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Bryant BH, Anderson SR, Brissette M, Childs JM, Gratzinger D, Johnson K, Powell DE, Zein-Eldin Powell S, Timmons CF, Chute D, Cummings TJ, Furlong MA, Hébert TM, Reeves HM, Rush D, Vitkovski T, McCloskey CB. National pilot of entrustable professional activities in pathology residency training. Acad Pathol 2024; 11:100110. [PMID: 38560425 PMCID: PMC10978478 DOI: 10.1016/j.acpath.2024.100110] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/25/2023] [Accepted: 01/21/2024] [Indexed: 04/04/2024] Open
Abstract
Entrustable professional activities (EPAs) are observable clinical skills and/or procedures that have been introduced into medical education at the student and resident levels in most specialties to determine readiness to advance into residency or independent practice, respectively. This publication describes the process and outcomes of a pilot study looking at the feasibility of using two anatomic pathology and two clinical pathology EPAs in pathology residency in 6 pathology residency programs that volunteered for the study. Faculty development on EPAs and their assessment was provided to pilot program faculty, and EPA assessment tools were developed and used by the pilot programs. Pre- and post-study surveys were given to participating residents, faculty, and program directors to gauge baseline practices and to gather feedback on the EPA implementation experience. Results demonstrated overall good feasibility in implementing EPAs. Faculty acceptance of EPAs varied and was less than that of program directors. Residents reported a significant increase in the frequency with which faculty provided formative assessments that included specific examples of performance and specific ways to improve, as well as increased frequency with which faculty provided summative assessments that included specific ways to improve. EPAs offered the most benefit in setting clear expectations for performance of each task, for providing more specific feedback to residents, and in increasing Program director's understanding of resident strengths abilities and weaknesses.
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Affiliation(s)
- Bronwyn H. Bryant
- University of Vermont Medical Center, Department of Pathology and Laboratory Medicine, Burlington, VT, USA
| | - Scott R. Anderson
- University of Vermont Medical Center, Department of Pathology and Laboratory Medicine, Burlington, VT, USA
| | - Mark Brissette
- University of Colorado Anschutz Medical Campus, Department of Pathology, Aurora, CO, USA
| | - John M. Childs
- Geisinger Medical Center, Department of Pathology, Danville, PA, USA
| | - Dita Gratzinger
- Stanford University School of Medicine, Department of Pathology, Stanford, CA, USA
| | | | - Deborah E. Powell
- University of Minnesota Medical School, Department of Laboratory Medicine and Pathology, Minneapolis, MN, USA
| | | | - Charles F. Timmons
- UT Southwestern Medical Center, Department of Pathology, Dallas, TX, USA
| | - Deborah Chute
- Cleveland Clinic, Department of Pathology and Laboratory Medicine, Cleveland, OH, USA
| | | | - Mary A. Furlong
- Georgetown University School of Medicine, Department of Pathology and Laboratory Medicine, Washington, DC, USA
| | - Tiffany M. Hébert
- Montefiore Health System/Albert Einstein College of Medicine, Department of Pathology, Bronx, NY, USA
| | - Hollie M. Reeves
- University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Department of Pathology, Cleveland, OH, USA
| | - Demaretta Rush
- University of Arizona College of Medicine, Department of Pathology, Tucson, AZ, USA
| | - Taisia Vitkovski
- Zucker School of Medicine at Hofstra/Northwell Health, Department of Pathology and Laboratory Medicine, Hempstead, NY, USA
| | - Cindy B. McCloskey
- University of Oklahoma College of Medicine, Department of Pathology, Oklahoma City, OK, USA
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Miller F, Wood S, Livingston P. The lived experience of Competence by Design: Canadian resident physicians' perspectives. Can J Anaesth 2024; 71:254-263. [PMID: 38133715 DOI: 10.1007/s12630-023-02678-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/12/2023] [Accepted: 07/21/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE Canadian specialist residency programs are in the process of transitioning to a hybrid time and competence model, Competence by Design (CBD), developed by the Royal College of Physicians and Surgeons Canada. Although there is extensive literature around competency-based medical education (CBME), few studies have evaluated the experience of residents after CBME implementation. The purpose of this study was to obtain a rich perspective on the lived experience of residents. METHODS We designed a qualitative study with inductive thematic analysis of semistructured interview data. The study population was residents in CBD postgraduate training programs in anesthesiology, internal medicine, or surgery (including all surgical subspecialties) at Dalhousie University (Halifax, NS, Canada). RESULTS Residents identified the following benefits of their programs and CBD: supportive peers and clinical supervisors, a roadmap for residency, formalized feedback opportunities, and program evolution. Resident-identified drawbacks of CBD included: a lack of transparency around CBD, CBD not as advertised, a lack of buy-in, increased administrative burden, difficulties obtaining evidence for entrustable professional activities (EPAs); the onus for CBD on residents, inconsistent feedback, cumbersome technology, and significant psychological burden. Resident-suggested improvements were reducing the number of EPAs, streamlining EPA requirements, increasing transparency and communication with competence committees, providing incentives and continuous education for clinical supervisors, improving on existing electronic interfaces, and developing technology better suited to the needs of CBD. CONCLUSION This study highlights that the significant administrative and psychological burden of CBD detracts from clinical learning and enthusiasm for residency. Future research could explore whether overcoming the identified challenges will improve residents' experiences.
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Affiliation(s)
- Franziska Miller
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada.
| | - Sarah Wood
- School of Medicine, University of Dundee, Dundee, Scotland, UK
| | - Patricia Livingston
- Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, NS, Canada
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Schmidt RL, White SK, Timme KH, McFarland MM, Lomo LC. Graduate Medical Education in Pathology: A Scoping Review. Arch Pathol Lab Med 2024; 148:117-127. [PMID: 37014974 DOI: 10.5858/arpa.2022-0365-ra] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2023] [Indexed: 04/06/2023]
Abstract
CONTEXT.— Pathologists have produced a substantial body of literature on graduate medical education (GME). However, this body of literature is diverse and has not yet been characterized. OBJECTIVE.— To chart the concepts, research methods, and publication patterns of studies on GME in pathology. DATA SOURCES.— This was a systematic scoping review covering all literature produced since 1980 in the PubMed and Embase databases. CONCLUSIONS.— Research on GME in pathology is evenly dispersed across educational topics. This body of literature would benefit from research based on theory, stronger study designs, and studies that can provide evidence to support decisions on educational policies.
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Affiliation(s)
- Robert L Schmidt
- From the Department of Pathology (Schmidt, White, Lomo) and Eccles Health Sciences Library (McFarland), University of Utah, Salt Lake City
| | - Sandra K White
- From the Department of Pathology (Schmidt, White, Lomo) and Eccles Health Sciences Library (McFarland), University of Utah, Salt Lake City
| | - Kathleen H Timme
- the Department of Endocrinology, Eccles Primary Children's Hospital, Salt Lake City, Utah (Timme)
| | - Mary M McFarland
- From the Department of Pathology (Schmidt, White, Lomo) and Eccles Health Sciences Library (McFarland), University of Utah, Salt Lake City
| | - Lesley C Lomo
- From the Department of Pathology (Schmidt, White, Lomo) and Eccles Health Sciences Library (McFarland), University of Utah, Salt Lake City
- ARUP Laboratories, Salt Lake City, Utah (Schmidt, Lomo)
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Felicelli C, Gama A, Chornenkyy Y, Choy B, Blanco LZ, Novo JE. From principles to practice: Implementation of entrustable professional activities (EPAs) for surgical pathology residency education in a large academic hospital. Acad Pathol 2023; 10:100097. [PMID: 38025045 PMCID: PMC10679497 DOI: 10.1016/j.acpath.2023.100097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 07/29/2023] [Accepted: 09/21/2023] [Indexed: 12/01/2023] Open
Abstract
Over the past decade, competency-based medical education (CBME) has gained momentum in the United States to develop trainees into independent and confident physicians by the end of their training. Entrustable professional activities (EPAs) are an established methodology for assessing trainee development through an outcomes-driven rather than a time-based model. While EPAs have been utilized as an assessment tool for CBME in Europe and Canada, their validation and implementation in some medical specialties has occurred more recently in the United States. Pediatrics was the first specialty in the US to conduct a large-scale UME-GME pilot. Pathology Residency EPAs were published in 2018; however, implementation in training programs has been slow. We have piloted EPAs in our residency program's surgical pathology rotation and propose a unique set of 4 surgical pathology EPAs to track trainee preparedness for independent practice.
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Affiliation(s)
| | - Alcino Gama
- Corresponding author. Northwestern University Feinberg School of Medicine, Department of Pathology, 303 E. Chicago Ave. Ward 3-140 W127, Chicago, IL 60611, USA.
| | - Yevgen Chornenkyy
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Bonnie Choy
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Luis Z. Blanco
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jorge E. Novo
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Liu L, Jiang Z, Qi X, Xie A, Wu H, Cheng H, Wang W, Li H. An update on current EPAs in graduate medical education: A scoping review. MEDICAL EDUCATION ONLINE 2021; 26:1981198. [PMID: 34569433 PMCID: PMC8477952 DOI: 10.1080/10872981.2021.1981198] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 08/23/2021] [Accepted: 09/11/2021] [Indexed: 05/31/2023]
Abstract
The purpose of this scoping review is to update the recent progress of EPAs research in GME, focusing on the topical concern of EPAs effectiveness, and to provide a reference for medical researchers in countries/regions interested in introducing EPAs. Guided by Arksey and O'Malley's framework regarding scoping reviews, the researchers, in January 2021, conducted a search in five databases to ensure the comprehensiveness of the literature. After the predetermined process, 29 articles in total were included in this study. The most common areas for the implementation and evaluation of EPAs were Surgery (n = 7,24.1%), Pediatric (n = 5,17.2%) and Internal medicine (n = 4,13.8%), a result that shows a relatively large change in the research trend of EPAs in the last two years. Prior to 2018, EPAs research focused on internal medicine, psychiatry, family medicine, and primary care. The articles in the category of EPAs implementation and evaluation had four main themes: (1) validation of EPAs (n = 16,55.2%); (2) describing the experience of implementing EPAs (n = 11,37.9%); (3) examining the factors and barriers that influence the implementation and evaluation of EPAs (n = 6,20.6%); and (4) researching the experiences of faculty, interns, and other relevant personnel in using EPAs. Training programs were the most common EPAs implementation setting (n = 26,89.6%); direct observation and evaluation (n = 12,41.4%), and evaluation by scoring reports (n = 5,17.2%) were the two most common means of assessing physicians' EPA levels; 19 papers (65.5%) used faculty evaluation, and nine of these papers also used self-assessment (31.0%); the most frequently used tools in the evaluation of EPAs were mainly researcher-made instruments (n = 37.9%), assessment form (n = 7,24.1%), and mobile application (n = 6,20.7%). Although EPAs occupy an increasingly important place in international medical education, this study concludes that the implementation and diffusion of EPAs on a larger scale is still difficult.
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Affiliation(s)
- Lu Liu
- Institute of Medical Education, Peking University, Beijing, China
- National Center for Health Professions Education Development, Peking University, Beijing, China
| | - Zhehan Jiang
- Institute of Medical Education, Peking University, Beijing, China
- National Center for Health Professions Education Development, Peking University, Beijing, China
| | - Xin Qi
- Peking University First Hospital, Beijing, China
| | - A’Na Xie
- National Center for Health Professions Education Development, Peking University, Beijing, China
| | - Hongbin Wu
- Institute of Medical Education, Peking University, Beijing, China
- National Center for Health Professions Education Development, Peking University, Beijing, China
| | - Huaqin Cheng
- Institute of Medical Education, Peking University, Beijing, China
- National Center for Health Professions Education Development, Peking University, Beijing, China
| | - Weimin Wang
- National Center for Health Professions Education Development, Peking University, Beijing, China
| | - Haichao Li
- Peking University First Hospital, Beijing, China
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Bryant BH. Feasibility of an Entrustable Professional Activity for Pathology Resident Frozen Section Training. Acad Pathol 2021; 8:23742895211041757. [PMID: 34485691 PMCID: PMC8411628 DOI: 10.1177/23742895211041757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/28/2021] [Accepted: 07/18/2021] [Indexed: 11/23/2022] Open
Abstract
Entrustable professional activities are an intuitive form of workplace-based
assessment that can support competency-based medical education. Many entrustable
professional activities have been written and published, but few studies
describe the feasibility or implementation of entrustable professional
activities in graduate medical education. The frozen section entrustable
professional activit was introduced into the pathology residency training at the
University of Vermont for postgraduate year 1 at the start of their training in
frozen section. The feasibility of the entrustable professional activit was
evaluated based on 3 criteria: (a) utilization, (b) support of frozen section
training, and (c) generating data to support entrustment decision about
residents’ readiness to take call. The entrustable professional activit was well
utilized and satisfactory to residents, faculty, pathologists’ assistants, and
Clinical Competency Committee members. Most members of the Clinical Competency
Committee agreed they had sufficient data and noted higher confidence in
assessing resident readiness to take call with the addition of entrustable
professional activit to the residents’ assessment portfolio. Residents did not
endorse it helped them prepare for call; however, the interruption to frozen
section training due to the COVID-19 pandemic was a significant contributing
factor. The frozen section entrustable professional activit is a feasible
addition to pathology resident training based on utilization, support of
training, and generation of data to support entrustment decisions for graduated
responsibilities. The implementation and integration of the entrustable
professional activit into pathology training at our institution is described
with discussion of adjustments for future use.
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Affiliation(s)
- Bronwyn H Bryant
- University of Vermont Medical Center, Larner College of Medicine, Burlington, VT, USA
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Pagano MB, Treml A, Stephens LD, Joshi S, Li Y, Lopez-Plaza I, Poyyapakkam S, Schwartz J, Tanhehco Y, Zantek ND. Entrustable professional activities for apheresis medicine education. Transfusion 2020; 60:2432-2440. [PMID: 32757215 DOI: 10.1111/trf.15983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/24/2020] [Accepted: 06/24/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Entrustable professional activities (EPAs) are well-defined, executable, observable, and measurable activities that are performed by a trainee and can be performed independently as training progresses. The purpose of this study is to develop EPAs specific for the practice of apheresis medicine (AM). METHODS Members of the American Society for Apheresis Graduate Medical Education subcommittee developed a list of 28 apheresis medical activities linked to Accreditation Council for Graduate Medical Education milestones and competencies in five areas: (a) consultation, (b) clinical care for therapeutic apheresis, (c) clinical care for donor collections, (d) test optimization, and (e) vascular access. Ten AM experts using a validated tool to measure the quality of the EPAs (QUEPA) evaluated these activities with use of a Likert scale. Per group consensus, an activity was considered acceptable for each domain if it had received an average score greater than 3.7, and it was rated 4 or 5 (agree or strongly agree) by at least 70% of experts. RESULTS Of the 28 activities, 11 did not have acceptable QUEPA scores: 7 activities were rated as unobservable, 4 were rated unfocused, 2 were rated unrealistic and not generalizable, and 2 were rated as not addressing multiple competencies. Four activities had unacceptable scores in more than one domain. Subcommittee members edited these 11 activities over two review cycles to produce a final list of 26 activities. CONCLUSION A set of practical, focused, and observable EPAs in AM were systematically developed. These EPAs can be used to assess and support trainee performance in AM.
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Affiliation(s)
- Monica B Pagano
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA
| | - Angela Treml
- Department of Pathology, Versiti WI, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Laura D Stephens
- Department of Pathology, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Sarita Joshi
- Department of Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - Yanhua Li
- Department of Pathology and Laboratory Medicine, New York University School of Medicine, New York, New York, USA
| | - Ileana Lopez-Plaza
- Department of Pathology and Laboratory Medicine, Henry Ford Health System, Detroit, Michigan, USA
| | | | - Joseph Schwartz
- Transfusion Medicine and Cellular Therapy, Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
| | - Yvette Tanhehco
- Transfusion Medicine and Cellular Therapy, Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
| | - Nicole D Zantek
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
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