUCATION 2021; 21:223. [PMID: 33882926 PMCID: PMC8059233 DOI: 10.1186/s12909-021-02637-4] [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: 11/17/2020] [Accepted: 03/27/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Entrustable professional activities (EPAs) in competency-based, undergraduate medical education (UME) have led to new formative workplace-based assessments (WBA) using entrustment-supervision scales in clerkships. We conducted an observational, prospective cohort study to explore the usefulness of a WBA designed to assess core EPAs in a psychiatry clerkship. METHODS We analyzed changes in self-entrustment ratings of students and the supervisors' ratings per EPA. Timing and frequencies of learner-initiated WBAs based on a prospective entrustment-supervision scale and resultant narrative feedback were analyzed quantitatively and qualitatively. Predictors for indirect supervision levels were explored via regression analysis, and narrative feedback was coded using thematic content analysis. Students evaluated the WBA after each clerkship rotation. RESULTS EPA 1 ("Take a patient's history"), EPA 2 ("Assess physical & mental status") and EPA 8 ("Document & present a clinical encounter") were most frequently used for learner-initiated WBAs throughout the clerkship rotations in a sample of 83 students. Clinical residents signed off on the majority of the WBAs (71%). EPAs 1, 2, and 8 showed the largest increases in self-entrustment and received most of the indirect supervision level ratings. We found a moderate, positive correlation between self-entrusted supervision levels at the end of the clerkship and the number of documented entrustment-supervision ratings per EPA (p < 0.0001). The number of entrustment ratings explained 6.5% of the variance in the supervisors' ratings for EPA 1. Narrative feedback was documented for 79% (n = 214) of the WBAs. Most narratives addressed the Medical Expert role (77%, n = 208) and used reinforcement (59%, n = 161) as a feedback strategy. Students perceived the feedback as beneficial. CONCLUSIONS Using formative WBAs with an entrustment-supervision scale and prompts for written feedback facilitated targeted, high-quality feedback and effectively supported students' development toward self-entrusted, indirect supervision levels.
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Affiliation(s)
- Severin Pinilla
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
- Department for Assessment and Evaluation, Institute for Medical Education, University of Bern, Bern, Switzerland.
| | - Alexandra Kyrou
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Stefan Klöppel
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Werner Strik
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Christoph Nissen
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Sören Huwendiek
- Department for Assessment and Evaluation, Institute for Medical Education, University of Bern, Bern, Switzerland
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14
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Pinilla S, Matthes O, Gehret A, Huwendiek S, Lenouvel E, Lindert S, Marty AP, Nick B, Nissen C, Schneeberger A, Stocker L, Wallies M, Weidt S, Weiss-Breckwoldt A, Klöppel S. [Entrustable Professional Activities in Graduate Medical Education in Psychiatry: A Promising Concept]. PRAXIS 2021; 110:30-36. [PMID: 33406929 DOI: 10.1024/1661-8157/a003601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Entrustable Professional Activities in Graduate Medical Education in Psychiatry: A Promising Concept Abstract. Entrustable Professional Activities (EPAs) are competency-based learning goals derived from observable clinical activities. In undergraduate medical education, they have now been adopted throughout Switzerland as part of the so-called PROFILES catalog (Principal Relevant Objectives and Framework for Integrated Learning and Education in Switzerland). The nine core EPAs to be mastered in undergraduate medical education can serve as a basis for introducing EPAs in graduate medical education as well. We will discuss this approach in the context of graduate medical education in psychiatry and psychotherapy from the perspective of different training contexts and a pilot example. In this position paper, we describe a promising opportunity to improve graduate medical training through the implementation of EPAs, both in terms of the quality of training and thus of patient care, as well as in terms of the attractiveness of the specialty for future residents.
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Affiliation(s)
- Severin Pinilla
- Universitätsklinik für Alterspsychiatrie und Psychotherapie, Universität Bern
- Institut für Medizinische Lehre (IML), Abteilung für Assessment und Evaluation, Universität Bern
- Geteilte Erstautorenschaft
| | - Oliver Matthes
- Klinik für Konsiliarpsychiatrie und Psychosomatik, Universitätsspital Zürich
- Geteilte Erstautorenschaft
| | | | - Sören Huwendiek
- Institut für Medizinische Lehre (IML), Abteilung für Assessment und Evaluation, Universität Bern
| | - Eric Lenouvel
- Universitätsklinik für Alterspsychiatrie und Psychotherapie, Universität Bern
| | - Susanne Lindert
- Clienia Schlössli, Privatklinik und Lehrkrankenhaus der Universität Zürich, Oetwil am See/Zürich
| | | | - Beat Nick
- Psychiatrische Dienste der Spitäler AG, Solothurn, Psychiatrische Dienste der Spitäler AG Solothurn, Präsident der Prüfungskommission und Mitglied der Kommission Weiter- und Fortbildung (SKWF), Schweizerische Gesellschaft für Psychiatrie und Psychotherapie (SGPP)
- Ressort Qualität der Ständigen Kommission Weiter- und Fortbildung (SKWF), Schweizerische Gesellschaft für Psychiatrie und Psychotherapie (SGPP)
| | - Christoph Nissen
- Universitätsklinik für Psychiatrie und Psychotherapie, Universität Bern
| | | | - Lea Stocker
- Akuttagesklinik, Psychiatrische Universitätsklinik Zürich
| | - Michael Wallies
- Privatklinik für Psychiatrie und Psychotherapie, Clienia Littenheid
| | | | | | - Stefan Klöppel
- Universitätsklinik für Alterspsychiatrie und Psychotherapie, Universität Bern
- Ressort Qualität der Ständigen Kommission Weiter- und Fortbildung (SKWF), Schweizerische Gesellschaft für Psychiatrie und Psychotherapie (SGPP)
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15
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Pagano MB, Treml A, Stephens LD, Joshi S, Li Y, Lopez-Plaza I, Poyyapakkam S, Schwartz J, Tanhehco Y, Zantek ND. Entrustable professional activities for apheresis medicine education. Transfusion 2020; 60:2432-2440. [PMID: 32757215 DOI: 10.1111/trf.15983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/24/2020] [Accepted: 06/24/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Entrustable professional activities (EPAs) are well-defined, executable, observable, and measurable activities that are performed by a trainee and can be performed independently as training progresses. The purpose of this study is to develop EPAs specific for the practice of apheresis medicine (AM). METHODS Members of the American Society for Apheresis Graduate Medical Education subcommittee developed a list of 28 apheresis medical activities linked to Accreditation Council for Graduate Medical Education milestones and competencies in five areas: (a) consultation, (b) clinical care for therapeutic apheresis, (c) clinical care for donor collections, (d) test optimization, and (e) vascular access. Ten AM experts using a validated tool to measure the quality of the EPAs (QUEPA) evaluated these activities with use of a Likert scale. Per group consensus, an activity was considered acceptable for each domain if it had received an average score greater than 3.7, and it was rated 4 or 5 (agree or strongly agree) by at least 70% of experts. RESULTS Of the 28 activities, 11 did not have acceptable QUEPA scores: 7 activities were rated as unobservable, 4 were rated unfocused, 2 were rated unrealistic and not generalizable, and 2 were rated as not addressing multiple competencies. Four activities had unacceptable scores in more than one domain. Subcommittee members edited these 11 activities over two review cycles to produce a final list of 26 activities. CONCLUSION A set of practical, focused, and observable EPAs in AM were systematically developed. These EPAs can be used to assess and support trainee performance in AM.
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Affiliation(s)
- Monica B Pagano
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA
| | - Angela Treml
- Department of Pathology, Versiti WI, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Laura D Stephens
- Department of Pathology, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Sarita Joshi
- Department of Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - Yanhua Li
- Department of Pathology and Laboratory Medicine, New York University School of Medicine, New York, New York, USA
| | - Ileana Lopez-Plaza
- Department of Pathology and Laboratory Medicine, Henry Ford Health System, Detroit, Michigan, USA
| | | | - Joseph Schwartz
- Transfusion Medicine and Cellular Therapy, Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
| | - Yvette Tanhehco
- Transfusion Medicine and Cellular Therapy, Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
| | - Nicole D Zantek
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
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