Twelve tips to develop entrustable professional activities

Towards a flexible and personalised development of veterinarians and veterinary nurses working in a companion animal referral care setting

In the Netherlands, the demand for veterinarians and veterinary nurses (VNs) working within referral care is rapidly growing and currently exceeds the amount of available board-certified specialists. Simultaneously, a transparent structure to guide training and development and to assess quality of non-specialist veterinarians and VNs working in a referral setting is lacking. In response, we developed learning pathways guided by an entrustable professional activity (EPA) framework and programmatic assessment to support personalised development and competence of veterinarians and VNs working in referral settings. Between 4 and 35 EPAs varying per discipline (n = 11) were developed. To date, 20 trainees across five disciplines have been entrusted. Trainees from these learning pathways have proceeded to acquire new EPAs in addition to their already entrusted set of EPAs or progressed to specialist training during (n = 3) or after successfully completing (n = 1) the learning pathway. Due to their outcome-based approach, the learning pathways support flexible ways of development.

Special Report: Entrustable Professional Activities in Sex- and Gender-Based Women's Health

BACKGROUND

A set of core competencies in sex- and gender-based women's health (SGWH) has been endorsed by the Society of General Internal Medicine (SGIM), but many residencies lack the resources to implement curricula and clinical assessments that would support achievement of these competencies.

AIM

Develop entrustable professional activities (EPA) to support implementation and assessment of clinical care for SGIM's SGWH Core Competencies.

PROGRAM DESCRIPTION

Members of SGIM's SGWH Education Interest Group developed 18 SGWH EPAs for internal medicine residents. A team of clinician educators coordinated the preparation, drafting, quality control, and curriculum alignment of the SGWH EPAs through a rigorous process aligned with best practices for EPAs. All EPAs are mapped to the larger competency domains from the Accreditation Council for Graduate Medical Education (ACGME), for use with ACGME Milestones. The authors provide suggestions for the implementation of the EPAs into residency training.

CONCLUSION

As residency education moves towards a competency-based structure, EPAs are needed to translate broad competencies into observable clinical skills. The SGWH EPAs provide a rigorously developed and ready-made tool for programs to link the SGWH core competencies to residency curriculum development, clinical assessment, and program evaluation.

A multi-method approach to drafting candidate entrustable professional activities for a general internal medicine residency programme

INTRODUCTION

Entrustable professional activities (EPAs) are units of concrete daily clinical tasks that trainee physicians should be able to handle with increasing autonomy during their postgraduate training. EPAs are gaining international recognition as an essential component of competency-based medical training programmes. The process of developing EPAs for a nationwide training programme is complex and requires an in-depth understanding of EPAs as a concept and good knowledge of appropriate development processes. This article provides a detailed description of the methodology and results of a multi-step approach for developing a list of candidate EPAs for Switzerland's postgraduate training programme in general internal medicine (GIM).

METHODS

We took a multi-step approach including a systematic review of international literature, four national focus groups, a national consensus process using a RAND appropriateness method, and a quality check of the selected candidate EPAs using EQual criteria.

RESULTS

These steps generated a final list of 247 candidate EPAs in general internal medicine that were submitted for the national consensus process. After two rounds of rating, experts agreed on the appropriateness for general internal medicine postgraduate training of 225 candidate EPAs. Twenty-two were deemed inappropriate, and disagreement persisted only for two EPAs.

DISCUSSION

This multi-step programme is one of the few describing in detail the process of developing a list of EPAs and providing evidence of validity at each step. The clinical breadth of our candidate EPAs, together with the detailed description of our methodology, could serve as a useful starting point from which medical education specialists or clinicians could develop or revise applicable lists of EPAs, particularly for postgraduate training programmes in either general internal medicine or family medicine.

Development of the entrustable professional activity 'medication reconciliation' for clinical pharmacy

BACKGROUND

Entrustable professional activities (EPAs) are observable process descriptions of clinical work units. EPAs support learners and tutors in assessment within healthcare settings. For use amongst our pharmacy students as well as pre-registration pharmacists we wanted to develop and validate an EPA for use in a clinical pharmacy setting at LMU University Hospital.

METHODS

The development of the clinical pharmacy EPA followed a set pathway. A rapid literature review informed the first draft, an interprofessional consensus group consisting of pharmacists, nurses, and medical doctors refined this draft. The refined version was then validated via online survey utilising clinical pharmacists from Germany.

RESULTS

We designed, refined and validated an EPA regarding medication reconciliation for assessment of pharmacy students and trainees within the pharmacy department at LMU University Hospital in Munich. Along with the EPA description an associated checklist to support the entrustment decision was created. For validation an online survey with 27 clinical pharmacists from all over Germany was conducted. Quality testing with the EQual rubric showed a good EPA quality.

CONCLUSIONS

We developed the first clinical pharmacy EPA for use in a German context. Medication reconciliation is a suitable EPA candidate as it describes a clinical activity performed by pharmacists in many clinical settings. The newly developed and validated EPA 'Medication Reconciliation' will be used to assess pharmacy students and trainees.

Establishing entrustable professional activities for psychiatry residents in China

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.

Evaluating the Quality of the Core Entrustable Professional Activities for New Pharmacy Graduates

This study aimed to evaluate the quality of the American Association of Colleges of Pharmacy Core Entrustable Professional Activities (Core EPAs) for New Pharmacy Graduates according to standards outlined in competency-based education literature utilizing the Queen's EPA Quality (EQual) rubric. A cohort of pharmacists with EPA expertise rated Core EPA quality with the EQual rubric and provided recommendations for revisions. A generalizability study determined the reliability of the EQual ratings with pharmacist users. Nine pharmacists responded (4.4%). Most EPAs (9/15) did not reach the overall cut-off score, indicating low quality. EPAs 1 through 5 and EPA 14 (fulfill a medication order) were deemed high quality. EPA 12 (use evidence-based information to advance patient care) scored the lowest at 3.47 (SEM 0.29). EPA 14 scored the highest at 4.60 (SEM 0.14). EPA 15 (create a written plan for continuous professional development) was the only EPA to fail to reach the cut-off across all EQual domains. EPAs in the Patient Care Provider Domain received significantly higher ratings than other EPAs. On average, three respondents recommended revision for each. Most comments aligned with the EPA's EQual rubric performance. The generalizability study analysis revealed excellent reliability (G = 0.80). Determining EPA quality utilizing objective measurement tools should drive EPA development and revisions to more accurately reflect the roles, responsibilities, and expectations of pharmacists on the healthcare team.

Determining Critical Topics for Undergraduate Surgical Education in Rwanda: Results of a Modified Delphi Process and a Consensus Conference

Background Developing a contextually appropriate curriculum is critical to train physicians who can address surgical challenges in sub-Saharan Africa. An innovative modified Delphi process was used to identify contextually optimized curricular content to meet sub-Saharan Africa and Rwanda's surgical needs. Methods Participants were surgeons from East, Central, Southern, and West Africa and general practitioners with surgical experience. Delphi participants excluded or prioritized surgical topic areas generated from extensive grey and formal literature review. Surgical educators first screened and condensed identified topics. Round 1 screened and prioritized identified topics, with a 75% consensus cut-off based on the content validity index and a prioritization score. Topics that reached consensus were screened again in round 2 and re-prioritized, following controlled feedback. Frequencies for aggregate prioritization scores, experts in agreement, item-level content validity index, universal agreement and scale-level content validity index based on the average method (S-CVI/Ave) using proportion relevance, and intra-class correlation (ICC) (based on a mean-rating, consistency, two-way mixed-effects model) were performed. We also used arithmetic mean values and modal frequency. Cronbach's Alpha was also calculated to ascertain reliability. Results were validated through a multi-institution consensus conference attended by Rwanda-based surgical specialists, general practitioners, medical students, surgical educators, and surgical association representatives using an inclusive, participatory, collaborative, agreement-seeking, and cooperative, a priori consensus decision-making model. Results Two-hundred and sixty-seven broad surgical content areas were identified through the initial round and presented to experts. In round 2, a total of 247 (92%) content areas reached 75% consensus among 31 experts. Topics that did not achieve consensus consisted broadly of small intestinal malignancies, rare hepatobiliary pathologies, and transplantation. In the final round, 99.6% of content areas reached 75% consensus among 31 experts. The highest prioritization was on wound healing, fluid and electrolyte management, and appendicitis, followed by metabolic response, infection, preoperative preparation, antibiotics, small bowel obstruction and perforation, breast infection, acute urinary retention, testicular torsion, hemorrhoids, and surgical ethics. Overall, the consistency and average agreement between panel experts was strong. ICC was 0.856 (95% CI: 0.83-0.87). Cronbach's Alpha for round 2 was very strong (0.985, 95% CI: 0.976-0.991) and higher than round 1, demonstrating strong reliability. All 246 topics from round 4 were verbally accepted by 40 participants in open forum discussions during the consensus conference. Conclusions A modified Delphi process and consensus were able to identify essential topics to be included within a highly contextualized, locally driven surgical clerkship curriculum delivered in rural Rwanda. Other contexts can use similar processes to develop relevant curricula.

Inconsistently reporting post-licensure EPA specifications in different clinical professions hampers fidelity and practice translation: a scoping review

BACKGROUND

Entrustable Professional Activities (EPAs) are defined units of professional practice entrusted to professionals once they have attained the specific competencies required to complete the end-to-end task. They provide a contemporary framework for capturing real-world clinical skillsets and integrating clinical education with practice. Our scoping review question was: how are post-licensure EPAs reported in peer reviewed literature, in different clinical professions?

METHOD

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist, Arksey and O'Malley and Joanna Briggs Institute (JBI) methodology. Searching ten electronic databases returned 1622 articles, with 173 articles included. Data extracted included demographics, EPA discipline, titles and further specifications.

RESULTS

All articles were published between 2007-2021 across sixteen country contexts. The majority were from North America (n = 162, 73%) describing medical sub-specialty EPAs (n = 126, 94%). There were comparably few EPA frameworks reported in clinical professions other than medicine (n = 11, 6%). Many articles reported only EPA titles without further explanation and limited content validation. The majority did not include information about the EPA design process. Few EPAs and frameworks were reported according to all the recommended EPA attributes. There was unclear distinction between specialty-specific EPAs and those that could be useful across disciplines.

DISCUSSION

Our review highlights the large volume of EPAs reported in post-licensure medicine, including the volume disparity compared to other clinical professions. Basing our enquiry upon existing guidelines for EPA attributes and features, our experience in conducting the review and our primary finding demonstrated heterogeneity of EPA reporting according to these specifications. To promote EPA fidelity, and quality appraisal, and to reduce interpretation subjectivity, we advocate: diligently reporting EPA attributes and features; including reference or citation to EPA design and content validity information; and considering distinguishing EPAs as specialty-specific or transdisciplinary.

CONCLUSION

A large volume of post-licensure EPAs were identified in medicine relative to other clinical professions. EPA specifications were absent or variously reported in the literature, risking ambiguous interpretation. The authors recommend that future EPAs are reported with reference to established and evolving construct recommendations, which is integral to concept fidelity and translation to practice and education.