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Harrison DS, Sigman EJ, Ch'ang JH, Sarwal A, Celotto A, Malone A, Nowicki A, Martin A, Boling B, Nobleza COS, Reeves C, Greer DM, McLaughlin D, Woods EO, Fields E, Perets E, Jannotta GE, Mears J, Twomey K, Rath KA, Peronti K, Garner KM, Bevers MB, Morris NA, Martinez P, Zafar S, Livesay S, Wahlster S, Lawson T, Albin CSW. A Modified Delphi Consensus Approach to Define Entrustable Professional Activities for Neurocritical Care Advanced Practice Providers. Crit Care Med 2024; 52:1032-1042. [PMID: 38488423 DOI: 10.1097/ccm.0000000000006260] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
OBJECTIVES To define consensus entrustable professional activities (EPAs) for neurocritical care (NCC) advanced practice providers (APPs), establish validity evidence for the EPAs, and evaluate factors that inform entrustment expectations of NCC APP supervisors. DESIGN A three-round modified Delphi consensus process followed by application of the EQual rubric and assessment of generalizability by clinicians not affiliated with academic medical centers. SETTING Electronic surveys. SUBJECTS NCC APPs ( n = 18) and physicians ( n = 12) in the United States with experience in education scholarship or APP program leadership. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The steering committee generated an initial list of 61 possible EPAs. The panel proposed 30 additional EPAs. A total of 47 unique nested EPAs were retained by consensus opinion. The steering committee defined six core EPAs addressing medical knowledge, procedural competencies, and communication proficiency which encompassed the nested EPAs. All core EPAs were retained and subsequently met the previously described cut score for quality and structure using the EQual rubric. Most clinicians who were not affiliated with academic medical centers rated each of the six core EPAs as very important or mandatory. Entrustment expectations did not vary by prespecified groups. CONCLUSIONS Expert consensus was used to create EPAs for NCC APPs that reached a predefined quality standard and were important to most clinicians in different practice settings. We did not identify variables that significantly predicted entrustment expectations. These EPAs may aid in curricular design for an EPA-based assessment of new NCC APPs and may inform the development of EPAs for APPs in other critical care subspecialties.
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Affiliation(s)
- Daniel S Harrison
- Department of Neurology, Brigham and Women's Hospital, Boston, MA
- Department of Neurology, Harvard Medical School, Boston, MA
- Department of Neurology, Massachusetts General Hospital, Boston, MA
- Departments of Neurology and Neurosurgery, Emory University SOM, Atlanta, GA
- Department of Neurology, Weill Cornell Medicine, New York. NY
- Department of Neurology, Atrium Wake Forest School of Medicine, Winston-Salem. NC
- Department of Neurology, University of Maryland Medical System, Baltimore, MD
- Department of Anesthesiology, University of Kentucky, Lexington, KY
- Department of Neurology, Emory University Hospital, Atlanta, GA
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN
- Department of Neurology, Baptist Memorial Hospital, Memphis, TN
- Department of Nursing, Boston Children's Hospital, Boston, MA
- Department of Neurology, Boston Medical Center, Boston, MA
- Department of Neurology, Boston University Chobanian and Avedisian SOM, Boston, MA
- Department of Neurosurgery, Lyerly Neurosurgery, Jacksonville, FL
- Department of Neurology, University of Oklahoma Health, Oklahoma City, OK
- Department of Neurology, Grady Memorial Hospital, Atlanta, GA
- Department of Neurology, Harborview Medical Center, Seattle, WA
- Department of Neurology & Rehabilitation Medicine, University of Cincinnati COM, Cincinnati, OH
- Department of Neurology, University of Maryland SOM, Baltimore, MD
- Department of Neurosurgery, University of Texas Health San Antonio, San Antonio, TX
- Department of Nursing, Rush University College of Nursing, Chicago, IL
- Department of Neurology, University of Washington, Seattle, WA
- Department of Neurology, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH
| | - Erika J Sigman
- Departments of Neurology and Neurosurgery, Emory University SOM, Atlanta, GA
| | - Judy H Ch'ang
- Department of Neurology, Weill Cornell Medicine, New York. NY
| | - Aarti Sarwal
- Department of Neurology, Atrium Wake Forest School of Medicine, Winston-Salem. NC
| | - Abigale Celotto
- Department of Neurology, University of Maryland Medical System, Baltimore, MD
| | - Alexandra Malone
- Department of Anesthesiology, University of Kentucky, Lexington, KY
| | - Ariel Nowicki
- Department of Neurology, Brigham and Women's Hospital, Boston, MA
| | - Ashley Martin
- Department of Neurology, Emory University Hospital, Atlanta, GA
| | - Bryan Boling
- Department of Anesthesiology, University of Kentucky, Lexington, KY
| | - Christa O'Hana S Nobleza
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN
- Department of Neurology, Baptist Memorial Hospital, Memphis, TN
| | | | - David M Greer
- Department of Neurology, Boston Medical Center, Boston, MA
- Department of Neurology, Boston University Chobanian and Avedisian SOM, Boston, MA
| | - Diane McLaughlin
- Department of Neurosurgery, Lyerly Neurosurgery, Jacksonville, FL
| | | | - Emmaculate Fields
- Department of Neurology, University of Oklahoma Health, Oklahoma City, OK
| | - Erica Perets
- Department of Neurology, Grady Memorial Hospital, Atlanta, GA
| | - Gemi E Jannotta
- Department of Neurology, Harborview Medical Center, Seattle, WA
| | - Jennifer Mears
- Department of Neurology, Weill Cornell Medicine, New York. NY
| | - Kaitlyn Twomey
- Department of Neurology, Weill Cornell Medicine, New York. NY
| | - Kelly A Rath
- Department of Neurology & Rehabilitation Medicine, University of Cincinnati COM, Cincinnati, OH
| | - Kelly Peronti
- Department of Neurology, Grady Memorial Hospital, Atlanta, GA
| | - Krista M Garner
- Department of Neurology, Emory University Hospital, Atlanta, GA
| | - Matthew B Bevers
- Department of Neurology, Brigham and Women's Hospital, Boston, MA
- Department of Neurology, Harvard Medical School, Boston, MA
| | | | - Paola Martinez
- Department of Neurosurgery, University of Texas Health San Antonio, San Antonio, TX
| | - Sahar Zafar
- Department of Neurology, Harvard Medical School, Boston, MA
- Department of Neurology, Massachusetts General Hospital, Boston, MA
| | - Sarah Livesay
- Department of Neurology, Harborview Medical Center, Seattle, WA
- Department of Nursing, Rush University College of Nursing, Chicago, IL
| | - Sarah Wahlster
- Department of Neurology, Harborview Medical Center, Seattle, WA
- Department of Neurology, University of Washington, Seattle, WA
| | - Thomas Lawson
- Department of Neurology, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH
| | - Catherine S W Albin
- Departments of Neurology and Neurosurgery, Emory University SOM, Atlanta, GA
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Tu CY, Huang KM, Cheng CH, Lin WJ, Liu CH, Yang CW. Development, implementation, and evaluation of entrustable professional activities (EPAs) for medical radiation technologists in Taiwan: a nationwide experience. BMC MEDICAL EDUCATION 2024; 24:95. [PMID: 38287396 PMCID: PMC10826224 DOI: 10.1186/s12909-024-05088-9] [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: 08/26/2023] [Accepted: 01/23/2024] [Indexed: 01/31/2024]
Abstract
BACKGROUND Competency-based medical education (CBME) is an outcomes-oriented approach focused on developing competencies that translate into clinical practice. Entrustable professional activities (EPAs) bridge competency assessment and clinical performance by delineating essential day-to-day activities that can be entrusted to trainees. EPAs have been widely adopted internationally, but not yet implemented for medical radiation professionals in Taiwan. MATERIALS AND METHODS A nationwide consensus process engaged 97 experts in radiation technology education representing diagnostic radiography, radiation therapy, and nuclear medicine. Preliminary EPAs were developed through the focus group discussion and the modified Delphi method. The validity of these EPAs was evaluated using the QUEPA and EQual tools. RESULTS Through iterative consensus building, six core EPAs with 18 component observable practice activities (OPAs) in total were developed, encompassing routines specific to each radiation technology specialty. QUEPA and EQual questionnaire data verified these EPAs were valid, and of high quality for clinical teaching and evaluation. CONCLUSION The consensus development of tailored EPAs enables rigorous competency assessment during medical radiation technology education in Taiwan. Further expansion of EPAs and training of clinical staff could potentially enhance care quality by producing competent professionals.
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Affiliation(s)
- Chun-Yuan Tu
- Taiwan Association of Medical Radiation Technologists, Taipei, Taiwan
- Department of Medical Imaging and Radiological Sciences, I-Shou University, Kaohsiung, Taiwan
| | - Kuo-Ming Huang
- Taiwan Association of Medical Radiation Technologists, Taipei, Taiwan
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ching-Hsueh Cheng
- Taiwan Association of Medical Radiation Technologists, Taipei, Taiwan
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Jou Lin
- Taiwan Association of Medical Radiation Technologists, Taipei, Taiwan
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Cheng-Heng Liu
- Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department and Graduate Institute of Medical Education and Bioethics, College of Medicine, National Taiwan University, No. 1, Sec. 1, Ren'ai Rd., Zhongzheng Dist., Taipei, 100, Taiwan
| | - Chih-Wei Yang
- Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan.
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
- Department and Graduate Institute of Medical Education and Bioethics, College of Medicine, National Taiwan University, No. 1, Sec. 1, Ren'ai Rd., Zhongzheng Dist., Taipei, 100, Taiwan.
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