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Flores-Cohaila JA, Vizcarra-Jiménez SF, Bermúdez-Peláez MF, Vascones-Román FF, Rivarola-Hidalgo M, Taype-Rondan A. Effects of SNAPPS in clinical reasoning teaching: a systematic review with meta-analysis of randomized controlled trials. Diagnosis (Berl) 2024; 11:220-230. [PMID: 38446132 DOI: 10.1515/dx-2023-0149] [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: 10/17/2023] [Accepted: 02/09/2024] [Indexed: 03/07/2024]
Abstract
INTRODUCTION Clinical reasoning is crucial in medical practice, yet its teaching faces challenges due to varied clinical experiences, limited time, and absence from competency frameworks. Despite efforts, effective teaching methodologies remain elusive. Strategies like the One Minute Preceptor (OMP) and SNAPPS are proposed as solutions, particularly in workplace settings. SNAPPS, introduced in 2003, offers a structured approach but lacks comprehensive evidence of its effectiveness. Methodological shortcomings hinder discerning its specific effects. Therefore, a systematic review is proposed to evaluate SNAPPS' impact on clinical reasoning teaching. CONTENT We searched PubMed, EMBASE, and CINAHL for randomized controlled trials (RCTs) comparing SNAPPS against other methods. Data selection and extraction were performed in duplicate. Bias and certainty of evidence were evaluated using Cochrane RoB-2 and GRADE approach. SUMMARY We identified five RCTs performed on medical students and residents. Two compared SNAPPS with an active control such as One Minute Preceptor or training with feedback. None reported the effects of SNAPPS in workplace settings (Kirkpatrick Level 3) or patients (Kirkpatrick Level 4). Low to moderate certainty of evidence suggests that SNAPPS increases the total presentation length by increasing discussion length. Low to moderate certainty of evidence may increase the number of differential diagnoses and the expression of uncertainties. Low certainty of evidence suggests that SNAPPS may increase the odds of trainees initiating a management plan and seeking clarification. OUTLOOK Evidence from this systematic review suggests that SNAPPS has some advantages in terms of clinical reasoning, self-directed learning outcomes, and cost-effectiveness. Furthermore, it appears more beneficial when used by residents than medical students. However, future research should explore outcomes outside SNAPPS-related outcomes, such as workplace or patient-related outcomes.
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Affiliation(s)
| | - Sonia F Vizcarra-Jiménez
- Escuela de Medicina Humana, Facultad de Ciencias de la Salud, 120782 Universidad Privada de Tacna , Tacna, Peru
| | | | | | - Marco Rivarola-Hidalgo
- Centro de Estudios e Investigación en Educación Médica y Bioética, 120782 Universidad Privada de Tacna , Tacna, Peru
| | - Alvaro Taype-Rondan
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, 33225 Universidad San Ignacio de Loyola , Lima, Peru
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Wade DT. Does a service provide safe, effective rehabilitation? An evaluation method for providers and purchasers. Clin Rehabil 2024:2692155241259644. [PMID: 39053145 DOI: 10.1177/02692155241259644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
BACKGROUND Independent organisations monitor the safety and governance of clinical services but do not assess specialist expertise. Peer review can assess service capability but is resource-intense and infeasible. THE PROBLEM How can you ensure a service provides safe, effective rehabilitation? You ask them to provide data as evidence that they can be trusted to do so. This article suggests a structured approach to providing data on entrustability. AN ANALOGY How is the specialist skill of a doctor in training established? They provide evidence about high-level outcomes (capabilities in practice) related to their speciality. An educational supervisor assesses whether they can be trusted to perform safely and effectively without supervision. The capabilities in practice define their expertise. THE SOLUTION A service can use seven high-level rehabilitation service capabilities, based on the clinical capabilities associated with medical training, with observable indicative descriptors, to collect evidence of their rehabilitation approach. A service must also select four to eight high-level competencies indicating they can rehabilitate their patient caseload safely and effectively. These competencies also need indicative descriptors as evidence of their performance in the service; 11 examples are given. CAPABILITIES. The seven rehabilitation capabilities are: using the biopsychosocial model, having a multi-professional team, making a person-centred rehabilitation plan, working collaboratively across all boundaries, tailoring treatments to the patient's needs, ensuring staff have specific competencies required for their caseload, and acknowledging and managing uncertainty and complexity. CONCLUSION. Service providers could use this structured approach to develop and provide users with evidence of their rehabilitation expertise.
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Affiliation(s)
- Derick T Wade
- Centre for Movement, Occupation and Rehabilitation Sciences (MOReS), Faculty of Health Sciences, Oxford Brookes University, Headington Campus, Oxford OX3 0BP, UK
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3
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Costa ML, Rego MAS, Rodrigues FC, Pinheiro SS, Deus MO, Moura AS. Validation of entrustable professional activities for use in neonatal care residency programs. J Pediatr (Rio J) 2024:S0021-7557(24)00073-1. [PMID: 38955326 DOI: 10.1016/j.jped.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 05/22/2024] [Accepted: 05/29/2024] [Indexed: 07/04/2024] Open
Abstract
OBJECTIVE Define and develop a set of entrustable professional activities (EPAs) to link clinical training and assessment of the hospital components of neonatal care in neonatology medical residency programs. METHODS An exploratory study was conducted in two phases using a modified Delphi approach. In the first phase, a committee of five neonatology residency program coordinators drafted an initial set of EPAs based on the national matrix of competencies and on EPAs defined by international organizations. In the second phase, a group of neonatal care physicians and medical residents rated the indispensability and clarity of the EPAs and provided comments and suggestions. RESULTS Seven EPAs were drafted by the coordinators´ committee (n = 5) and used in the content validation process with a group (n = 37) of neonatal care physicians and medical residents. In the first Delphi round, all EPAs reached a content validity index (CVI) above 0.8. The coordinators´ committee analyzed comments and suggestions and revised the EPAs. A second Delphi round with the revised EPAs was conducted to validate and all items maintained a CVI above 0.8 for indispensability and clarity. CONCLUSION Seven entrustable professional activities were developed to assess residents in the hospital components of neonatal care medicine. These EPAs might contribute to implementing competency-based neonatology medical residency programs grounded in core professional activities.
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Affiliation(s)
- Marcia L Costa
- Universidade Professor Edson Antônio Velano - UNIFENAS, Programa de Mestrado Ensino em Saúde, Belo Horizonte, MG, Brazil.
| | | | - Flavia Cardoso Rodrigues
- Hospital Metropolitano Odilon Behrens, Unidade de Cuidados Neonatais, Belo Horizonte, MG, Brazil
| | - Sandy S Pinheiro
- Universidade Professor Edson Antônio Velano - UNIFENAS, Curso de Medicina, Belo Horizonte, MG, Brazil
| | - Marcela O Deus
- Universidade Professor Edson Antônio Velano - UNIFENAS, Curso de Medicina, Belo Horizonte, MG, Brazil
| | - Alexandre S Moura
- Universidade Professor Edson Antônio Velano - UNIFENAS, Programa de Mestrado Ensino em Saúde, Belo Horizonte, MG, Brazil; Faculdade Santa Casa, Programa de Pós-Graduação em Medicina e Biomedicina, Belo Horizonte, MG, Brazil
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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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Bozic U, Witti MJ, Ralf S, Fischer MR, Zottmann JM, Pudritz YM. Development of the entrustable professional activity 'medication reconciliation' for clinical pharmacy. BMC MEDICAL EDUCATION 2024; 24:568. [PMID: 38789955 PMCID: PMC11127371 DOI: 10.1186/s12909-024-05504-0] [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: 01/16/2024] [Accepted: 05/02/2024] [Indexed: 05/26/2024]
Abstract
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.
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Affiliation(s)
- Ula Bozic
- Institute of Medical Education, LMU University Hospital, LMU Munich, Pettenkoferstr. 8a, 80336, Munich, Germany
- Doctoral Programme Clinical Pharmacy, LMU University Hospital, LMU Munich, Marchioninstr. 15, 81377, Munich, Germany
| | - Matthias J Witti
- Institute of Medical Education, LMU University Hospital, LMU Munich, Pettenkoferstr. 8a, 80336, Munich, Germany
| | - Schmidmaier Ralf
- Institute of Medical Education, LMU University Hospital, LMU Munich, Pettenkoferstr. 8a, 80336, Munich, Germany
- Department of Medicine IV, LMU University Hospital, LMU Munich, Ziemsenstr. 5, 80336, Munich, Germany
| | - Martin R Fischer
- Institute of Medical Education, LMU University Hospital, LMU Munich, Pettenkoferstr. 8a, 80336, Munich, Germany
| | - Jan M Zottmann
- Institute of Medical Education, LMU University Hospital, LMU Munich, Pettenkoferstr. 8a, 80336, Munich, Germany
| | - Yvonne M Pudritz
- Institute of Medical Education, LMU University Hospital, LMU Munich, Pettenkoferstr. 8a, 80336, Munich, Germany.
- Doctoral Programme Clinical Pharmacy, LMU University Hospital, LMU Munich, Marchioninstr. 15, 81377, Munich, Germany.
- Pharmacy Department - Clinical Pharmacy and Pharmacotherapy, LMU Munich, Butenandtstr. 5-13, 81377, Munich, Germany.
- Pharmacy, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
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Woodworth GE, Goldstein ZT, Ambardekar AP, Arthur ME, Bailey CF, Booth GJ, Carney PA, Chen F, Duncan MJ, Fromer IR, Hallman MR, Hoang T, Isaak R, Klesius LL, Ladlie BL, Mitchell SA, Miller Juve AK, Mitchell JD, McGrath BJ, Shepler JA, Sims CR, Spofford CM, Tanaka PP, Maniker RB. Development and Pilot Testing of a Programmatic System for Competency Assessment in US Anesthesiology Residency Training. Anesth Analg 2024; 138:1081-1093. [PMID: 37801598 DOI: 10.1213/ane.0000000000006667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Abstract
BACKGROUND In 2018, a set of entrustable professional activities (EPAs) and procedural skills assessments were developed for anesthesiology training, but they did not assess all the Accreditation Council for Graduate Medical Education (ACGME) milestones. The aims of this study were to (1) remap the 2018 EPA and procedural skills assessments to the revised ACGME Anesthesiology Milestones 2.0, (2) develop new assessments that combined with the original assessments to create a system of assessment that addresses all level 1 to 4 milestones, and (3) provide evidence for the validity of the assessments. METHODS Using a modified Delphi process, a panel of anesthesiology education experts remapped the original assessments developed in 2018 to the Anesthesiology Milestones 2.0 and developed new assessments to create a system that assessed all level 1 through 4 milestones. Following a 24-month pilot at 7 institutions, the number of EPA and procedural skill assessments and mean scores were computed at the end of the academic year. Milestone achievement and subcompetency data for assessments from a single institution were compared to scores assigned by the institution's clinical competency committee (CCC). RESULTS New assessment development, 2 months of testing and feedback, and revisions resulted in 5 new EPAs, 11 nontechnical skills assessments (NTSAs), and 6 objective structured clinical examinations (OSCEs). Combined with the original 20 EPAs and procedural skills assessments, the new system of assessment addresses 99% of level 1 to 4 Anesthesiology Milestones 2.0. During the 24-month pilot, aggregate mean EPA and procedural skill scores significantly increased with year in training. System subcompetency scores correlated significantly with 15 of 23 (65.2%) corresponding CCC scores at a single institution, but 8 correlations (36.4%) were <30.0, illustrating poor correlation. CONCLUSIONS A panel of experts developed a set of EPAs, procedural skill assessment, NTSAs, and OSCEs to form a programmatic system of assessment for anesthesiology residency training in the United States. The method used to develop and pilot test the assessments, the progression of assessment scores with time in training, and the correlation of assessment scores with CCC scoring of milestone achievement provide evidence for the validity of the assessments.
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Affiliation(s)
- Glenn E Woodworth
- From the Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, Oregon
| | - Zachary T Goldstein
- Department of Anesthesiology, Cedars Sinai Medical Center, Los Angeles, California
| | - Aditee P Ambardekar
- Department of Anesthesiology and Pain Management, University of Texas, Southwestern Medical Center, Dallas, Texas
| | - Mary E Arthur
- Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Caryl F Bailey
- Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Gregory J Booth
- Uniformed Services University of the Health Sciences, Department of Anesthesiology and Pain Medicine, Naval Medical Center Portsmouth, Portsmouth, Virginia
| | - Patricia A Carney
- Division of Hospital Medicine, Department of Family Medicine and Internal Medicine, Oregon Health & Science University, Portland, Oregon
| | - Fei Chen
- Department of Anesthesiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Michael J Duncan
- Department of Anesthesiology, University of Missouri-Kansas City, Kansas City, Missouri
| | - Ilana R Fromer
- Department of Anesthesiology, University of Minnesota, Minneapolis, Minnesota
| | - Matthew R Hallman
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | - Thomas Hoang
- From the Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, Oregon
| | - Robert Isaak
- Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina
| | - Lisa L Klesius
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Beth L Ladlie
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota
| | | | - Amy K Miller Juve
- From the Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, Oregon
| | - John D Mitchell
- Department of Anesthesiology, Critical Care, and Perioperative Medicine, Henry Ford Health, Detroit, Michigan
| | - Brian J McGrath
- Department of Anesthesiology, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida
| | - John A Shepler
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Charles R Sims
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Christina M Spofford
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Pedro P Tanaka
- Department of Anesthesiology, Stanford University, Stanford, California
| | - Robert B Maniker
- Department of Anesthesiology, Columbia University, New York, New York
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van Keulen SG, de Raad T, Raymakers-Janssen P, Ten Cate O, Hennus MP. Exploring Interprofessional Development of Entrustable Professional Activities For Pediatric Intensive Care Fellows: A Proof-of-Concept Study. TEACHING AND LEARNING IN MEDICINE 2024; 36:154-162. [PMID: 37071751 DOI: 10.1080/10401334.2023.2200760] [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: 07/14/2022] [Accepted: 03/13/2023] [Indexed: 06/19/2023]
Abstract
Phenomenon: Entrustable professional activities (EPAs) delineate major professional activities that an individual in a given specialty must be "entrusted" to perform, ultimately without supervision, to provide quality patient care. Until now, most EPA frameworks have been developed by professionals within the same specialty. As safe, effective, and sustainable health care ultimately depends on interprofessional collaboration, we hypothesized that members of interprofessional teams might have clear and possibly additional insight into which activities are essential to the professional work of a medical specialist. Approach: We recently employed a national modified Delphi study to develop and validate a set of EPAs for Dutch pediatric intensive care fellows. In this proof-of-concept study, we explored what pediatric intensive care physicians' non-physician team members (physician assistants, nurse practitioners, and nurses) constitute as essential professional activities for PICU physicians and how they regarded the newly developed set of nine EPAs. We compared their judgments with the PICU physicians' opinions. Findings: This study shows that non-physician team members share a mental model with physicians about which EPAs are indispensable for pediatric intensive care physicians. Despite this agreement however, descriptions of EPAs are not always clear for non-physician team members who have to work with them on a daily basis. Insights: Ambiguity as to what an EPA entails when qualifying a trainee can have implications for patient safety and trainees themselves. Input from non-physician team members may add to the clarity of EPA descriptions. This finding supports the involvement of non-physician team members in the developmental process of EPAs for (sub)specialty training programs.
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Affiliation(s)
- Sabrina G van Keulen
- Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Timo de Raad
- Pediatric Intensive Care, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Paulien Raymakers-Janssen
- Pediatric Intensive Care, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Olle Ten Cate
- Utrecht Center for Research and Development of Health Professions Education, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marije P Hennus
- Pediatric Intensive Care, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
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Pålsson P, Cederborg A, Johansson M, Hult HV, Naredi S, Jood K. Clinical supervisors' experience of a first-time application of entrustable professional activities in clinical supervision of medical students: findings from a Swedish pilot study. BMC MEDICAL EDUCATION 2024; 24:297. [PMID: 38491437 PMCID: PMC10943870 DOI: 10.1186/s12909-024-05211-w] [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: 12/14/2023] [Accepted: 02/22/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Recently, all medical universities in Sweden jointly developed a framework for Entrustable Professional Activities (EPAs) for work-based training and assessment. This framework is now being introduced nationally in the new 6-year undergraduate medical programme that directly lead to a licence to practise. When EPAs are introduced, it is of central importance to gain clinical supervisors' acceptance to apply the framework in their supervision of students. The aim of this study was therefore to investigate how clinical supervisors, not familiar with EPAs, experience clinical supervision using the framework for EPAs. METHODS We used a purposive sampling to recruit clinical supervisors. They were given written information on EPAs with a selection of suitable EPAs and the Swedish observation rating scale for assessment of autonomy, and they were offered to attend a 30-minute introductory web course. The participants were informed that EPAs were to be tested, and the students were asked to participate. After the study period the clinical supervisors participated in semi-structured interviews. Inductive qualitative content analysis was used to analyse the transcribed interviews. RESULTS Three general themes emerged in the qualitative analysis: Promoting Feedback, Trusting Assessments and Engaging Stakeholders. The participants described benefits from using EPAs, but pointed out a need for preparation and adaptation to facilitate implementation. The structure was perceived to provide structured support for feedback, student involvement, entrustment decisions, enabling supervisors to allow the students to do more things independently, although some expressed caution to rely on others' assessments. Another concern was whether assessments of EPAs would be perceived as a form of examination, steeling focus from formative feedback. To understand the concept of EPA, the short web-based course and written information was regarded as sufficient. However, concern was expressed whether EPA could be applied by all clinical supervisors. Involvement and adaption of the workplace was pointed out as important since more frequent observation and feedback, with documentation requirements, increase the time required for supervision. CONCLUSIONS EPAs were accepted as beneficial, promoting structured feedback and assessments of the students' autonomy. Preparation of supervisors and students as well as involvement and adaptation of the workplace was pointed out as important.
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Affiliation(s)
- Paul Pålsson
- Department of Education, Region Västra Götaland, NU-hospital group, 46185, Trollhättan, Sweden.
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Anna Cederborg
- Institute of Medicine, Department of Molecular and Clinical Medicine, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Department of Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Monica Johansson
- Department of Education and Special Education, University of Gothenburg, Gothenburg, Sweden
| | - Helena Vallo Hult
- Department of Education, Region Västra Götaland, NU-hospital group, 46185, Trollhättan, Sweden
- School of Business, Economics and IT, Department of Informatics, University West, Trollhättan, Sweden
| | - Silvana Naredi
- Institute of Clinical Sciences, Department of Anaesthesiology and Intensive Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Katarina Jood
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
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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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Patel R, Marquis TJ, Cook A, Gielissen K. A Qualitative Study of Drivers for Use of the Primary Care Exception Among Internal Medicine Teaching Faculty. J Gen Intern Med 2024; 39:255-262. [PMID: 37698722 PMCID: PMC10853130 DOI: 10.1007/s11606-023-08406-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 08/30/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND The Primary Care Exception (PCE) is a billing rule from the Centers for Medicare and Medicaid Services (CMS) that allows supervising physicians to bill for ambulatory care provided by a resident without their direct supervision. There has been increased focus on entrustment as a method to assess readiness for unsupervised practice. OBJECTIVE To understand the factors influencing attending physicians' use of the PCE in ambulatory settings and identify common themes defining what motivates faculty preceptors to use the PCE. APPROACH This was a qualitative exploratory study. Participants were interviewed one-on-one using a semi-structured template informed by the entrustment literature. Analysis was conducted using a thematically framed, grounded theory-based approach to identify major themes and subthemes. PARTICIPANTS Twenty-seven internal medicine teaching faculty took part in a multi-institutional study representing four residency training programs across two academic medical centers in Connecticut. KEY RESULTS Four predominant categories of themes influencing PCE use were identified: (1) clinical environment factors, (2) attending attitudes, (3) resident characteristics, and (4) patient attributes. An attending's "internal rules" drawn from prior experiences served as a significant driver of PCE non-use regardless of the trainee, patient, or clinical context. A common conflict existed between using the PCE to promote resident autonomy versus waiving the PCE to promote safety. CONCLUSIONS The PCE can serve as a tool to support resident autonomy, confidence, and overall clinical efficiency. Choice of PCE use by attendings involved complex internal decision-making schema balancing internal, patient, resident, and environmental-related factors. The lack of standardized processes in competency evaluation may increase susceptibility to biases, which could be mitigated by applying standardized modes of assessment that encompass shared principles.
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Affiliation(s)
- Roshni Patel
- Yale University School of Medicine, New Haven, CT, USA
| | | | - Aliza Cook
- Yale-New Haven Hospital, New Haven, CT, USA
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Czaja AS, Mink RB, Herman BE, Weiss P, Turner DA, Curran ML, Stafford DEJ, Myers AL, Langhan ML. Exploring Factors for Implementation of EPAs in Pediatric Subspecialty Fellowships: A Qualitative Study of Program Directors. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2024; 11:23821205231225011. [PMID: 38268726 PMCID: PMC10807342 DOI: 10.1177/23821205231225011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 12/19/2023] [Indexed: 01/26/2024]
Abstract
OBJECTIVE To understand fellowship program directors' (FPDs) perspectives on facilitators and barriers to using entrustable professional activities (EPAs) in pediatric subspecialty training. METHODS We performed a qualitative study of FPDs, balancing subspecialty, program size, geographic region and current uses of EPAs. A study coordinator conducted 1-on-1 interviews using a semistructured approach to explore EPA use or nonuse and factors supporting or preventing their use. Investigators independently coded transcribed interviews using an inductive approach and the constant comparative method. Group discussion informed code structure development and refinement. Iterative data collection and analysis continued until theoretical sufficiency was achieved, yielding a thematic analysis. RESULTS Twenty-eight FPDs representing 11 pediatric subspecialties were interviewed, of whom 16 (57%) reported current EPA use. Five major themes emerged: (1) facilitators including the intuitive nature and simple wording of EPAs; (2) barriers such as workload burden and lack of a regulatory requirement; (2) variable knowledge and training surrounding EPAs, leading to differing levels of understanding; (3) limited current use of EPAs, even among self-reported users; and (4) complementary nature of EPAs and milestones. FPDs acknowledged the differing strengths of both EPAs and milestones but sought additional knowledge about the value added by EPAs for assessing trainees, including the impact on outcomes. CONCLUSIONS Identified themes can inform effective and meaningful EPA implementation strategies: Supporting and educating FPDs, ongoing assessment of the value of EPAs in training, and practical integration with current workflow. Generating additional data and engaging stakeholders is critical for successful implementation for the pediatric subspecialties.
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Affiliation(s)
- Angela S. Czaja
- Department of Pediatrics, Section of Critical Care, University of Colorado School of Medicine, Aurora, CO, USA
| | - Richard B. Mink
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Department of Pediatrics, Harbor-UCLA Medical Center and The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Bruce E. Herman
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Pnina Weiss
- Department of Pediatrics, Section of Pulmonology, Allergy, Immunology and Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA
| | | | - Megan L. Curran
- Department of Pediatrics, Section of Rheumatology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Diane E. J. Stafford
- Department of Pediatrics, Division of Endocrinology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Angela L. Myers
- Department of Pediatrics, Children's Mercy, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Melissa L. Langhan
- Department of Pediatrics and Emergency Medicine, Section of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
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Quinonez RB, Broome A, Nesbit S, Tittemore A, Kowlowitz V, Duqum I, Uyan D, Musskopf ML, Phillips K, Moretti A, Mason M, Jacobs A, Brian Z, Simancas-Pallares M, Swift EJ, Ramaswamy V, Guthmiller JM. Developing entrustable professional activities for general dentistry at the University of North Carolina. J Dent Educ 2023; 87:1718-1724. [PMID: 37740716 DOI: 10.1002/jdd.13374] [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: 05/06/2023] [Revised: 08/25/2023] [Accepted: 09/03/2023] [Indexed: 09/25/2023]
Abstract
INTRODUCTION As part of curriculum innovation, the University of North Carolina (UNC) Adams School of Dentistry identified core entrustable professional activities (EPAs) that graduates must demonstrate for practice readiness. This paper describes the development of the UNC EPAs and the perceptions of the general dentistry faculty. METHODS Upon establishing a blueprint of knowledge, skills, and attitudes of UNC graduates, using a distributed leadership approach, faculty teams developed EPAs focused on the patient care process. The American Dental Education Association Compendium of Clinical Competency Assessments and Commission on Dental Accreditation Standards informed the team's work. Perceptions of the assessment framework were examined using a questionnaire completed by 13 general dentistry faculty considering the importance, accuracy, and agreement of each EPA, associated domains of competence, and encounter management on a 6-point rating scale. RESULTS Distributed leadership was a useful strategy in EPA development to disperse decision-making and build ownership. Through multiple iterations, four EPAs (assessment, plan of care, collaborative care, and provision of care) with associated sub-EPAs emerged. EPAs included a description, required knowledge and skills, and rubrics for assessment. The general dentistry faculty reported a high level of importance, accuracy, and agreement with EPAs, domains of competence, and encounter management. DISCUSSION EPAs provide a standardized manner to describe the comprehensive work dentists perform, shifting away from individual competencies. The UNC EPAs provide the foundation for longitudinal measures of competence preparing graduates for independent practice. With limited EPAs frameworks available in dentistry, we aim to inform the development and implementation of EPAs across dental education.
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Affiliation(s)
- Rocio B Quinonez
- University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, North Carolina, USA
| | - Angela Broome
- Division of Diagnostic Sciences, University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, North Carolina, USA
| | - Sam Nesbit
- Division of Comprehensive Oral Health, University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, North Carolina, USA
| | - Ashley Tittemore
- University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, North Carolina, USA
| | - Vicki Kowlowitz
- University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, North Carolina, USA
| | - Ibrahim Duqum
- Division of Comprehensive Oral Health, University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, North Carolina, USA
| | - Dilek Uyan
- Division of Comprehensive Oral Health, University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, North Carolina, USA
| | - Marta L Musskopf
- Division of Comprehensive Oral Health, University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, North Carolina, USA
| | - Keith Phillips
- Division of Comprehensive Oral Health, University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, North Carolina, USA
| | - Antonio Moretti
- Division of Comprehensive Oral Health, University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, North Carolina, USA
| | - Matt Mason
- Division of Comprehensive Oral Health, University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, North Carolina, USA
| | - Alexa Jacobs
- University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, North Carolina, USA
| | - Zachary Brian
- Division of Pediatric and Public Health, University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, North Carolina, USA
| | - Miguel Simancas-Pallares
- Division of Pediatric and Public Health, University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, North Carolina, USA
| | - Edward J Swift
- University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, North Carolina, USA
| | - Vidya Ramaswamy
- University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Janet M Guthmiller
- University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, North Carolina, USA
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Brasel KJ, Lindeman B, Jones A, Sarosi GA, Minter R, Klingensmith ME, Whiting J, Borgstrom D, Buyske J, Mellinger JD. Implementation of Entrustable Professional Activities in General Surgery: Results of a National Pilot Study. Ann Surg 2023; 278:578-586. [PMID: 37436883 DOI: 10.1097/sla.0000000000005991] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
OBJECTIVE The ongoing complexity of general surgery training has led to an increased focus on ensuring the competence of graduating residents. Entrustable professional activities (EPAs) are units of professional practice that provide an assessment framework to drive competency-based education. The American Board of Surgery convened a group from the American College of Surgeons, Accreditation Council for Graduate Medical Education (ACGME) Surgery Review Committee, and Association of Program Directors in Surgery to develop and implement EPAs in a pilot group of residency programs across the country. The objective of this pilot study was to determine the feasibility and utility of EPAs in general surgery resident training. METHODS 5 EPAs were chosen based on the most common procedures reported in ACGME case logs and by practicing general surgeons (right lower quadrant pain, biliary disease, inguinal hernia), along with common activities covering additional ACGME milestones (performing a consult, care of a trauma patient). Levels of entrustment assigned (1 to 5) were observation only, direct supervision, indirect supervision, unsupervised, and teaching others. Participating in site recruitment and faculty development occurred from 2017 to 2018. EPA implementation at individual residency programs began on July 1, 2018, and was completed on June 30, 2020. Each site was assigned 2 EPAs to implement and collected EPA microassessments on residents for those EPAs. The site clinical competency committees (CCC) used these microassessments to make summative entrustment decisions. Data submitted to the independent deidentified data repository every 6 months included the number of microassessments collected per resident per EPA and CCC summative entrustment decisions. RESULTS Twenty-eight sites were selected to participate in the program and represented geographic and size variability, community, and university-based programs. Over the course of the 2-year pilot programs reported on 14 to 180 residents. Overall, 6,272 formative microassessments were collected (range, 0 to 1144 per site). Each resident had between 0 and 184 microassessments. The mean number of microassessments per resident was 5.6 (SD = 13.4) with a median of 1 [interquartile range (IQR) = 6]. There were 1,763 summative entrustment ratings assigned to 497 unique residents. The average number of observations for entrustment was 3.24 (SD 3.61) with a median of 2 (IQR 3). In general, PGY1 residents were entrusted at the level of direct supervision and PGY5 residents were entrusted at unsupervised practice or teaching others. For each EPA other than the consult EPA, the degree of entrustment reported by the CCC increased by resident level. CONCLUSIONS These data provide evidence that widespread implementation of EPAs across general surgery programs is possible, but variable. They provide meaningful data that graduating chief residents are entrusted by their faculty to perform without supervision for several common general surgical procedures and highlight areas to target for the successful widespread implementation of EPAs.
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Affiliation(s)
- Karen J Brasel
- Department of Surgery, Oregon Health and Science University, Portland, OR
| | - Brenessa Lindeman
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | | | - George A Sarosi
- Department of Surgery, University of Florida, Gainesville, FL
| | - Rebecca Minter
- Department of Surgery, University of Wisconsin, Madison, WI
| | - Mary E Klingensmith
- Accreditation Council for Graduate Medical Education, Chicago, IL
- Department of Surgery, Washington University in St. Louis, St. Louis, MO
| | - James Whiting
- Department of Surgery, Maine Medical Center, Portland, ME
| | - David Borgstrom
- Department of Surgery, University of West Virginia, Morgantown, WV
| | - Jo Buyske
- American Board of Surgery, Philadelphia, PA
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Krecko LK, Jung S, Martin S, Krebsbach C, Rosser AA, Stahl C, Varley P, Greenberg J, Minter RM. Enhancing the Value of Surgical Entrustable Professional Activities through Integrative Learning Analytics. JOURNAL OF SURGICAL EDUCATION 2023; 80:1370-1377. [PMID: 37596105 DOI: 10.1016/j.jsurg.2023.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/16/2023] [Accepted: 07/23/2023] [Indexed: 08/20/2023]
Abstract
OBJECTIVE To demonstrate the value of integrating surgical resident Entrustable Professional Activity (EPA) data into a learning analytics platform that provides meaningful feedback for formative and summative decision-making. DESIGN Description of the Surgical Entrustable Professional Activities (SEPA) analytics dashboard, and examples of summary analytics and intuitive display features. SETTING Department of Surgery, University of Wisconsin Hospital and Clinics. PARTICIPANTS Surgery residents, faculty, and residency program administrators. RESULTS We outline the major functionalities of the SEPA dashboard and offer concrete examples of how these features are utilized by various stakeholders to support progressive entrustment decisions for surgical residents. CONCLUSIONS Our intuitive analytics platform allows for seamless integration of SEPA microassessment data to support Clinical Competency Committee (CCC) decisions for resident evaluation and provides point of training feedback to faculty and trainees in support of progressive autonomy.
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Affiliation(s)
- Laura K Krecko
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Sarah Jung
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Shaun Martin
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Craig Krebsbach
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | - Christopher Stahl
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Patrick Varley
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Jacob Greenberg
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Rebecca M Minter
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
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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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Edwards C, Perry R, Chester D, Childs J. Entrustable professional activities of graduate accredited General Medical Sonographers in Australia - Industry perceptions. J Med Radiat Sci 2023; 70:229-238. [PMID: 37029950 PMCID: PMC10500106 DOI: 10.1002/jmrs.676] [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: 01/11/2023] [Accepted: 03/20/2023] [Indexed: 04/09/2023] Open
Abstract
INTRODUCTION Linking individual competencies to entrustable professional tasks provides a holistic view of Sonography graduate work readiness. The Australian Sonographers Accreditation Registry (ASAR) publishes a set of entrustable professional activities (EPAs) as part of its Standards for Accreditation of Sonography Courses. EPAs are distinct ultrasound examinations grouped within six critical practice units. This study reports on industry perspectives of current EPAs and their classification for graduates completing general sonography courses in Australia. The article also examines the value of EPAs and links their function to the assessment of graduate competency. METHODS An online survey tool elicited stakeholder feedback on graduate EPAs across six critical practice units and the potential for including a new Paediatric unit. From an original sample size of 655, 309 responded to questions about general sonography courses. RESULTS A majority (55.3%) recommended no changes to the existing EPA list, and 44.7% recommended amending the list. From respondents that recommended changes (138/309), all current EPAs received >80% agreement to be retained; in addition, nine new examinations received >70% agreement for inclusion at the graduate level. Whilst 42.7% (132/309) supported the current ASAR model requiring competency in five out of six critical practice units, 45.6% (141/309) recommended increasing it to all six. There was limited support, 11.7% (36/309), to reduce this number. Responding to the potential to add a new Paediatric specific critical practice unit, 61.8% (181/293) recommended its inclusion. CONCLUSIONS The findings demonstrate that the current list of EPAs aligns with industry expectations. In contrast, there are divergent views on the modelling and grouping of critical practice units. The article's critical analysis of the results and implications provides stakeholders with a practical approach to clinical teaching and EPA assessment, and helps to inform any review of accreditation standards.
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Affiliation(s)
- Christopher Edwards
- School of Clinical Sciences, Faculty of HealthQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - Rebecca Perry
- Allied Health and Human PerformanceUniversity of South AustraliaAdelaideSouth AustraliaAustralia
| | - Deanne Chester
- School of Health, Medical and Applied SciencesCentral Queensland UniversityBrisbaneQueenslandAustralia
| | - Jessie Childs
- Allied Health and Human PerformanceUniversity of South AustraliaAdelaideSouth AustraliaAustralia
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Abeyaratne C, Vienet M, Galbraith K. Development and Validation of Entrustable Professional Activities for Provisionally Registered (Intern) Pharmacists in Australia. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2023; 87:100036. [PMID: 37714661 DOI: 10.1016/j.ajpe.2022.12.005] [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: 08/09/2022] [Revised: 11/27/2022] [Accepted: 12/02/2022] [Indexed: 09/17/2023]
Abstract
OBJECTIVE The purpose of this study was to describe the development and validation of entrustable professional activities (EPAs) for a pharmacy intern training program in Australia. METHODS Performance outcomes with EPAs suggested as an assessment in the intern year were identified and EPAs were developed. The EQual rubric, designed for EPAs in graduate medical education settings, was used to validate the EPAs. Eight subject matter experts were recruited to validate 14 EPAs using prespecified cutoffs in the EQual rubric to determine the degree of alignment with established key domains of the EPA construct. Descriptive statistics for the EQual rubric scores were calculated for each of the 14 EPAs overall and for each of the 3 domains. Any EPA falling below the prespecified cut score required revisions and a second round of validation. RESULTS Eight responses were recorded for the first round of validation. Seven EPAs were below the discrete units of work cutoff (4.17); 2 of these EPAs were also below the EPA curricular role cutoff (4.00). All scores described in the EPAs as entrustable, essential, and important tasks of the profession were above the cutoff (4.00). Seven subject matter experts responded to the second round of validation. All 7 revised EPAs scored above the EQual rubric's overall cutoff of 4.07. CONCLUSION Fourteen EPAs were validated for use with provisionally registered (intern) pharmacists. To our knowledge, this is the first time that the EQual rubric has been used in the evaluation and validation of pharmacy EPAs.
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Affiliation(s)
- Carmen Abeyaratne
- Monash University, Faculty of Pharmacy and Pharmaceutical Sciences, Parkville, Australia.
| | - Michelle Vienet
- Monash University, Faculty of Pharmacy and Pharmaceutical Sciences, Parkville, Australia
| | - Kirsten Galbraith
- Monash University, Faculty of Pharmacy and Pharmaceutical Sciences, Parkville, Australia
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Pool I, Hofstra S, van der Horst M, Ten Cate O. Transdisciplinary entrustable professional activities. MEDICAL TEACHER 2023; 45:1019-1024. [PMID: 36708704 DOI: 10.1080/0142159x.2023.2170778] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Healthcare has become highly specialized. Specialists, in medicine as well as in nursing, determine much of the high quality of current health care. But healthcare has also become increasingly fragmented, with professionals trained in separate postgraduate silos, with boundaries often difficult to cross. While a century ago, generalists dominated patient care provision, now specialists prevail and risk becoming alienated from each other, losing the ability to adapt to neighboring professional domains. Current health care requires a flexible workforce, ready to serve in multiple contexts, as the COVID-19 crisis has shown.The new concept of transdisciplinary entrustable professional activities, EPAs applicable in more than one specialty, was recently conceived to enhance collaboration and transfer between educational programs in postgraduate nursing in the Netherlands.In this paper, we reflect on our experiences so far, and on practical and conceptual issues concerning transdisciplinary EPAs, such as: who should define, train, assess, and register transdisciplinary EPAs? How can different prior education prepare for similar EPAs? And how do transdisciplinary EPAs affect professional identity?We believe that transdisciplinary EPAs can contribute to creating more flexible curricula and hence to a more coherent, collaborative healthcare workforce, less determined by the boundaries of traditional specialties.
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Affiliation(s)
- Inge Pool
- Isala Academy, Isala Hospitals, Zwolle, The Netherlands
| | - Saskia Hofstra
- Health Academy, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Olle Ten Cate
- Utrecht Center for Research and Development of Health Professions Education, University Medical Center Utrecht, Utrecht, The Netherlands
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Hirvonen J, Becker M, Aronen HJ. Resident education in radiology in Europe including entrustable professional activities: results of an ESR survey. Insights Imaging 2023; 14:139. [PMID: 37606861 PMCID: PMC10444922 DOI: 10.1186/s13244-023-01489-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 07/25/2023] [Indexed: 08/23/2023] Open
Abstract
Entrustable professional activity (EPA) is a tool for comprehensively evaluating the level of confidence in resident performances across various competencies in medicine. The application of and attitudes towards EPAs in radiology across the European Society of Radiology (ESR) national institutional member societies is still to be determined. An online survey was conducted among ESR national institutional member societies to assess the current use of EPAs and other resident assessment forms among different countries.Although the primary focus was on the use of EPAs, additional questions also addressed the adherence of training programs to the European Training Curriculum (ETC), other methods of continuous assessment, and examinations. A total of 65 responses were received from 38 countries (81% response rate among national institutional member societies). EPAs were being used in radiology in 21% of countries and planned to be used in 26%. Most responders considered EPAs suitable for radiology and, regarding the future, preferred European-level guidelines on EPAs over national or institutional levels. The majority (63%) of national training programs were reported to be similar to or following the content of the ETC, and the majority (95%) of countries rated the requirements of the European Training Curriculum (ETC) to be adequate. In conclusion, EPAs are beginning to be used in radiology resident training programs across Europe, and their use is expected to increase. There seems to be a positive attitude toward using EPAs in radiology and toward a common European framework.Critical relevance statement As a result of this survey, we found positive attitudes towards using entrustable professional activities (EPA) in radiology among the institutional member societies of the European Society of Radiology (ESR).Key points• Twenty-one percent of national member societies use entrustable professional activities (EPA) in radiology.• There is a positive attitude toward using EPAs in radiology.• Majority of respondents preferred a common European framework for EPAs.• Majority of radiology training curricula adhere to the European Training Curriculum (ETC).
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O'Connor P, Reid A, Mongan O, Egan C, Reid-McDermott B, Augusthinose PP, Smith M, Cooney R, Byrne D. An assessment of the simulated performance of basic clinical procedures by junior doctors during the first year of clinical practice. BMC MEDICAL EDUCATION 2023; 23:565. [PMID: 37559003 PMCID: PMC10413605 DOI: 10.1186/s12909-023-04545-1] [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: 03/22/2023] [Accepted: 07/27/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Upon entering the healthcare system, junior doctors may lack the skills required to care for patients, and feel unprepared for their role, with considerable variation in the level of proficiency in the performance of particular clinical procedures. OBJECTIVE To compare the performance and proficiency (self-report and observed) of the performance of nine basic clinical procedures. METHODS Seventeen interns were observed performing nine clinical procedures in a simulated setting in June 2021 (Assessment 1) and January 2022 (Assessment 2). The observers identified whether each step in the procedure was performed correctly, and provided an overall assessment of proficiency. The participants also rated their own level proficiency. RESULTS At Assessment 1 the number of steps performed correctly ranged from a mean of 41.9-83.5%. At Assessment 2 the number of steps performed correctly ranged from a mean of 41.9-97.8%. The most common median proficiency rating for Assessment 1 was 'close supervision', and was 'indirect supervision' at Assessment 2. There was a significant and large effect size in the improvement in performance from Assessment 1 to Assessment 2. Low correlations were found between observer and self-reported proficiency in performance of the procedures. CONCLUSIONS The large improvement in performance across the two assessments is encouraging. However, there is a need to address the variability in performance on graduation from medical school, and to ensure that any assessment of proficiency is not only reliant on self-report.
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Affiliation(s)
- Paul O'Connor
- Department of General Practice, School of Medicine, University of Galway, 1 Distillery Road, Newcastle, Co Galway, Galway, H91 TK33, Ireland.
- Irish Centre for Applied Patient Safety and Simulation, University of Galway, Galway, Ireland.
| | - Ambyr Reid
- Irish Centre for Applied Patient Safety and Simulation, University of Galway, Galway, Ireland
- School of Medicine, University of Galway, Galway, Ireland
| | - Orla Mongan
- Irish Centre for Applied Patient Safety and Simulation, University of Galway, Galway, Ireland
- School of Medicine, University of Galway, Galway, Ireland
| | - Cara Egan
- Irish Centre for Applied Patient Safety and Simulation, University of Galway, Galway, Ireland
- School of Medicine, University of Galway, Galway, Ireland
| | - Bronwyn Reid-McDermott
- Irish Centre for Applied Patient Safety and Simulation, University of Galway, Galway, Ireland
- School of Medicine, University of Galway, Galway, Ireland
| | - Philip Parackal Augusthinose
- Irish Centre for Applied Patient Safety and Simulation, University of Galway, Galway, Ireland
- Saolta University Health Care Group, Galway, Ireland
| | - Michael Smith
- Irish Centre for Applied Patient Safety and Simulation, University of Galway, Galway, Ireland
- School of Medicine, University of Galway, Galway, Ireland
| | - Ruth Cooney
- Irish Centre for Applied Patient Safety and Simulation, University of Galway, Galway, Ireland
- Saolta University Health Care Group, Galway, Ireland
| | - Dara Byrne
- Irish Centre for Applied Patient Safety and Simulation, University of Galway, Galway, Ireland
- School of Medicine, University of Galway, Galway, Ireland
- Saolta University Health Care Group, Galway, Ireland
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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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Moore SJ, Egerton T, Merolli M, Lees J, La Scala N, Parry SM. Inconsistently reporting post-licensure EPA specifications in different clinical professions hampers fidelity and practice translation: a scoping review. BMC MEDICAL EDUCATION 2023; 23:372. [PMID: 37226147 DOI: 10.1186/s12909-023-04364-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 05/16/2023] [Indexed: 05/26/2023]
Abstract
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.
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Affiliation(s)
- Sonya J Moore
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Level 7, Alan Gilbert Building, Victoria, 3010, Australia.
| | - Thorlene Egerton
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Level 7, Alan Gilbert Building, Victoria, 3010, Australia
| | - Mark Merolli
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Level 7, Alan Gilbert Building, Victoria, 3010, Australia
| | - Jessica Lees
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Level 7, Alan Gilbert Building, Victoria, 3010, Australia
- Faculty of Health and Centre for Research in Assessment and Digital Learning, Deakin University, Deakin, Australia
| | - Nino La Scala
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Level 7, Alan Gilbert Building, Victoria, 3010, Australia
| | - Selina M Parry
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Level 7, Alan Gilbert Building, Victoria, 3010, Australia
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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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Paterson QS, Alrimawi H, Sample S, Bouwsema M, Anjum O, Vincent M, Cheung WJ, Hall A, Woods R, Martin LJ, Chan T. Examining enablers and barriers to entrustable professional activity acquisition using the theoretical domains framework: A qualitative framework analysis study. AEM EDUCATION AND TRAINING 2023; 7:e10849. [PMID: 36994315 PMCID: PMC10041073 DOI: 10.1002/aet2.10849] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/20/2023] [Accepted: 01/29/2023] [Indexed: 06/19/2023]
Abstract
Background Without a clear understanding of the factors contributing to the effective acquisition of high-quality entrustable professional activity (EPA) assessments, trainees, supervising faculty, and training programs may lack appropriate strategies for successful EPA implementation and utilization. The purpose of this study was to identify barriers and facilitators to acquiring high-quality EPA assessments in Canadian emergency medicine (EM) training programs. Methods We conducted a qualitative framework analysis study utilizing the Theoretical Domains Framework (TDF). Semistructured interviews of EM resident and faculty participants underwent audio recording, deidentification, and line-by-line coding by two authors, being coded to extract themes and subthemes across the domains of the TDF. Results From 14 interviews (eight faculty and six residents) we identified, within the 14 TDF domains, major themes and subthemes for barriers and facilitators to EPA acquisition for both faculty and residents. The two most cited domains (and their frequencies) among residents and faculty were environmental context and resources (56) and behavioral regulation (48). Example strategies to improving EPA acquisition include orienting residents to the competency-based medical education (CBME) paradigm, recalibrating expectations relating to "low ratings" on EPAs, engaging in continuous faculty development to ensure familiarity and fluency with EPAs, and implementing longitudinal coaching programs between residents and faculty to encourage repetitive longitudinal interactions and high-quality specific feedback. Conclusions We identified key strategies to support residents, faculty, programs, and institutions in overcoming barriers and improving EPA assessment processes. This is an important step toward ensuring the successful implementation of CBME and the effective operationalization of EPAs within EM training programs.
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Affiliation(s)
- Quinten S. Paterson
- Department of Emergency MedicineUniversity of SaskatchewanSaskatoonSaskatchewanCanada
| | - Hussein Alrimawi
- Emergency Medicine Division, Department of MedicineMcMaster UniversityHamiltonOntarioCanada
| | - Spencer Sample
- Emergency Medicine Division, Department of MedicineMcMaster UniversityHamiltonOntarioCanada
| | - Melissa Bouwsema
- Department of Emergency MedicineQueens UniversityKingstonOntarioCanada
| | - Omar Anjum
- Department of Emergency MedicineUniversity of OttawaOttawaOntarioCanada
| | - Maggie Vincent
- Emergency Medicine Division, Department of MedicineMcMaster UniversityHamiltonOntarioCanada
| | - Warren J. Cheung
- Department of Emergency MedicineUniversity of OttawaOttawaOntarioCanada
| | - Andrew Hall
- Department of Emergency MedicineQueens UniversityKingstonOntarioCanada
- Department of Emergency MedicineUniversity of OttawaOttawaOntarioCanada
| | - Rob Woods
- Department of Emergency MedicineUniversity of SaskatchewanSaskatoonSaskatchewanCanada
| | - Lynsey J. Martin
- Department of Emergency MedicineUniversity of SaskatchewanSaskatoonSaskatchewanCanada
| | - Teresa Chan
- Emergency Medicine Division, Department of MedicineMcMaster UniversityHamiltonOntarioCanada
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Villaizán Pérez C, Aparicio Rodrigo M, Kovacs A, Barak S, Calamita P, Dejak Gornik K, Jaeger-Roman E, Kartousova B, Katz M, Rafele I, Reali L, Reingold S, Sauseng W, Fehr F. Entrustable Professional Activities for the Training of Postgraduate Primary Care Pediatricians. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:468-472. [PMID: 36584098 DOI: 10.1097/acm.0000000000005132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PROBLEM Competency-based training is a model of medical education program that uses an organized framework of competencies to develop entrustable professional activities (EPAs) for each specialty. Implementation of EPAs varies by medical specialty and country. Although national models for primary care pediatrics have been suggested in the past, standardized EPAs have not been established. APPROACH The authors, all members of the curriculum working group of the European Confederation of Primary Care Paediatricians, describe the development and design of a training model based on EPAs specifically for pediatricians in primary care. The objective was to facilitate and disseminate a training model that standardizes and improves training in primary care pediatrics. They aimed to make the model flexible enough so that it can be adapted to different training models and different European health systems. OUTCOMES Between May 2017 and December 2019, the authors developed a framework that includes 7 domains of competencies for the training in pediatric primary care and a set of 11 core EPAs to guide the learning process. They structured each EPA as follows: title, activity profile, domains of competence, competencies within each domain, required knowledge and skills, learning objectives described in terms of outcomes, and a 3-stage rating supervision scale to evaluate the level of performance. NEXT STEPS The next step is the progressive implementation of these EPAs into the postgraduate primary care pediatrics training programs of European health systems. To support this implementation, the authors intend to develop training videos to assist in daily teaching of the EPAs. The authors will also develop a pan-European online resident forum designed specifically to facilitate EPA learning by sharing and discussing clinical cases. They plan to launch a pilot study on the use of the EPAs in primary care health centers in 6 European countries.
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Affiliation(s)
- Carmen Villaizán Pérez
- C. Villaizán Pérez is chair of the European Confederation of Primary Care Paediatricians curriculum working groupa primary care pediatrician, Toledo, Spain
| | - María Aparicio Rodrigo
- M. Aparicio Rodrigo is a primary care pediatrician and associate professor, Department of Pediatrics, Complutense University of Madrid, Madrid, Spain
| | - Akos Kovacs
- A. Kovacs is a primary care pediatrician, Budapest, Hungary
| | - Shimon Barak
- S. Barak is a primary care pediatrician, Maccabi Healthcare Services, and senior pediatrician, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | | | - Elke Jaeger-Roman
- E. Jaeger-Roman was a primary care pediatrician, Berlin, Germany, at the time of writing
| | - Beata Kartousova
- B. Kartousova is a primary care pediatrician, Bratislava, Slovakia
| | - Manuel Katz
- M. Katz is a primary care pediatrician, Be'er Sheva, Israel
| | | | - Laura Reali
- L. Reali is a primary care pediatrician, Rome, Italy
| | - Stephen Reingold
- S. Reingold is medical officer, Maternal and Child Health, Preventive Health Services, Jerusalem, Israel
| | - Werner Sauseng
- W. Sauseng is a primary care pediatrician, Kumberg, Austria
| | - Folkert Fehr
- F. Fehr is a primary care pediatrician and university teacher, Department of Pediatrics, Heidelberg University, Sinsheim, Germany
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Nel D, Jonas E, Burch V, Nel A, Cairncross L, Alseidi A, George B, Ten Cate O. Entrustable professional activities in postgraduate general surgery training: a scoping review protocol. BMJ Open 2023; 13:e067322. [PMID: 36921948 PMCID: PMC10030674 DOI: 10.1136/bmjopen-2022-067322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
INTRODUCTION The competency-based medical education (CBME) movement continues to gain momentum in postgraduate physician training, resulting in increasing interest among surgical training programmes on how to implement it effectively. Entrustable professional activities (EPAs) were introduced to connect competencies (characteristics/abilities of learners) and the professional activities to be entrusted to them on qualification/graduation. Although reviews related to the field of general surgery have been published on specific aspects of CBME, for example, workplace-based assessment, there is a paucity of published guidance available for surgeon-educators to plan and implement CBME using an EPA framework. This scoping review aims to provide an overview of the current use of EPAs in general surgery. METHODS AND ANALYSIS This scoping review will be based on the original five-stage approach described by Arksey and O'Malley with the addition of protocol-specific items from the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols extension for scoping reviews. The primary research question focuses on describing how EPAs have been used in general surgery and where potential gaps remain that warrant further study. The review will include peer-reviewed journal publications and an extensive review of grey literature sources. The following databases will be searched for published literature from 1 January 2005 to 31 December 2022: PubMed; CINAHL, Africa-Wide Information, PsycInfo and ERIC (via EBSCOhost); Scopus; and SciELO (via Web of Science). Studies that describe the use of EPAs for curriculum design, teaching and/or assessment of competence in postgraduate general surgery training will be eligible for inclusion. ETHICS AND DISSEMINATION The institutional ethics board of the University of Cape Town has granted a waiver of formal approval requirement. The dissemination strategy includes publication of results in peer-reviewed journals, presentation at international conferences and presentation to relevant stakeholders as deemed appropriate.
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Affiliation(s)
- Daniel Nel
- Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Eduard Jonas
- Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Vanessa Burch
- Department of Medicine, Groote Schuur Hospital and University of Cape Town, and the Colleges of Medicine of South Africa, Cape Town, South Africa
| | - Amy Nel
- Department of Public Health, University of Cape Town, Cape Town, South Africa
| | - Lydia Cairncross
- Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Adnan Alseidi
- Department of Surgery, University of California San Francisco, San Francisco, California, USA
| | - Brian George
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Olle Ten Cate
- Center for Research and Development of Education, UMC Utrecht, Utrecht, Netherlands
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Hoyler MM, Pryor KO, Gotian R, Brumberger ED, Chan JM. Resident Physicians as Clinical Educators in Anesthesiology: A Narrative Review. Anesth Analg 2023; 136:270-281. [PMID: 36638511 DOI: 10.1213/ane.0000000000006243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The importance of resident physicians as clinical educators is widely acknowledged in many clinical specialties and by national accreditation organizations for medical education. Within anesthesiology training programs, there is growing attention to the role of trainees as clinical educators. This narrative review describes the theoretical and demonstrated benefits of clinical teaching by residents in anesthesiology and other medical fields, summarizes current efforts to support and promote residents as educators, and suggests ways in which anesthesiology training programs can further assess and develop the role of residents as clinical educators.
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Affiliation(s)
- Marguerite M Hoyler
- From the Department of Anesthesiology, Weill Cornell Medicine/New York Presbyterian Hospital, New York, New York
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Looi JC, Bonner D, Maguire PA, Brazel M, Keightley P, Reay RE, Tedeschi M. Commentary on alignment of medical student assessment and vocational training in psychiatry and addiction medicine. Australas Psychiatry 2023; 31:220-223. [PMID: 36710072 PMCID: PMC10088331 DOI: 10.1177/10398562231153010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To comment upon the potential for alignment of medical student assessment and vocational specialist training through the RANZCP-CanMEDS model of Entrustable Professional Activities (EPAs) and Workplace-Based Assessments (WBAs). We discuss a specific post hoc example of such an alignment in an Australian graduate medical school in Psychiatry and Addiction Medicine. CONCLUSIONS Vocational training models of assessment, such as the RANZCP specialist training program for psychiatrists, can potentially be mapped to medical student education in formative and summative assessment through CanMEDs-based EPAs and WBAs, to assist in transition to specialist training.
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Affiliation(s)
- Jeffrey Cl Looi
- Academic Unit of Psychiatry and Addiction Medicine, 104822The Australian National University School of Medicine and Psychology, Canberra Hospital, Canberra, ACT, Australia
| | - Daniel Bonner
- Academic Unit of Psychiatry and Addiction Medicine, 104822The Australian National University School of Medicine and Psychology, Canberra Hospital, Canberra, ACT, Australia
| | - Paul A Maguire
- Academic Unit of Psychiatry and Addiction Medicine, 104822The Australian National University School of Medicine and Psychology, Canberra Hospital, Canberra, ACT, Australia
| | - Matthew Brazel
- Academic Unit of Psychiatry and Addiction Medicine, 104822The Australian National University School of Medicine and Psychology, Canberra Hospital, Canberra, ACT, Australia
| | - Philip Keightley
- Academic Unit of Psychiatry and Addiction Medicine, 104822The Australian National University School of Medicine and Psychology, Canberra Hospital, Canberra, ACT, Australia
| | - Rebecca E Reay
- Academic Unit of Psychiatry and Addiction Medicine, 104822The Australian National University School of Medicine and Psychology, Canberra Hospital, Canberra, ACT, Australia
| | - Michael Tedeschi
- Academic Unit of Psychiatry and Addiction Medicine, 104822The Australian National University School of Medicine and Psychology, Canberra Hospital, Canberra, ACT, Australia
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de Raad T, Wiersma F, Kuilman L, Ten Cate O. The Fate of Entrustable Professional Activities After Graduation: A Survey Study Among Graduated Physician Assistants. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023; 43:28-33. [PMID: 36728984 PMCID: PMC9973427 DOI: 10.1097/ceh.0000000000000467] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Entrustable professional activities (EPAs) are used during training but may also have significance after graduation. This domain has not yet been much explored. We investigated the use of EPAs among alumni of Master Physician Assistant programs in the Netherlands, where EPAs have been used since 2010. We aim to describe if and how EPAs have a role after graduation. Are EPAs used for continuous entrustment decisions or when shifting work settings? METHODS In September 2020, all registered Dutch physician assistants (PAs) ( n = 1441) were invited to participate in a voluntary, anonymous survey focusing on the use of EPAs after graduation. Survey items included questions regarding the use and usefulness of EPAs, views on continuous entrustment decisions, and how PAs document their competence. RESULTS A total of 421 PAs (response rate 29%) yielded information about the significance of EPAs after training. Among the respondents, 60% ( n = 252) reported adding new competencies and skills after graduation. One-third ( n = 120) of the respondents were trained in EPA-based programs. Almost all EPA-trained PAs (96%; n = 103) considered the EPA structure suitable to maintain and renew entrustment. Furthermore, PAs reported continued use of the EPA framework to seek formal qualifications through entrustment decisions. CONCLUSION This study shows that EPAs can play an ongoing role for PAs after graduation. EPA-trained PAs overwhelmingly support the continuous use of the EPA framework for entrustment decisions from graduation until retirement.
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Affiliation(s)
- Timo de Raad
- Mr. de Raad : Physician Assistant and Educator, Department of Pediatrics, University Medical Centre Utrecht, Utrecht, the Netherlands.Dr. Wiersma : Staff Member of the MSc Physician Assistant Program at the University of Applied Sciences, Utrecht, the Netherlands. Dr. Kuilman : Program Manager of the MSc Physician Assistant Program at the Hanze University of Applied Sciences, Groningen, the Netherlands, and Adjunct Professor, Department of Physician Assistant Studies, College of Health and Human Service, Northern Arizona University, Phoenix BMC, AZ. Dr. ten Cate : Professor of Medical Education and Senior Scientist, Utrecht Center for Research and Development of Health Professions Education, University Medical Center Utrecht, Utrecht, the Netherlands
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Kim ME, Tretter J, Wilmot I, Hahn E, Redington A, McMahon CJ. Entrustable Professional Activities and Their Relevance to Pediatric Cardiology Training. Pediatr Cardiol 2022; 44:757-768. [PMID: 36576524 PMCID: PMC9795145 DOI: 10.1007/s00246-022-03067-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 11/29/2022] [Indexed: 12/29/2022]
Abstract
Entrustable professional activities (EPAs) have become a popular framework for medical trainee assessment and a supplemental component for milestone and competency assessment. EPAs were developed to facilitate assessment of competencies and furthermore to facilitate translation into clinical practice. In this review, we explore the rationale for the introduction of EPAs, examine whether they fulfill the promise expected of them, and contemplate further developments in their application with specific reference to training in pediatric cardiology.
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Affiliation(s)
- Michael E. Kim
- Department of Pediatrics, College of Medicine, Heart Institute, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH USA
| | - Justin Tretter
- Department of Pediatric Cardiology, Pediatric Institute, Cleveland Clinic Children’s, and The Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, M-41, Cleveland, OH 44195 USA
| | - Ivan Wilmot
- Department of Pediatrics, College of Medicine, Heart Institute, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH USA
| | - Eunice Hahn
- Department of Pediatrics, College of Medicine, Heart Institute, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH USA
| | - Andrew Redington
- Department of Pediatrics, College of Medicine, Heart Institute, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH USA
| | - Colin J. McMahon
- Department of Paediatric Cardiology, Children’s Health Ireland at Crumlin, Crumlin, Dublin Ireland ,School of Medicine, University College Dublin, Dublin 4, Belfield, Ireland ,School of Health Professions Education, Maastricht University, Maastricht, Netherlands
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Prescott-Clements L, Soreskog-Turp J, Crawford B, Williams K. The Development and Implementation of a National Veterinary Graduate Development Programme (VetGDP) to Support Veterinarians Entering the UK Workforce. JOURNAL OF VETERINARY MEDICAL EDUCATION 2022:e20220112. [PMID: 36538366 DOI: 10.3138/jvme-2022-0112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The UK veterinary profession is facing significant challenges, including high rates of veterinarians leaving the profession amidst workforce shortages, alongside high levels of dissatisfaction, stress, and poor mental health. The highest rates of attrition are associated with veterinarians who have recently graduated and are at an early stage in their careers. Although there may be many contributory factors, a lack of adequate support during the transition from vet school into their first professional role following graduation may be one important cause. Consequently, it has never been more important to develop an effective system for supporting new graduates, which is accessible to all. A new Veterinary Graduate Development Programme (VetGDP) has been developed, using a framework of professional activities that are sufficiently flexible to create a bespoke, individualized program for each graduate depending on the role they enter. Each new graduate is assigned a dedicated coach (Adviser) within their workplace, who has been trained to provide effective support and has committed to doing so throughout the program. VetGDP has been implemented on a national scale in the UK; engagement is assured through the RCVS Code of Professional Conduct and quality assurance is in place. VetGDP has been developed using established educational, sociocultural, and behavioral theories, and the latest research in coaching and feedback within medical education. These methods, which aim to ensure there is the best possible impact on graduates' professional development, and the creation of a positive learning culture within the workplace, are taught to all Advisers via an e-learning package.
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Affiliation(s)
- Linda Prescott-Clements
- Royal College of Veterinary Surgeons (RCVS), The Cursitor, 38 Chancery Lane, London, WC2A 1EN UK
| | - Jenny Soreskog-Turp
- Royal College of Veterinary Surgeons (RCVS), The Cursitor, 38 Chancery Lane, London, WC2A 1EN UK
| | - Britta Crawford
- Royal College of Veterinary Surgeons (RCVS), The Cursitor, 38 Chancery Lane, London, WC2A 1EN UK
| | - Kirsty Williams
- Royal College of Veterinary Surgeons (RCVS), The Cursitor, 38 Chancery Lane, London, WC2A 1EN UK
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Gandomkar R, Zaeri R, Ten Cate O. Expectations for PhDs in health professions education: an international EPA-framed, modified Delphi study. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022; 27:1443-1456. [PMID: 35836036 DOI: 10.1007/s10459-022-10136-4] [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: 12/17/2021] [Accepted: 06/11/2022] [Indexed: 06/15/2023]
Abstract
Health professions education (HPE) has matured into field of study that employs and produces specialized educational scholars. Many academic institutions employ such scholars to support development and innovation in education. Simultaneously, the possibilities to obtain a PhD degree in HPE are expanding. Clarity in the expectations that such a degree brings along can be useful for scholars, employers and institutions. Anticipating that the views of what a PhD in HPE is or should be can vary between institutions, cultures and countries, we conducted an international Delphi study to identify EPAs for HPE PhDs. We used a framework of 24 EPAs resulted from a national consensus study in Iran as input to seek more generalized validity and a wider consensus of reasonably suitable activities. A three-round modified Delphi study was conducted with participation of 15 international experts. Final framework consisted of 17 relevant EPAs with a justification, specifications and limitations, and risks in case of failure per EPA (all had overall CVI > 0.8 for adequacy of description). Eleven EPAs were considered by the majority to be core to PhD training, 16 to be desirable for HPE PhDs as a capability to carry out without supervision, but the majority would trust current HPE PhDs to carry out only 5 of the 17 without supervision. The EPAs identified in this study arguably reflect the expectations of educators with a PhD degree in HPE. The framework has the potential to advance HPE training across countries and to inform personal development and employment decisions.
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Affiliation(s)
- Roghayeh Gandomkar
- Health Professions Education Research Center, Tehran University of Medical Sciences, Tehran, Iran.
- Department of Medical Education, School of Medicine, Tehran University of Medical Sciences, No. 57, Hojjatdust Alley, Naderi St., Keshavarz Blvd., Tehran, Iran.
| | - Reza Zaeri
- Department of Medical Education, School of Medicine, Tehran University of Medical Sciences, No. 57, Hojjatdust Alley, Naderi St., Keshavarz Blvd., Tehran, Iran
| | - Olle Ten Cate
- Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands
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Maundu J, Galbraith K, Croft H, Clark B, Kirsa S, Wilkinson G, Abeyaratne C. Development of
workplace‐based
assessment tools to support postgraduate training of provisionally registered pharmacists in Australia. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022. [DOI: 10.1002/jac5.1714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Josephine Maundu
- Australian Pharmacy Council Civic Square Australian Capital Territory Australia
| | - Kirsten Galbraith
- Faculty of Pharmacy and Pharmaceutical Sciences Monash University Parkville Victoria Australia
| | - Hayley Croft
- School of Biomedical Sciences and Pharmacy University of Newcastle Callaghan New South Wales Australia
| | - Bronwyn Clark
- Australian Pharmacy Council Civic Square Australian Capital Territory Australia
| | - Sue Kirsa
- Australian Pharmacy Council Civic Square Australian Capital Territory Australia
| | - Glenys Wilkinson
- Australian Pharmacy Council Civic Square Australian Capital Territory Australia
| | - Carmen Abeyaratne
- Australian Pharmacy Council Civic Square Australian Capital Territory Australia
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Valding B, Monti M, Junod Perron N, Frick S, Jaques C, Nendaz M, Gachoud D. Entrustable professional activities for residency in general internal medicine: a systematic review. Swiss Med Wkly 2022; 152:40002. [PMID: 36473152 DOI: 10.57187/smw.2022.40002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
CONTEXT Entrustable Professional Activities (EPAs) are observable tasks that are regular parts of a physician's daily clinical work. Before being permitted to accomplish these tasks independently, trainees must gain their supervisors' trust. Defining the list of EPAs that should be mastered by the end of a residency is critical to setting clear expectations about autonomous practice. OBJECTIVE To collect all the lists of EPAs defined for residencies in general internal medicine and synthesise them into a reference work useful for developing new lists of EPAs or improving existing ones. METHOD This systematic review searched five databases and relevant grey literature using keywords related to EPAs and postgraduate education, from 2005, when the first article on EPAs was published, to April 2022. Inclusion criteria were the availability of an EPAs list and a focus on general internal medicine. Two reviewers independently selected the studies, extracted data and performed a quality assessment using QATSDD and AACODS tools. Mean values and inter-rater reliability were calculated. RESULTS The review yielded 3292 records, with 16 articles meeting the inclusion criteria, mostly from North America. Synthesising their 16 lists generated 395 EPAs. The reviewers then inductively categoried those EPAs, 308 of which fell into 6 domains, 14 themes and 24 subthemes. The domains were: (1) care and management of the general adult population (n = 103 EPAs); (2) care and management of patients with specific needs (n = 67); (3) care coordination and communication (n = 52); (4) management and leadership (N = 21); (5) healthcare quality, education, and research (n = 41); and (6) miscellaneous (n = 24). The remaining 87 EPAs were disease-specific and did not fit into this categorisation. CONCLUSIONS Categorising EPAs created a unique synthesis of the existing lists of EPAs for educating residents in general internal medicine. This synthesis could be used as a reference for anyone tasked with developing new lists of EPAs or improving existing ones.
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Affiliation(s)
- Bastien Valding
- Department of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Matteo Monti
- Department of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland.,Medical Education Unit, University of Lausanne, Switzerland
| | - Noëlle Junod Perron
- Institute of Primary Care, Geneva University Hospitals, Geneva, Switzerland.,Unit for Development and Research in Medical Education, Faculty of Medicine, Geneva, Switzerland
| | - Sonia Frick
- Department of Internal Medicine, Lachen Hospital, Lachen, Switzerland.,School of Medicine, University of Zürich, Switzerland
| | - Cécile Jaques
- Medical Library, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Mathieu Nendaz
- Unit for Development and Research in Medical Education, Faculty of Medicine, Geneva, Switzerland.,Division of Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - David Gachoud
- Department of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland.,Medical Education Unit, University of Lausanne, Switzerland
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Bramley A, Forsyth A, McKenna L. Development and evaluation of Entrustable Professional Activities embedded in an e-portfolio for work-based assessment in community and public health dietetics. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5445-e5456. [PMID: 35942519 PMCID: PMC10087043 DOI: 10.1111/hsc.13967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 06/02/2022] [Accepted: 07/25/2022] [Indexed: 06/15/2023]
Abstract
Entrustable professional activities (EPAs) is a recent concept that helps operationalise competency-based education. In this paper, we report on the development of EPAs and incorporation into an e-portfolio for work-based assessment of final year dietetics students in a community and public health professional placement. We aimed to determine the utility of the EPAs for work-based assessment in this context. We used action research methodology to conduct broad consultation with students and supervisors using anonymous surveys and focus groups to understand their beliefs and attitudes towards work-based assessment. Consequently, 40 EPAs with an accompanying four-point entrustment scale were developed and mapped to the National Competency Standards for Dietitians in Australia. The EPAs and assessment tool were piloted and evaluated via an anonymous online user survey across three cohorts of students (n = 133) and supervisors (n = 67). Following mediocre pilot year evaluation results, EPAs were revised and reduced in number. While students positively evaluated the e-portfolio, their appraisal of the EPAs and entrustment scale was less positive compared to supervisors. Supervisor evaluation of the EPA-based e-portfolio supported the validity, feasibility and acceptability of this novel assessment method in a community and public health setting. Assessment using EPAs, and the resulting educational data collected by the tool, offers potential for individual learners to identify areas needing development during placement, as well as potential to inform curriculum improvements and increase understanding of learning opportunities and outcomes for dietetic students in community and public health settings.
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Affiliation(s)
- Andrea Bramley
- Department of Dietetics and Human NutritionLa Trobe UniversityBundooraVictoriaAustralia
- Monash HealthClayton RoadClaytonVictoriaAustralia
| | - Adrienne Forsyth
- Dietetics and Nutrition at Australian Catholic University, School of Allied Health, Human Services and SportLa Trobe UniversityBundooraVictoriaAustralia
| | - Lisa McKenna
- School of Nursing and Midwifery, College of Science, Health and EngineeringLa Trobe UniversityBundooraVictoriaAustralia
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Francischetti I, Holzhausen Y, Peters H. Entrustable professional activities for Junior Brazilian Medical Students in community medicine. BMC MEDICAL EDUCATION 2022; 22:737. [PMID: 36284283 PMCID: PMC9598029 DOI: 10.1186/s12909-022-03762-4] [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: 11/01/2021] [Revised: 09/07/2022] [Accepted: 09/20/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Entrustable professional activities (EPAs) have been defined to promote the workplace participation of undergraduate medical students, generally in the context of high-income countries with a focus on the secondary and tertiary health care sectors. These EPAs have limited applicability to training and health care contexts in low- to middle-income countries that have a focus on primary health care, for instance, the context of community medicine. The purpose of this article is to report the process and results of defining EPAs for undergraduate medical training in a community health care setting. METHODS A modified Delphi study was performed to develop EPAs for the training of medical students in community medicine during their first and second years of education at the Marília Medical School (FAMEMA), Brazil. The supervision level was operationalized in terms of a student's ability to perform the EPA autonomously in an effective and safe manner with supervision readily available on request. Panellists (9 physicians and 6 nurses) rated the completeness of the proposed list of EPAs and EPA categories on four-point Likert scales. The threshold for consensus among panellists was a mean content validity index of at least 80%. RESULTS Consensus was reached after two Delphi rounds, resulting in 11 EPAs for undergraduate medical education and training in community medicine. These EPAs were organized into three overarching EPA domains: integrality of care for individual health needs in all phases of the life cycle (5 EPAs), integrality of care for family health needs (3 EPAs), and integrality of care for community health needs (3 EPAs). For each EPA, descriptions of the following categories were created: title; specifications and limitations; conditions and implications of the entrustment decision; knowledge, skills, and attitudes; links to competencies; and assessment sources. CONCLUSION The resulting 11 EPAs for training medical students in community medicine expand the application of the EPA framework to both early undergraduate medical education and the context of primary health care. This report can support and guide other medical schools in their attempts to train students in primary health care contexts and to incorporate EPAs into their curricula.
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Affiliation(s)
- Ieda Francischetti
- Dieter Scheffner Center for Medical Education and Educational Research Charité - Universitätsmedizin Berlin, Dean?s Office of Study Affairs, Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany
- Marília Medical School (Faculdade de Medicina de Marília - FAMEMA), Marília, São Paulo, Brazil
| | - Ylva Holzhausen
- Dieter Scheffner Center for Medical Education and Educational Research Charité - Universitätsmedizin Berlin, Dean?s Office of Study Affairs, Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Harm Peters
- Dieter Scheffner Center for Medical Education and Educational Research Charité - Universitätsmedizin Berlin, Dean?s Office of Study Affairs, Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany
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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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Hennus MP, van Dam M, Gauthier S, Taylor DR, ten Cate O. The logic behind entrustable professional activity frameworks: A scoping review of the literature. MEDICAL EDUCATION 2022; 56:881-891. [PMID: 35388517 PMCID: PMC9542438 DOI: 10.1111/medu.14806] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 03/21/2022] [Accepted: 03/29/2022] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Entrustable professional activities (EPAs), discrete profession-specific tasks requiring integration of multiple competencies, are increasingly used to help define and inform curricula of specialty training programmes. Although guidelines exist to help guide the developmental process, deciding what logic to use to draft a preliminary EPA framework poses a crucial but often difficult first step. The logic of an EPA framework can be defined as the perspective used by its developers to break down the practice of a profession into units of professional work. This study aimed to map dominant logics and their rationales across postgraduate medical education and fellowship programmes. METHODS A scoping review using systematic searches within five electronic databases (Medline, Embase, Google Scholar, Scopus and Web of Science) was performed. Dominant logics of included papers were identified using inductive coding and iterative analysis. RESULTS In total, 42 studies were included. Most studies were conducted in the United States (n = 22; 52%), Canada (n = 6; 14%) and the Netherlands (n = 4; 10%). Across the reported range of specialties, family medicine (n = 4; 10%), internal medicine (n = 4; 10%), paediatrics (n = 3; 7%) and psychiatry (n = 3; 7%) were the most common. Three dominant logics could be identified, namely, 'service provision', 'procedures' and/or 'disease or patient categories'. The majority of papers (n = 37; 88%) used two or more logics when developing EPA frameworks (median = 3, range = 1-4). Disease or patient groups and service provision were the most common logics used (39% and 37%, respectively). CONCLUSIONS Most programmes used a combination of logics when trying to capture the essential tasks of a profession in EPAs. For each of the three dominant logics, the authors arrived at a definition and identified benefits, limitations and examples. These findings may potentially inform best practice guidelines for EPA development.
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Affiliation(s)
- Marije P. Hennus
- Department of Pediatric Intensive CareUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Marjel van Dam
- Intensive Care CenterUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Stephen Gauthier
- Department of MedicineQueen's University School of MedicineKingstonOntarioCanada
| | - David R. Taylor
- Department of MedicineQueen's University School of MedicineKingstonOntarioCanada
| | - Olle ten Cate
- Center for Research and Development of EducationUniversity Medical Center UtrechtUtrechtThe Netherlands
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Matsuzaka Y, Taniho K, Maeda K, Sakai S, Michitsuji T, Ozono E, Morimoto Y, Kinoshita H, Matsushima K, Hamada H, Imamura A, Kumazaki H, Ozawa H. Subjective achievement from psychiatry rotation in the Japanese postgraduate residency system: a longitudinal questionnaire study. BMC MEDICAL EDUCATION 2022; 22:646. [PMID: 36030203 PMCID: PMC9419334 DOI: 10.1186/s12909-022-03712-0] [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: 06/13/2022] [Accepted: 08/24/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Psychiatry rotation has been mandatory in the Japanese postgraduate residency system since 2020. Some psychiatry-related competency items are stipulated as mandatory for residents. The current study aimed to clarify whether psychiatry rotation affected residents' subjective achievement of these competency items. METHODS This longitudinal study was conducted among postgraduate residents who completed a rotation in the psychiatry department at Nagasaki University Hospital across two academic years (2020-2021). The survey was administered at the start and at the end of the psychiatry rotation. Residents evaluated their subjective understanding and confidence regarding initiating treatment for these competency items using a six-point Likert scale. The average scores for each item were compared between pre-rotation and post-rotation. RESULTS In total, 99 residents (91.7%) responded to this survey. Residents had significantly higher scores at post-rotation compared with pre-rotation in all psychiatry-related competency items in both subjective understanding and confidence in initiating treatment. Additionally, strong effect sizes were found for many items. CONCLUSION Residents improved learning about psychiatry-related competency items through psychiatry rotation. This finding suggests that it is reasonable for psychiatry rotation to be mandatory in the current Japanese postgraduate residency system. The importance of psychiatry is likely to increase in both undergraduate and postgraduate medical education in the future. It is necessary to continuously update educational strategies to meet changing social needs over time. As this study was conducted at a single institution, a multi-center study is needed to expand the current findings.
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Affiliation(s)
- Yusuke Matsuzaka
- Department of Neuropsychiatry, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki city, 852-8501, Japan.
- Medical Education Development Center, Nagasaki University Hospital, Nagasaki city, Japan.
| | - Koichi Taniho
- Department of Neuropsychiatry, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki city, 852-8501, Japan
| | - Kengo Maeda
- Department of Neuropsychiatry, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki city, 852-8501, Japan
| | - Shintaro Sakai
- Department of Neuropsychiatry, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki city, 852-8501, Japan
| | - Toru Michitsuji
- Medical Education Development Center, Nagasaki University Hospital, Nagasaki city, Japan
| | - Eriko Ozono
- Medical Education Development Center, Nagasaki University Hospital, Nagasaki city, Japan
| | - Yoshiro Morimoto
- Department of Neuropsychiatry, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki city, 852-8501, Japan
| | - Hirohisa Kinoshita
- Department of Neuropsychiatry, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki city, 852-8501, Japan
- Health Center, Nagasaki University, Nagasaki city, Japan
| | - Kayoko Matsushima
- Medical Education Development Center, Nagasaki University Hospital, Nagasaki city, Japan
| | - Hisayuki Hamada
- Medical Education Development Center, Nagasaki University Hospital, Nagasaki city, Japan
| | - Akira Imamura
- Department of Neuropsychiatry, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki city, 852-8501, Japan
- Department of Occupational Therapy Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki city, Japan
| | - Hirokazu Kumazaki
- Department of Neuropsychiatry, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki city, 852-8501, Japan
- Department of Future Mental Health Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki city, Japan
| | - Hiroki Ozawa
- Department of Neuropsychiatry, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki city, 852-8501, Japan
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Hsu DC, Baghdassarian A, Caglar D, Rose JA, Herman BE, Schwartz A, Mink R, Langhan ML. Pediatric Emergency Medicine Fellowship Program Directors' Viewpoint: Minimum Levels of Entrustment for Graduating Fellows and Practicing Physicians to Perform the Subspecialty's Professional Activities. Pediatr Emerg Care 2022:00006565-990000000-00110. [PMID: 35947053 DOI: 10.1097/pec.0000000000002817] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Entrustable Professional Activities (EPAs) are essential tasks physicians perform within their professions. Entrustment levels that pediatric emergency medicine (PEM) fellowship program directors (FPDs) expect graduating fellows to achieve for PEM-specific and common pediatric subspecialty EPAs remain unreported. This study aims to determine minimum entrustment levels FPDs require fellows to achieve to graduate from fellowship and to compare FPD expectations for fellows versus practicing PEM physicians. METHODS Secondary analysis of PEM-specific data from a national multispecialty cross-sectional survey of pediatric subspecialty FPDs. For 6 PEM-specific and 7 common pediatric subspecialty EPAs, PEM FPDs indicated (1) minimum entrustment levels fellows should achieve by training completion, (2) whether they would allow a fellow to graduate below these minimum levels, and (3) minimum levels for safe and effective practice by PEM physicians. Minimum levels were defined as the level that more than 80% of FPDs would not drop below. RESULTS Sixty of 77 PEM FPDs (78%) completed the survey. Most respondents did not require fellows to achieve the highest level (level 5-no supervision) by graduation for any PEM-specific EPAs. The median level FPDs expected for practicing PEM physicians was 5 (trusted to perform without supervision) for EPAs 1 and 4 and level 4 (indirect supervision for complex cases) for the remaining PEM-specific EPAs. Minimum levels expected by FPDs for common subspecialty pediatric EPAs were lower for both groups. CONCLUSIONS Most PEM FPDs indicated that they would graduate fellows before their achievement of the highest entrustment level for all EPAs. Most also indicated that they do not expect practicing PEM physicians to perform all EPAs without supervision. These findings indicate need for stakeholders to evaluate current structure and outcomes of PEM fellowship programs and for institutions and organizations to ensure adequate support in time and resources for ongoing learning for practicing PEM physicians.
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Affiliation(s)
- Deborah C Hsu
- From the Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Aline Baghdassarian
- Inova L.J. Murphy Children's Hospital, Inova Fairfax Medical Campus, UVA School of Medicine, Falls Church, VA
| | - Derya Caglar
- Division of Emergency Medicine, University of Washington, Seattle Children's Hospital, Seattle, WA
| | - Jerri A Rose
- Division of Pediatric Emergency Medicine, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Bruce E Herman
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT
| | | | - Richard Mink
- Division of Pediatric Critical Care Medicine, Harbor-UCLA Medical Center, The Lundquist Institute for Biomedical Innovation and David Geffen School of Medicine, Los Angeles, CA
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Cate OT. How can Entrustable Professional Activities serve the quality of health care provision through licensing and certification? CANADIAN MEDICAL EDUCATION JOURNAL 2022; 13:8-14. [PMID: 36091739 PMCID: PMC9441117 DOI: 10.36834/cmej.73974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This paper about Entrustable Professional Activities (EPAs) was solicited to support the discussion about the future of licensing within the Medical Council of Canada. EPAs, units of professional practice to be entrusted to learners or professionals once they have shown to possess sufficient competence, were proposed in 2005 to operationalize competency-based postgraduate medical education and have become widely popular for various health professions education programs in many countries. EPAs break the breadth of competence for license down to units of practice that can be overseen, assessed, monitored, documented, and entrusted. EPAs together may constitute an individual's portfolio of qualifications, and define a scope of practice. A medical license and a specialty certification can then be defined as the required combination of EPAs for which one is qualified at any specific moment in time. That 'snapshot' could change over time and reflect the professional development of the individual, both in their competence and in their privileges to practice. Micro-credentialing and digital badges might become an adequate option to show-case one's scope of practice at any time and operationalize the idea of a dynamic portfolio of EPAs.
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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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Burkhart CS, Dell-Kuster S, Touchie C. Who can do this procedure? Using entrustable professional activities to determine curriculum and entrustment in anesthesiology - An international survey. MEDICAL TEACHER 2022; 44:672-678. [PMID: 35021934 DOI: 10.1080/0142159x.2021.2020231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION As competency-based curricula get increasing attention in postgraduate medical education, Entrustable Professional Activities (EPAs) are gaining in popularity. The aim of this survey was to determine the use of EPAs in anesthesiology training programs across Europe and North America. METHODS A survey was developed and distributed to anesthesiology residency training program directors in Switzerland, Germany, Austria, Netherlands, USA and Canada. A convergent design mixed-methods approach was used to analyze both quantitative and qualitative data. RESULTS The survey response rate was 38% (108 of 284). Seven percent of respondents used EPAs for making entrustment decisions. Fifty-three percent of institutions have not implemented any specific system to make such decisions. The majority of respondents agree that EPAs should become an integral part of the training of residents in anesthesiology as they are universal and easy to use. CONCLUSION Although recommended by several national societies, EPAs are used in few anesthesiology training programs. Over half of responding programs have no specific system for making entrustment decisions. Although several countries are adopting or planning to adopt EPAs and national societies are recommending the use of EPAs as a framework in their competency-based programs, few are yet using these to make "competence" decisions.
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Affiliation(s)
| | - Salome Dell-Kuster
- Department of Anesthesiology, University Hospital Basel, Basel, Switzerland
- Institute for Clinical Epidemiology and Biostatistics, University of Basel, Basel, Switzerland
| | - Claire Touchie
- Department of Medicine, University of Ottawa, Ottawa, Canada
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Carbajal MM, Dadiz R, Sawyer T, Kane S, Frost M, Angert R. Part 5: Essentials of Neonatal-Perinatal Medicine Fellowship: evaluation of competence and proficiency using Milestones. J Perinatol 2022; 42:809-814. [PMID: 35149835 DOI: 10.1038/s41372-021-01306-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 11/03/2021] [Accepted: 12/23/2021] [Indexed: 11/09/2022]
Abstract
The Accreditation Council for Graduate Medical Education (ACGME) Pediatric Subspecialty Milestone Project competencies are used for Neonatal-Perinatal Medicine (NPM) fellows. Milestones are longitudinal markers that range from novice to expert (levels 1-5). There is no standard approach to the required biannual evaluation of fellows by fellowship programs, resulting in significant variability among programs regarding procedural experience and exposure to pathology during clinical training. In this paper, we discuss the opportunities that Milestones provide, potential strategies to address challenges, and future directions.
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Affiliation(s)
- Melissa M Carbajal
- Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Houston, TX, USA.
| | - Rita Dadiz
- Departments of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Taylor Sawyer
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Sara Kane
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mackenzie Frost
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | | | - Robert Angert
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
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Hay A, Howell JA, Rudaizky D, Breen LJ. Experiences and Support Needs of Bereaved Students in Higher Education. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221096565. [PMID: 35549940 DOI: 10.1177/00302228221096565] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Bereavement is commonly experienced by students in higher education and is associated with negative health and academic consequences. We conducted a systematic review of the literature to identify how grief affects students in higher education and the types of support they seek and/or find beneficial. A search of Health Collection, Medline, CINAHL Plus, Web of Science, Taylor and Francis online, ProQuest, and Open Grey resulted in 30 articles that met inclusion criteria. A narrative synthesis resulted in 11 themes focused on the university experience following bereavement (six themes) and supports following bereavement (five themes). Our review highlights how grief symptoms can have a negative impact on bereaved students' academic and social experiences. These difficulties are exacerbated by barriers to accessing grief supports, and unhelpful responses from staff and peers. Students' grief is often disenfranchised and so students learn to avoid grief related emotions, communications, and support-seeking.
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Affiliation(s)
- Ashton Hay
- Population Health, 1649Curtin University, Perth, WA, Australia
| | - Joel A Howell
- Population Health, 1649Curtin University, Perth, WA, Australia
| | - Daniel Rudaizky
- Population Health, 1649Curtin University, Perth, WA, Australia
| | - Lauren J Breen
- Population Health, 1649Curtin University, Perth, WA, Australia
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Competency-Based Education and Entrustable Professional Activities: An Electronic Clinical Tracking System Solution. Comput Inform Nurs 2022; 40:429-434. [PMID: 35524341 DOI: 10.1097/cin.0000000000000924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jeyalingam T, Brydges R, Ginsburg S, McCreath GA, Walsh CM. How Clinical Supervisors Conceptualize Procedural Entrustment: An Interview-Based Study of Entrustment Decision Making in Endoscopic Training. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:586-592. [PMID: 34935727 DOI: 10.1097/acm.0000000000004566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Entrustment is central to assessment in competency-based medical education (CBME). To date, little research has addressed how clinical supervisors conceptualize entrustment, including factors they consider in making entrustment decisions. The aim of this study was to characterize supervisors' decision making related to procedural entrustment, using gastrointestinal endoscopy as a test case. METHOD Using methods from constructivist grounded theory, the authors interviewed 29 endoscopy supervisors in the United States and Canada across multiple specialties (adult and pediatric gastroenterology, surgery, and family medicine). Semistructured interviews, conducted between April and November 2019, focused on how supervisors conceptualize procedural entrustment, how they make entrustment decisions, and what factors they consider. Transcripts were analyzed using constant comparison to generate an explanatory framework and themes. RESULTS Three themes were identified from the analysis of interview transcripts: (1) entrustment occurs in varying degrees and fluctuates over time; (2) entrustment decisions can transfer within and across procedural and nonprocedural contexts; (3a) persistent static factors (e.g., supervisor competence, institutional culture, legal considerations) influence entrustment decisions, as do (3b) fluctuating, situated dynamic factors (e.g., trainee skills, patient acuity, time constraints), which tend to change from one training encounter to the next. CONCLUSIONS In the process of making procedural entrustment decisions, clinical supervisors appear to synthesize multiple dynamic factors against a background of static factors, culminating in a decision of whether to entrust. Entrustment decisions appear to fluctuate over time, and assessors may transfer decisions about specific trainees across settings. Understanding which factors supervisors perceive as influencing their decision making has the potential to inform faculty development, as well as competency committees seeking to aggregate faculty judgments about trainee unsupervised practice. Those leading CBME programs may wish to invest in optimizing the observed static factors, such that these foundational factors are tuned to facilitate trainee learning and achievement of entrustment.
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Affiliation(s)
- Thurarshen Jeyalingam
- T. Jeyalingam is an advanced fellow in luminal therapeutic endoscopy, University of Calgary, Calgary, Alberta, Canada; ORCID: http://orcid.org/0000-0002-7254-9639
| | - Ryan Brydges
- R. Brydges is a scientist and holds the Professorship in Technology-Enabled Education, St. Michael's Hospital, Unity Health Toronto, and is associate professor, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shiphra Ginsburg
- S. Ginsburg is professor of medicine, Department of Medicine, Sinai Health System and Faculty of Medicine, a scientist, Wilson Centre for Research in Education, and Canada Research Chair in Health Professions Education, University of Toronto, Toronto, Ontario, Canada; ORCID: http://orcid.org/0000-0002-4595-6650
| | - Graham A McCreath
- G.A. McCreath is clinical research project coordinator, SickKids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada; ORCID: http://orcid.org/0000-0002-9312-8665
| | - Catharine M Walsh
- C.M. Walsh is staff gastroenterologist, Division of Gastroenterology, Hepatology, and Nutrition, educational researcher, SickKids Learning Institute, scientist, Child Health Evaluative Sciences, SickKids Research Institute, Hospital for Sick Children, scientist, Wilson Centre for Research in Education, and associate professor of paediatrics, University of Toronto, Toronto, Ontario, Canada; ORCID: http://orcid.org/0000-0003-3928-703X
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Kelly GM, Roberts A, Lynch CD. A Literature Review: Entrustable Professional Activities, an assessment tool for postgraduate dental training? J Dent 2022; 120:104099. [PMID: 35337899 DOI: 10.1016/j.jdent.2022.104099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 10/18/2022] Open
Abstract
Assessing when dental trainees are ready to independently undertake clinical procedures at specialist level is critical for dental postgraduate programmes to determine when a trainee is 'work ready', in addition to ensuring patient safety. Entrustable professional activities (EPA) are a novel method of competency-based assessment. An EPA is a unit of professional practice or critical clinical activity identified within dental training programmes, which should be assessed during training, to establish if trainees are ready for independent practice, with a progressive decrease in supervision, based on supervisors' entrustment decisions. This article describes EPAs, entrustment decisions, including entrustment supervision scales and the process recommended to develop EPAs within dental curricula. EPAs have not been formally introduced for assessment within dental education programmes in the United Kingdom, but recent developments have been described in undergraduate dental education globally. Clinical significance: Competency-based assessments need to be continually developed to adapt to rapidly changing population health care and dental needs, to determine when dental trainees are ready for independent clinical practice. Early development of entrustable professional activities for assessment in undergraduate dental programmes has been well received by both trainees and supervisors. Further investigation is required to consider formal development of EPAs within postgraduate dental programmes.
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Affiliation(s)
- Grace M Kelly
- School of Dentistry, Cardiff University, Cardiff, United Kingdom.
| | - Anthony Roberts
- Cork University Dental School and Hospital, University College Cork, Cork, Ireland.
| | - Christopher D Lynch
- Cork University Dental School and Hospital, University College Cork, Cork, Ireland.
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Matsuzaka Y, Michitsuji T, Ozono E, Matsushima K, Hamada H, Morimoto Y, Kanegae S, Kinoshita H, Imamura A, Ozawa H. Significance of a psychiatry rotation for subjective achievement of competencies related to psychiatry in the Japanese postgraduate residency system. Psychiatry Clin Neurosci 2022; 76:63-64. [PMID: 34825749 PMCID: PMC10138735 DOI: 10.1111/pcn.13316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 10/10/2021] [Accepted: 11/14/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Yusuke Matsuzaka
- Medical Education Development Center, Nagasaki University Hospital, Nagasaki, Japan.,Department of Neuropsychiatry, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Toru Michitsuji
- Medical Education Development Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Eriko Ozono
- Medical Education Development Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Kayoko Matsushima
- Medical Education Development Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Hisayuki Hamada
- Medical Education Development Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Yoshiro Morimoto
- Department of Neuropsychiatry, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Shinji Kanegae
- Department of Neuropsychiatry, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | | | - Akira Imamura
- Department of Neuropsychiatry, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiroki Ozawa
- Department of Neuropsychiatry, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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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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