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Schumacher DJ, Michelson C, Winn AS, Turner DA, Martini A, Kinnear B. A realist synthesis of prospective entrustment decision making by entrustment or clinical competency committees. MEDICAL EDUCATION 2024; 58:812-824. [PMID: 38088227 DOI: 10.1111/medu.15296] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 11/03/2023] [Accepted: 11/21/2023] [Indexed: 06/04/2024]
Abstract
INTRODUCTION The real-world mechanisms underlying prospective entrustment decision making (PEDM) by entrustment or clinical competency committees (E/CCCs) are poorly understood. To advance understanding in this area, the authors conducted a realist synthesis of the published literature to address the following research question: In E/CCC efforts to make defensible prospective entrustment decisions (PEDs), what works, for whom, under what circumstances and why? METHODS Realist work seeks to understand the contexts (C), mechanisms (M) and outcomes (O) that explain how and why things work (or do not). In the authors' study, contexts included individual E/CCC members, E/CCC structures and processes, and training programmes. The outcome (i.e. desired outcome) was a PED. Mechanisms were a substantial focus of the analysis and informed the core findings. To define a final corpus of 52 included papers, the authors searched four databases, screened all results from those searches and performed a full-text review of a subset of screened papers. Data extraction focused on developing context-mechanism-outcome configurations from the papers, which were used to create a theory for how PEDM leads to PEDs. RESULTS PEDM is often driven by default (non-deliberate) decision making rather than a deliberate process of deciding whether a trainee should be entrusted or not. When defaulting, some E/CCCs find red flags that sometimes lead to being more deliberate with decision making. E/CCCs that seek to be deliberate describe PEDM that can be effortful (when data are insufficient or incongruent) or effortless (when data are robust and tell a congruent story about a trainee). Both information about trainee trustworthiness and the sufficiency of data about trainee performance influence PEDM. Several moderators influence what is considered to be sufficient data, how trustworthiness data are viewed and how PEDM is carried out. These include perceived consequences and associated risks, E/CCC member trust propensity, E/CCC member personal knowledge of and experience with trainees and E/CCC structures and processes. DISCUSSION PEDM is rarely deliberate but should be. Data about trainee trustworthiness are foundational to making PEDs. Bias, equity and fairness are nearly absent from the papers in this synthesis, and future efforts must seek to advance understanding and practice regarding the roles of bias, equity and fairness in PEDM.
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Affiliation(s)
- Daniel J Schumacher
- Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Catherine Michelson
- Ann and Robert H. Lurie Children's Hospital of Chicago/Northwestern University, Chicago, Illinois, USA
| | - Ariel S Winn
- Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - David A Turner
- American Board of Pediatrics, Chapel Hill, North Carolina, USA
| | - Abigail Martini
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Benjamin Kinnear
- Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Ramaswamy V, Danciu T, Kennedy EN, Romito L, Stewart D, Gul G, Marucha P, Quinonez RB. American Dental Education Association Compendium Entrustable Professional Activities Workgroup report. J Dent Educ 2024; 88:639-653. [PMID: 38693898 DOI: 10.1002/jdd.13542] [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: 03/27/2024] [Accepted: 03/27/2024] [Indexed: 05/03/2024]
Abstract
PURPOSE Entrustable professional activities (EPAs) are discrete clinical tasks that can be evaluated to help define readiness for independent practice in the health professions and are intended to increase trust in the dental graduate. EPAs provide a framework that bridges competencies to clinical practice. This report describes the work of the American Dental Education Association (ADEA) Compendium EPA Workgroup to develop a list of EPAs for dental education and supportive resources, including specifications and a glossary. METHODS Preliminary work including literature and resource review, mapping of existing competencies, and review of other health professions' EPAs informed the development of our EPAs list. Workgroup members achieved consensus using a modified Delphi process. A Qualtrics survey using a validated rubric for the assessment of EPAs as described in peer-reviewed literature was used. Dental educators, including academic deans, were surveyed for feedback on the content and format of the EPAs. RESULTS Based on findings in the literature analysis of existing EPAs and competencies in health professions, a list of EPAs was developed along with a description of specifications. The EPA workgroup (nine members from multiple institutions) used the Delphi process in receiving feedback from various experts. A list of 11 core EPAs was vetted by dental educators including academic deans (n = ∼23), and the process of development was reviewed by EPAs experts outside dental education. A glossary was developed to align language. CONCLUSION These EPAs define the scope of dental practice. This report represents Phase 1 of the EPA framework development and vetting process. Future directions will include a broader vetting of the EPA list, faculty development, and national standardized technology that support this work to optimize implementation.
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Affiliation(s)
- Vidya Ramaswamy
- Director for Curriculum Evaluation and Promotion of Teaching and Learning at the University of Michigan, School of Dentistry, Ann Arbor, Michigan, USA
| | - Theodora Danciu
- Clinical Professor and Director of Engaged Learning and Assessment at the University of Michigan, School of Dentistry, Ann Arbor, Michigan, USA
| | - Erinne N Kennedy
- Assistant Professor and Assistant Dean for Curriculum and Integrated Learning at Kansas City University College of Dental Medicine, Joplin, Missouri, USA
| | - Laura Romito
- Professor and Associate Dean of Education and Academic Affairs at the Indiana University School of Dentistry, Indianapolis, Indiana, USA
| | - Denice Stewart
- Adjunct Professor at the University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, North Carolina, USA
| | - Gulsun Gul
- Chief of Innovation, Clinical Education & Public Health at the American Dental Education Association, Washington, District of Columbia, USA
| | - Phillip Marucha
- Co-Chair, ADEA EPA group; Professor, Oregon Health & Science University School of Dentistry, Portland, Oregon, USA
| | - Rocio B Quinonez
- Co-Chair, ADEA EPA group; Professor and Associate Dean for Curriculum, University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, North Carolina, USA
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Baker MJ, Maggio LA, Dorris CS, Uijtdehaage S, Soh M. Clinical supervision in medical education: A citation analysis. MEDICAL TEACHER 2024; 46:505-511. [PMID: 37949084 DOI: 10.1080/0142159x.2023.2257375] [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: 11/12/2023]
Abstract
PURPOSE Medical education relies on clinical supervision for critical functions, including trainee assessment and ensuring patient safety. Yet, there is substantial variance in supervision, which has led to calls for a shared definition of the concept and guidelines to inform practice. AMEE Guide No. 27 provided these desired elements and is highly cited, suggesting that translation and utilization of the Guide's knowledge is suboptimal. This study investigates utilization by systematically characterizing citations to the Guide and by describing translation of its recommendations in relation to supervision. MATERIALS AND METHODS Citations were identified using Web of Science, Scopus, and Google Scholar. The authors coded all citations and conducted a subanalysis of studies specific to supervision. RESULTS 583 studies were identified; 268 met inclusion criteria for general analysis of which 167 studies were further analyzed. Most studies reiterated the Guide's characterization of effective supervision, but few demonstrate how these recommendations inform innovations in supervisory practice. CONCLUSION Translation of the Guide's recommendations regarding clinical supervision appears limited. Future research should consider the extent of knowledge translation occurring in clinical supervision literature as well as AMEE Guides. Increased attention to knowledge translation in medical education may benefit the distribution of similar knowledge products.
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Affiliation(s)
- M J Baker
- Center for Health Professions Education, Uniformed Services University, Bethesda, MD, USA
- Department of Psychiatry, Wright State University, Boonshoft School of Medicine, Dayton, OH, USA
| | - L A Maggio
- Center for Health Professions Education, Uniformed Services University, Bethesda, MD, USA
| | - C S Dorris
- Dahlgren Memorial Library, Georgetown University Medical Center, Washington, DC, USA
| | - S Uijtdehaage
- Center for Health Professions Education, Uniformed Services University, Bethesda, MD, USA
| | - M Soh
- Center for Health Professions Education, Uniformed Services University, Bethesda, MD, USA
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Shim S, Kim H, Lee YM. Scoping review: exploring residents' views of supervisor entrustment and its effect on learning and professional development. KOREAN JOURNAL OF MEDICAL EDUCATION 2024; 36:81-98. [PMID: 38462244 PMCID: PMC10925806 DOI: 10.3946/kjme.2024.286] [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: 10/10/2023] [Revised: 11/21/2023] [Accepted: 11/27/2023] [Indexed: 03/12/2024]
Abstract
This scoping review aimed to systematically explore the complex and nuanced perceptions of residents entrusted with significant responsibilities by their supervisors in the clinical context. We conducted a comprehensive search strategy targeting six major electronic databases. Data were extracted using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist and a scoping review protocol. Resident perceptions regarding entrustment and its impact on learning and professional development were categorized. This review elucidated the role of supervisor entrustment in shaping residents' clinical performance, notably influencing autonomy, self-confidence, responsibility for patients, learning needs and goals, uncertainty management, and professional identity formation. Residents identified factors that promote and hinder performance and entrustment development resulting from supervisor entrustment and distinguished between appropriate supervision and over- or under-supervision. Our review suggests that residents' perceptions of supervisor entrustment, as bestowed by supervisors, serves as a catalyst for enhancing autonomy, thereby exerting a significant influence on clinical performance, and fostering the development of a professional identity. However, residents' views on appropriate supervision differ in some ways from supervisors' perspectives. Further research is needed to bridge the gap between residents' expectations of autonomy and what they are given, and to explore the intricate relationship between autonomy and entrustment.
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Affiliation(s)
- Sunhee Shim
- Department of Medical Education, Korea University College of Medicine, Seoul, Korea
| | | | - Young-Mee Lee
- Department of Medical Education, Korea University College of Medicine, Seoul, Korea
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Sigurdsson V, Ten Cate O. Do summative entrustment decisions actually lead to entrustment? CLINICAL TEACHER 2024; 21:e13668. [PMID: 37817015 DOI: 10.1111/tct.13668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 09/05/2023] [Indexed: 10/12/2023]
Abstract
BACKGROUND Entrustable professional activities (EPAs) were introduced across Dutch postgraduate programmes between 2017 and 2019. We aimed to understand the extent to which residents actually were granted increased clinical responsibility upon receiving summative entrustment for an EPA, a critical feature of its use. METHODS A survey study was conducted among all Dutch residents who started dermatology training in 2018 and 2019 and all Dutch dermatology programme directors (PDs). We chose an EPA designed for early entrustment in residency (identification, treatment and care regarding a simple dermatological problem in the ambulatory setting). The survey contained two hypothetical clinical cases that aligned with this EPA. The questions were aimed to determine whether and when residents should request supervision. Similar questions were posed to PDs. FINDINGS Twenty four residents (56%) and 19 PDs (79%) completed the survey. The majority of the residents (65%) and PDs (63%) confirmed that competent dermatology residents (level 4) are generally allowed to perform EPA1 unsupervised, particularly when seeing patients from GPs. However, still a substantial proportion of the level 4 residents, working in University Medical Centers (36%) indicated that they had to request supervision in the assessment of these patients. For 2nd opinions, the results were typically the opposite. DISCUSSION AND CONCLUSION This study demonstrated that, at least in one specialty and one country, the introduction of EPAs and entrustment decision making procedure generally led to the intended autonomy of the resident.
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Affiliation(s)
- Vigfús Sigurdsson
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Olle Ten Cate
- Utrecht Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands
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Gilchrist PT, Beaton NSM, Atkin JN, Roberts LJ. The new Diploma of Rural Generalist Anaesthesia: Supporting Australian rural and remote communities. Anaesth Intensive Care 2024; 52:6-15. [PMID: 38006613 DOI: 10.1177/0310057x231196909] [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] [Indexed: 11/27/2023]
Abstract
In 2023, a Diploma of Rural Generalist Anaesthesia (DipRGA) was implemented across Australia. Developed collaboratively by the Australian and New Zealand College of Anaesthetists (ANZCA), the Australian College of Rural and Remote Medicine (ACRRM) and the Royal Australian College of General Practitioners (RACGP), the 12-month qualification is completed during or following ACRRM or RACGP Rural Generalist Fellowship training. Focused on the needs of rural and remote communities for elective and emergency surgery, maternity care, resuscitative care for medical illness or injury, and stabilisation for retrieval, the DipRGA supports rural generalist anaesthetists working within collaborative teams in geographically isolated settings. The goal is a graduate who can anaesthetise American Society of Anesthesiologists physical status class 1, 2 and stable 3 patients for elective surgery, provide obstetric anaesthesia and analgesia, anaesthetise paediatric patients and undertake advanced crisis care within their scope of practice. Crucially, they also recognise both limitations of their skills and local resources available when considering whether to provide care, defer, refer or transfer patients. DipRGA curriculum design commenced by adapting the ANZCA specialist training curriculum with consideration of the training approach of both the ACRRM and the RACGP, particularly the rural and remote context. Curriculum content is addressed in seven entrustable professional activities supported by workplace-based assessments and multisource feedback. Trainees are supervised by rural generalist anaesthetists and specialist anaesthetists, and complete flexible learning activities to accommodate geographical dispersion. Standardised summative assessments include an early test of knowledge and an examination, adapted from the ACRRM structured assessment using multiple patient scenarios.
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Affiliation(s)
- Peter T Gilchrist
- Flinders and Upper North Local Health Network, Whyalla, Australia
- Rural Generalist Program, South Australia Health, Adelaide, Australia
- Royal Australian College of General Practitioners, East Melbourne, Australia
- Rural Clinical School, The University of Adelaide, Adelaide, Australia
| | - Neil St M Beaton
- Australian College of Rural and Remote Medicine, Brisbane, Australia
- James Cook University College of Medicine and Dentistry, Townsville, Australia
| | | | - Lindy J Roberts
- Australian and New Zealand College of Anaesthetists, Melbourne, Australia
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Tavares W, Kinnear B, Schumacher DJ, Forte M. "Rater training" re-imagined for work-based assessment in medical education. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:1697-1709. [PMID: 37140661 DOI: 10.1007/s10459-023-10237-8] [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: 01/13/2023] [Accepted: 04/30/2023] [Indexed: 05/05/2023]
Abstract
In this perspective, the authors critically examine "rater training" as it has been conceptualized and used in medical education. By "rater training," they mean the educational events intended to improve rater performance and contributions during assessment events. Historically, rater training programs have focused on modifying faculty behaviours to achieve psychometric ideals (e.g., reliability, inter-rater reliability, accuracy). The authors argue these ideals may now be poorly aligned with contemporary research informing work-based assessment, introducing a compatibility threat, with no clear direction on how to proceed. To address this issue, the authors provide a brief historical review of "rater training" and provide an analysis of the literature examining the effectiveness of rater training programs. They focus mainly on what has served to define effectiveness or improvements. They then draw on philosophical and conceptual shifts in assessment to demonstrate why the function, effectiveness aims, and structure of rater training requires reimagining. These include shifting competencies for assessors, viewing assessment as a complex cognitive task enacted in a social context, evolving views on biases, and reprioritizing which validity evidence should be most sought in medical education. The authors aim to advance the discussion on rater training by challenging implicit incompatibility issues and stimulating ways to overcome them. They propose that "rater training" (a moniker they suggest be reserved for strong psychometric aims) be augmented with "assessor readiness" programs that link to contemporary assessment science and enact the principle of compatibility between that science and ways of engaging with advances in real-world faculty-learner contexts.
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Affiliation(s)
- Walter Tavares
- Department of Health and Society, Wilson Centre, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Benjamin Kinnear
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Daniel J Schumacher
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Milena Forte
- Department of Family and Community Medicine, Temerty Faculty of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
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Poeppelman RS, Moore-Clingenpeel M, Siems A, Mitchell DL, Jani P, Stewart C. Faculty Decision Making in Ad Hoc Entrustment of Pediatric Critical Care Fellows: A National Case-Based Survey. TEACHING AND LEARNING IN MEDICINE 2023:1-8. [PMID: 37933862 DOI: 10.1080/10401334.2023.2269402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 10/02/2023] [Indexed: 11/08/2023]
Abstract
Phenomenon: Ad hoc entrustment decisions reflect a clinical supervisor's estimation of the amount of supervision a trainee needs to successfully complete a task in the moment. These decisions have important consequences for patient safety, trainee learning, and preparation for independent practice. Determinants of these decisions have previously been described but have not been well described for acute care contexts such as critical care and emergency medicine. The ad hoc entrustment of trainees caring for vulnerable patient populations is a high-stakes decision that may differ from other contexts. Critically ill patients and children are vulnerable patient populations, making the ad hoc entrustment of a pediatric critical care medicine (PCCM) fellow a particularly high-stakes decision. This study sought to characterize how ad hoc entrustment decisions are made for PCCM fellows through faculty ratings of vignettes. The authors investigated how acuity, relationship, training level, and task interact to influence ad hoc entrustment decisions. Approach: A survey containing 16 vignettes that varied by four traits (acuity, relationship, training level, and task) was distributed to U.S. faculty of pediatric critical care fellowships in 2020. Respondents determined an entrustment level for each case and provided demographic data. Entrustment ratings were dichotomized by "high entrustment" versus "low entrustment" (direct supervision or observation only). The authors used logistic regression to evaluate the individual and interactive effects of the four traits on dichotomized entrustment ratings. Findings: One hundred seventy-eight respondents from 30 institutions completed the survey (44% institutional response rate). Acuity, relationship, and task all significantly influenced the entrustment level selected but did not interact. Faculty most frequently selected "direct supervision" as the entrustment level for vignettes, including for 24% of vignettes describing fellows in their final year of training. Faculty rated the majority of vignettes (61%) as "low entrustment." There was no relationship between faculty or institutional demographics and the entrustment level selected. Insights: As has been found in summative entrustment for pediatrics, internal medicine, and surgery trainees, PCCM fellows often rated at or below the "direct supervision" level of ad hoc entrustment. This may relate to declining opportunities to practice procedures, a culture of low trust propensity among the specialty, and/or variation in interpretation of entrustment scales.
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Affiliation(s)
- Rachel Stork Poeppelman
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA
| | - Melissa Moore-Clingenpeel
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA
| | - Ashley Siems
- Department of Pediatrics, Children's National, Washington, DC, USA
| | - Diana L Mitchell
- Department of Pediatrics, Advocate Children's Hospital Park Ridge, Park Ridge, Illinois, USA
- Department of Pediatrics, University of Chicago, Chicago, Illinois, USA
| | - Priti Jani
- Department of Pediatrics, University of Chicago, Chicago, Illinois, USA
| | - Claire Stewart
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA
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Nelson K, McQuillan S, Gingerich A, Regehr G. Residents as supervisors: How senior residents make ad hoc entrustment decisions. MEDICAL EDUCATION 2023; 57:723-731. [PMID: 36606657 DOI: 10.1111/medu.15017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 12/29/2022] [Accepted: 01/04/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND As residency programmes transition to competency-based medical education, there has been substantial inquiry into understanding how ad hoc entrustment decisions are made by attending supervisors in the clinical context. However, although attendings are ultimately responsible for the decisions and actions of resident trainees, senior residents are often the ones directly supervising junior residents enrolled in competency-based training programmes. This clinical dynamic has been largely overlooked in the ad hoc entrustment literature. The purpose of this study was to explore the considerations senior residents entertain when making ad hoc entrustment decisions for their junior resident colleagues. METHODS In semi-structured interviews, 11 senior resident supervisors (third, fourth and fifth year) in obstetrics and gynaecology described how they entrust junior residents with clinical activities in the moment. Following constructivist grounded theory methodology, data were iteratively collected and coded with constant comparison until theoretical sufficiency was determined. RESULTS Senior residents described many similar considerations as attendings regarding ad hoc entrustment of junior residents, including patient safety, desire to optimise the learning environment, junior resident qualities (such as discernment and communication skills), learner handover from colleagues, and situational factors. Uniquely, senior residents discussed how their role as a middle manager and their desire to protect the junior resident (from burnout, becoming a second victim and from attendings) impacts their decisions. CONCLUSIONS Although senior residents make ad hoc entrustment decisions with some similar considerations to attendings, they also seem to think about additional factors. It may be that these different considerations need to be accommodated in documentation of ad hoc entrustment decisions if these documents are to be used for high-stakes summative entrustment decisions made by competency committees.
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Affiliation(s)
- Kayla Nelson
- Obstetrics and Gynecology, Pediatric and Adolescent Gynecology, University of Calgary, Calgary, Alberta, Canada
| | - Sarah McQuillan
- Obstetrics and Gynecology, Pediatric and Adolescent Gynecology, University of Calgary, Calgary, Alberta, Canada
| | - Andrea Gingerich
- Northern Medical Program, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Glenn Regehr
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Matava CT, Alam F, Kealey A, Bahrey LA, McCreath GA, Walsh CM. The influence of resident and faculty gender on assessments in anesthesia competency-based medical education. Can J Anaesth 2023; 70:978-987. [PMID: 37165126 PMCID: PMC10171726 DOI: 10.1007/s12630-023-02454-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 11/15/2022] [Accepted: 11/17/2022] [Indexed: 05/12/2023] Open
Abstract
PURPOSE Competency-based medical education (CBME) relies on frequent workplace-based assessments of trainees, providing opportunities for conscious and implicit biases to reflect in these assessments. We aimed to examine the influence of resident and faculty gender on performance ratings of residents within a CBME system. METHODS This retrospective cohort study took place from August 2017 to January 2021 using resident assessment data from two workplace-based assessments: the Anesthesia Clinical Encounter Assessment (ACEA) and Entrustable Professional Activities (EPAs). Self-reported gender data were also extracted. The primary outcome-gender-based differences in entrustment ratings of residents on the ACEA and EPAs-was evaluated using mixed-effects logistic regression, with differences reported through odds ratios and confidence intervals (α = 0.01). Gender-based differences in the receipt of free-text comments on the ACEA and EPAs were also explored. RESULTS In total, 14,376 ACEA and 4,467 EPA assessments were analyzed. There were no significant differences in entrustment ratings on either assessment tool between men and women residents. Regardless of whether assessments were completed by men or women faculty, entrustment rates between men and women residents were not significantly different for any postgraduate year level. Additionally, men and women residents received strengths-related and actions-related comments on both assessments at comparable frequencies, irrespective of faculty gender. CONCLUSION We found no gender-based differences in entrustment ratings for both the ACEA and EPAs, which suggests an absence of resident gender bias within this CBME system. Given considerable heterogeneity in rater leniency, future work would be strengthened by using rater leniency-adjusted scores rather than raw scores.
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Affiliation(s)
- Clyde T Matava
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada.
- Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- SickKids Research Institute, The Hospital for Sick Children, Toronto, ON, Canada.
| | - Fahad Alam
- Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Alayne Kealey
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada
- Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Lisa A Bahrey
- Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia, University Health Network-Toronto General Hospital, Toronto, ON, Canada
| | - Graham A McCreath
- SickKids Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Catharine M Walsh
- SickKids Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- The Wilson Centre, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Bremer AE, van de Pol MHJ, Laan RFJM, Fluit CRMG. An Innovative Undergraduate Medical Curriculum Using Entrustable Professional Activities. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2023; 10:23821205231164894. [PMID: 37123076 PMCID: PMC10134152 DOI: 10.1177/23821205231164894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 03/02/2023] [Indexed: 05/03/2023]
Abstract
The need to educate medical professionals in changing medical organizations has led to a revision of the Radboudumc's undergraduate medical curriculum. Entrustable professional activities (EPAs) were used as a learning tool to support participation and encourage feedback-seeking behavior, in order to offer students the best opportunities for growth. This paper describes the development of the Radboudumc's EPA-based Master's curriculum and how EPAs can facilitate continuity in learning in the clerkships. Four guiding principles were used to create a curriculum that offers possibilities for the students' development: (1) working with EPAs, (2) establishing entrustment, (3) providing continuity in learning, and (4) organizing smooth transitions. The new curriculum was designed with the implementation of EPAs and an e-portfolio, based on these 4 principles. The authors found that the revised curriculum corresponds to daily practice in clerkships. Students used their e-portfolios throughout all clerkships, which stimulates feedback-seeking behavior. Moreover, EPAs promote continuity in learning while rotating clerkships every 1 to 2 months. This might encourage curriculum developers to use EPAs when aiming for greater continuity in the development of students. Future research needs to focus on the effect of EPAs on transitions across clerkships in order to further improve the undergraduate medical curriculum.
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Affiliation(s)
- Anne E Bremer
- Radboud Institute for Health Sciences,
Department of Radboudumc Health Academy, Radboud University Medical Center, Nijmegen, the Netherlands
- Anne E Bremer, Radboudumc Health Academy,
Postbus 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Marjolein H J van de Pol
- Department of Primary and Community
Care, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Roland F J M Laan
- Department of Radboudumc Health Academy, Radboud University Medical Center, Nijmegen, the
Netherlands
| | - Cornelia R M G Fluit
- Department of Radboudumc Health Academy, Radboud University Medical Center, Nijmegen, the
Netherlands
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Schumacher DJ, Michelson C, Winn AS, Turner DA, Elshoff E, Kinnear B. Making prospective entrustment decisions: Knowing limits, seeking help and defaulting. MEDICAL EDUCATION 2022; 56:892-900. [PMID: 35263474 DOI: 10.1111/medu.14797] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 02/28/2022] [Accepted: 03/02/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Many studies focused on entrustment have not considered prospective entrustment decisions, where clinical competency and entrustment committees determine how much supervision trainees will require in the future for tasks occurring in not completely known contexts. The authors sought to explore factors that influence and determine prospective entrustment decisions made by members of such committees in graduate medical education (GME) and undergraduate medical education (UME). METHODS The authors conducted a constructivist grounded theory study with 23 faculty participants from GME and UME clinical competency and entrustment committees in the United States between October 2020 and March 2021. Interviews sought to explore factors and considerations participants weigh in making prospective entrustment decisions about trainees. Data collection and analysis occurred in an iterative fashion, ensuring constant comparison. Theoretical sampling was used to confirm, disconfirm and elaborate on the evolving results. RESULTS Trainees' ability to know limits and seek help is the foundation of participants' prospective entrustment decision making. Most participants, however, describe a presumption of trainee readiness to progress and describe commonly making default prospective entrustment decisions unless 'red flags' in performance are present. Although participants desire sufficient and trusted data about trainee performance to inform decisions, they often lack it. Finally, the perceived permanence and consequences of prospective entrustment decisions influence how participants weigh other factors contributing to prospective entrustment decisions. CONCLUSION Trainees' ability to know limits and seek help appears to be the foundation of prospective entrustment decision making. Training programmes should strive to collect and employ robust data supporting and questioning the presence of these attributes.
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Affiliation(s)
- Daniel J Schumacher
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Catherine Michelson
- Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Ariel S Winn
- Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - David A Turner
- American Board of Pediatrics, Chapel Hill, North Carolina, USA
| | | | - Benjamin Kinnear
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Ten Cate O, Schumacher DJ. Entrustable professional activities versus competencies and skills: Exploring why different concepts are often conflated. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022; 27:491-499. [PMID: 35226240 PMCID: PMC9117349 DOI: 10.1007/s10459-022-10098-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 01/23/2022] [Indexed: 05/25/2023]
Abstract
Despite explanations in the literature, a returning question in the use of entrustable professional activities (EPAs) is how to distinguish them from competencies and skills. In this article, we attempt to analyze the causes of the frequent confusion and conflation of EPAs with competencies and skills, and argue why the distinction is important for education, qualification and patient safety. 'Tracheotomy', 'lumbar puncture', 'interprofessional collaboration' for example are colloquially called 'skills', but its is a person's ability to perform these activities that is the actual skill; the EPA is simply the activity itself. We identify two possible causes for the confusion. One is a tendency to frame all educational objectives as EPAs. Many objectives of medical training can be conceptualized as EPAs, if 'the ability to do X' is the corresponding competency; but that does not work for all. We offer ways to deal with objectives of training that are not usefully conceptualized as EPAs. A more fundamental cause relates to entrustment decisions. The permission to contribute to health care reflects entrustment. Entrustment decisions are the links or pivots between a person's readiness for the task and the actual task execution. However, if entrustment decisions do not lead to increased autonomy in the practice of health care, but only serve to decide upon the advancement to a next stage of training, EPAs can become the tick boxes learners feel they need to collect to 'pass'. Gradually, then, EPAs can loose their original meaning of units of practice for which one becomes qualified.
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Affiliation(s)
- Olle Ten Cate
- Utrecht Center for Research and Development of Health Professions Education, University Medical Center Utrecht, P.O. Box # 85500, 3508 GA, Utrecht, The Netherlands.
| | - Daniel J Schumacher
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Chartash D, Hart L. Building the Generalist Physician to Support Adolescence and Emerging Adulthood: A Narrative Review. Cureus 2022; 14:e22533. [PMID: 35345691 PMCID: PMC8956274 DOI: 10.7759/cureus.22533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 02/20/2022] [Indexed: 11/09/2022] Open
Abstract
Undergraduate medical education serves as a foundation for the medical student to develop the skills of a generalist physician. Given the "blurring" of the demarcations between childhood and adulthood and the increased scope of pediatric practice, an extra layer has been added to medical education which seeks to address care across the lifespan. While approaches have been developed to teach this layer, clerkship reform has not focused on advancing the clinical science of adolescence. Furthermore, as we look towards the vanguard of entrustable professional activities (EPA), specific attention to transition care for the adolescent has seen minimal attention. Drawing on prior examples of curriculum integration between specialties as well as solutions to complex care management from clinical reasoning, we suggest that attention to the development of the generalist physician requires attention to the combined medicine-pediatrics specialty.
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Tavares W, Gofton W, Bhanji F, Dudek N. Reframing the O-SCORE as a Retrospective Supervision Scale Using Validity Theory. J Grad Med Educ 2022; 14:22-24. [PMID: 35222815 PMCID: PMC8848889 DOI: 10.4300/jgme-d-21-00592.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Walter Tavares
- Walter Tavares, PhD, is Assistant Professor and Scientist, The Wilson Centre and Temerty Faculty of Medicine, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Wade Gofton
- Wade Gofton, MD, MEd, is Professor, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Farhan Bhanji
- Farhan Bhanji, MD, MSc(Ed), is Professor, Department of Pediatrics, McGill University, Montreal, Quebec, Canada, and Associate Director of Assessment Strategy Royal College of Physicians and Surgeons, Ottawa, Ontario, Canada
| | - Nancy Dudek
- Nancy Dudek, MD, MEd, is Professor, Department of Medicine, Division of Physical Medicine and Rehabilitation, and The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
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Frank JR, Snell LS, Oswald A, Hauer KE. Further on the journey in a complex adaptive system: Elaborating CBME. MEDICAL TEACHER 2021; 43:734-736. [PMID: 34097832 DOI: 10.1080/0142159x.2021.1931083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Jason R Frank
- Office of Specialty Education, Royal College of Physicians and Surgeons of Canada, Ottawa, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, Canada
| | - Linda S Snell
- Office of Specialty Education, Royal College of Physicians and Surgeons of Canada, Ottawa, Canada
- Department of Medicine, McGill University, Montreal, Canada
| | - Anna Oswald
- Office of Specialty Education, Royal College of Physicians and Surgeons of Canada, Ottawa, Canada
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Karen E Hauer
- Department of Medicine, San Francisco (UCSF) School of Medicine, University of California, San Francisco, CA, USA
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