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Langhan ML, Boyer DL, Hsu D, Moffatt ME, Pitts SA, Atlas MP, Aye T, Chess P, Curran ML, Czaja AS, Dammann CEL, Fussell J, George RP, Herman BE, High P, James SH, Kamin DS, Karnik R, Kesselheim J, Lopez MA, Mahan JD, McFadden V, McGann KA, Mehta JJ, Rama J, Robinson BW, Sauer C, Stafford DEJ, Turner DA, Weiss P, Yussman SM, Schwartz A, Mink R. Implementing Entrustable Professional Activities in Pediatric Fellowships: Facilitating the Process. Pediatrics 2024; 153:e2023065024. [PMID: 38757175 DOI: 10.1542/peds.2023-065024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/02/2024] [Accepted: 02/20/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Entrustable professional activities (EPAs) will be used for initial certification by the American Board of Pediatrics by 2028. Less than half of pediatric fellowships currently use EPAs for assessment, yet all will need to adopt them. Our objectives were to identify facilitators and barriers to the implementation of EPAs to assess pediatric fellows and to determine fellowship program directors' (FPD) perceptions of EPAs and Milestones. METHODS We conducted a survey of FPDs from 15 pediatric subspecialties. EPA users were asked about their implementation of EPAs, barriers encountered, and perceptions of EPAs. Nonusers were queried about deterrents to using EPAs. Both groups were asked about potential facilitators of implementation and their perceptions of Milestones. RESULTS The response rate was 65% (575/883). Of these, 344 (59.8%) were EPA users and 231 (40.2%) were nonusers. Both groups indicated work burden as a barrier to implementation. Nonusers reported more barriers than users (mean [SD]: 7 [3.8] vs 5.8 [3.4], P < .001). Both groups identified training materials and premade assessment forms as facilitators to implementation. Users felt that EPAs were easier to understand than Milestones (89%) and better reflected what it meant to be a practicing subspecialty physician (90%). In contrast, nonusers felt that Milestones were easy to understand (57%) and reflected what it meant to be a practicing subspecialist (58%). CONCLUSIONS Implementing EPA-based assessment will require a substantial investment by FPDs, facilitated by guidance and easily accessible resources provided by multiple organizations. Perceived barriers to be addressed include FPD time constraints, a need for additional assessment tools, and outcomes data.
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Affiliation(s)
| | - Donald L Boyer
- Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Deborah Hsu
- Stanford University School of Medicine, Stanford, California
| | - Mary E Moffatt
- University of Missouri Kansas City School of Medicine, Kansas City, Missouri
| | - Sarah A Pitts
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mark P Atlas
- Zucker School of Medicine at Hofstra-Northwell, Cohen Children's Medical Center, Queens, New York
| | - Tandy Aye
- Stanford University School of Medicine, Stanford, California
| | - Patricia Chess
- University of Rochester Medical Center, Rochester, New York
| | - Megan L Curran
- University of Colorado School of Medicine, Aurora, Colorado
| | - Angela S Czaja
- University of Colorado School of Medicine, Aurora, Colorado
| | | | - Jill Fussell
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Roshan P George
- Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Bruce E Herman
- University of Utah School of Medicine, Salt Lake City, Utah
| | - Pamela High
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Scott H James
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Daniel S Kamin
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ruchika Karnik
- Yale University School of Medicine, New Haven, Connecticut
| | - Jennifer Kesselheim
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Michelle A Lopez
- Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - John D Mahan
- The Ohio State University College of Medicine, Columbus, Ohio
| | | | | | - Jay J Mehta
- Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jennifer Rama
- Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Bradley W Robinson
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Cary Sauer
- Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
| | | | - David A Turner
- American Board of Pediatrics, Chapel Hill, North Carolina
| | - Pnina Weiss
- Yale University School of Medicine, New Haven, Connecticut
| | | | - Alan Schwartz
- University of Illinois College of Medicine at Chicago, Chicago, Illinois
| | - Richard Mink
- Harbor-UCLA Medical Center and The Lundquist Institute for Biomedical Innovation, Torrance, California
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Ten Cate O, Khursigara-Slattery N, Cruess RL, Hamstra SJ, Steinert Y, Sternszus R. Medical competence as a multilayered construct. MEDICAL EDUCATION 2024; 58:93-104. [PMID: 37455291 DOI: 10.1111/medu.15162] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/31/2023] [Accepted: 06/15/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND The conceptualisation of medical competence is central to its use in competency-based medical education. Calls for 'fixed standards' with 'flexible pathways', recommended in recent reports, require competence to be well defined. Making competence explicit and measurable has, however, been difficult, in part due to a tension between the need for standardisation and the acknowledgment that medical professionals must also be valued as unique individuals. To address these conflicting demands, a multilayered conceptualisation of competence is proposed, with implications for the definition of standards and approaches to assessment. THE MODEL Three layers are elaborated. This first is a core layer of canonical knowledge and skill, 'that, which every professional should possess', independent of the context of practice. The second layer is context-dependent knowledge, skill, and attitude, visible through practice in health care. The third layer of personalised competence includes personal skills, interests, habits and convictions, integrated with one's personality. This layer, discussed with reference to Vygotsky's concept of Perezhivanie, cognitive load theory, self-determination theory and Maslow's 'self-actualisation', may be regarded as the art of medicine. We propose that fully matured professional competence requires all three layers, but that the assessment of each layer is different. IMPLICATIONS The assessment of canonical knowledge and skills (Layer 1) can be approached with classical psychometric conditions, that is, similar tests, circumstances and criteria for all. Context-dependent medical competence (Layer 2) must be assessed differently, because conditions of assessment across candidates cannot be standardised. Here, multiple sources of information must be merged and intersubjective expert agreement should ground decisions about progression and level of clinical autonomy of trainees. Competence as the art of medicine (Layer 3) cannot be standardised and should not be assessed with the purpose of permission to practice. The pursuit of personal excellence in this level, however, can be recognised and rewarded.
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Affiliation(s)
- Olle Ten Cate
- University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Richard L Cruess
- Institute of Health Sciences Education, McGill University, Montreal, Quebec, Canada
| | - Stanley J Hamstra
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Holland Bone and Joint Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Yvonne Steinert
- Institute of Health Sciences Education, McGill University, Montreal, Quebec, Canada
| | - Robert Sternszus
- Department of Pediatrics, Institute of Health Sciences Education, McGill University, Montreal, Quebec, Canada
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Ahmed S, Shersad F, Ziganshina A, Shadan M, Elmardi A, El Tayeb Y. Operationalizing competency-based assessment: Contextualizing for cultural and gender divides. MEDEDPUBLISH 2023; 13:210. [PMID: 37842229 PMCID: PMC10576182 DOI: 10.12688/mep.19728.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Abstract
Following current trends, educational institutions often decide to use a competency framework as an overarching structure in their assessment system. Despite the presence of a common understanding of how different examinations can contribute to the decision on attaining a particular competency, a detailed mapping of the data points appears to be a challenging area that remains to be explored. Faced with the newly emerged task of introducing the assessment of the attainment of UAE medical students against the EmiratesMEDs competency framework, Dubai Medical College for Girls (DMCG) attempted to operationalise the designed concept in the assessment system considering the cultural and gender divide. We believe that health professionals who attempt to implement contextualized competency-based assessment could benefit from being acquainted with our experience. The article offers a step-by-step guide on contextualized competency assessment operationalization, describing building the team, working with consultants and faculty development, estimating institutional assessment capacity, mapping and operationalizing the maps by using both human recourses and the software. We also offer the readers the list of enabling factors and introduce the scope of limitations in the process of developing the competency-based assessment system. We believe that following the present guide can allow educators to operationalize competency-based assessment in any context with respect to local culture and traditions.
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Affiliation(s)
- Samar Ahmed
- Faculty of Medicine, Forensic Medicine and Toxicology department, Ain Shams University, Cairo, Cairo Governorate, 11488, Egypt
- Associate Dean Academic Affairs, Dubai Medical College for Girls, Dubai, United Arab Emirates
| | - Fouzia Shersad
- Medical Education, Dubai Medical College for Girls, Dubai, United Arab Emirates
| | - Arina Ziganshina
- Clinical Department, Dubai Medical College for Girls, Dubai, United Arab Emirates
| | - Mariam Shadan
- Biomedical Department, Dubai Medical College for Girls, Dubai, United Arab Emirates
| | - Abdelmoneim Elmardi
- Biomedical Department, Dubai Medical College for Girls, Dubai, United Arab Emirates
| | - Yousif El Tayeb
- Clinical Department, Dubai Medical College for Girls, Dubai, United Arab Emirates
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Gummesson C, Alm S, Cederborg A, Ekstedt M, Hellman J, Hjelmqvist H, Hultin M, Jood K, Leanderson C, Lindahl B, Möller R, Rosengren B, Själander A, Svensson PJ, Särnblad S, Tejera A. Entrustable professional activities (EPAs) for undergraduate medical education - development and exploration of social validity. BMC MEDICAL EDUCATION 2023; 23:635. [PMID: 37667366 PMCID: PMC10478490 DOI: 10.1186/s12909-023-04621-6] [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: 03/09/2023] [Accepted: 08/28/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND The development of entrustable professional activities (EPAs) as a framework for work-based training and assessment in undergraduate medical education has become popular. EPAs are defined as units of a professional activity requiring adequate knowledge, skills, and attitudes, with a recognized output of professional labor, independently executable within a time frame, observable and measurable in its process and outcome, and reflecting one or more competencies. Before a new framework is implemented in a specific context, it is valuable to explore social validity, that is, the acceptability by relevant stakeholders. AIM The aim of our work was to define Core EPAs for undergraduate medical education and further explore the social validity of the constructs. METHOD AND MATERIAL In a nationwide collaboration, EPAs were developed using a modified Delphi procedure and validated according to EQual by a group consisting of teachers nominated from each of the seven Swedish medical schools, two student representatives, and an educational developer (n = 16). In the next step, social validity was explored in a nationwide survey. The survey introduced the suggested EPAs. For each EPA, the importance of the EPA was rated, as was the rater's perception of the present graduates' required level of supervision when performing the activity. Free-text comments were also included and analyzed. RESULTS Ten Core EPAs were defined and validated. The validation scores for EQual ranged from 4.1 to 4.9. The nationwide survey had 473 responders. All activities were rated as "important" by most responders, ranging from 54 to 96%. When asked how independent current graduates were in performing the ten activities, 6 to 35% reported "independent". The three themes of the free text comments were: 'relevant target areas and content'; 'definition of the activities'; and 'clinical practice and learning'. CONCLUSION Ten Core EPAs were defined and assessed as relevant for Swedish undergraduate medical education. There was a consistent gap between the perceived importance and the certainty that the students could perform these professional activities independently at the time of graduation. These results indicate that the ten EPAs may have a role in undergraduate education by creating clarity for all stakeholders.
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Affiliation(s)
- Christina Gummesson
- Faculty of Medicine, Faculty of Odontology, Lund University, Malmö University, Malmö, Sweden.
| | - Stina Alm
- Department of Clinical Sciences, Futurum - the Academy for Health and Care, Region Jönköping County, Umeå University, Paediatrics, Umeå, Sweden
| | - Anna Cederborg
- Institute of Medicine, Sahlgrenska Academy, Department of Medicine, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mattias Ekstedt
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, 581 83, Sweden
| | - Jarl Hellman
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Hans Hjelmqvist
- Department of Anesthesiology and Intensive Care, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Magnus Hultin
- Department of Surgical and Perioperative Sciences, Anesthesiology and Intensive Care Medicine, Umeå University, Umeå, Sweden
| | - Katarina Jood
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Department of Neurology, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Charlotte Leanderson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Bertil Lindahl
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Riitta Möller
- Department of Clinical Science, Intervention and Technology, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Karolinska Institutet, Stockholm, Sweden
| | - Björn Rosengren
- Clinical and Molecular Osteoporosis Research Unit, Department of Orthopedics and Clinical Sciences, Skåne University Hospital Malmö, Lund University, Malmö, Sweden
| | - Anders Själander
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Peter J Svensson
- Department of Clinical Sciences Lund University, Skåne University Hospital, Malmö, Sweden
| | - Stefan Särnblad
- Department of Pediatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Alexander Tejera
- Division of Translational Cancer Research, Department of Laboratory Medicine, Skåne University Hospital, Lund University, Lund University, Lund, Sweden
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Hennus MP, Jarrett JB, Taylor DR, Ten Cate O. Twelve tips to develop entrustable professional activities. MEDICAL TEACHER 2023; 45:701-707. [PMID: 37027517 DOI: 10.1080/0142159x.2023.2197137] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Entrustable professional activities (EPAs), units of professional practice that require proficient integration of multiple competencies and can be entrusted to a sufficiently competent learner, are increasingly being used to define and inform curricula of health care professionals. The process of developing EPAs can be challenging and requires a deep yet pragmatic understanding of the concepts underlying EPA construction. Based on recent literature and the authors' lessons learned, this article provides the following practical and more or less sequential recommendations for developing EPAs: [1] Assemble a core team; [2] Build up expertise; [3] Establish a shared understanding of the purpose of EPAs; [4] Draft preliminary EPAs; [5] Elaborate EPAs; [6] Adopt a framework of supervision; [7] Perform a structured quality check; [8] Use a Delphi approach for refinement and/or consensus; [9] Pilot test EPAs; [10] Attune EPAs to their feasibility in assessment; [11] Map EPAs to existing curriculum; [12] Build a revision plan.
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Affiliation(s)
| | - Jennie B Jarrett
- Department of Pharmacy Practice, University of Illinois Chicago College of Pharmacy, Chicago, IL, USA
| | - David R Taylor
- Department of Medicine, Queen's University School of Medicine, Kingston, Ontario, Canada
| | - Olle Ten Cate
- Center for Research and Development of Education, University Medial Center Utrecht, Utrecht, the Netherlands
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