scholarly journals Introducing a Psychiatry Clerkship Curriculum Based on Entrustable Professional Activities: an Explorative Pilot Study

2021 ◽  
Author(s):  
Severin Pinilla ◽  
Andrea Cantisani ◽  
Stefan Klöppel ◽  
Werner Strik ◽  
Christoph Nissen ◽  
...  
Keyword(s):  
Pilot Study ◽  
Psychiatry Clerkship ◽  
Entrustable Professional Activities ◽  
Clinical Supervisors ◽  
Professional Activities ◽  
Before And After ◽  
Substance Abuse Disorders ◽  
Competency Based ◽  
Self Assessments ◽  
Indirect Supervision

Abstract Objective The authors evaluated a reformed psychiatry clerkship curriculum based on entrustable professional activities (EPAs). Methods The authors conducted an exploratory pilot study of a reformed clerkship curriculum based on EPAs. A novel workplace-based assessment format including an entrustment-supervision scale and curricular adaptations were introduced. The Kirkpatrick model was used to evaluate outcomes of the reformed clerkship curriculum on three levels (1 = acceptance, 2 = learning, 3 = change of behavior). Results The pilot student cohort (n = 10) completed a questionnaire, 180 self-assessments (18 per student) on need for supervision, and 63 workplace-based assessments (6.3 per student, in 4 weeks). Level 1: high overall satisfaction with the clerkship (five-point Likert item: average, 4.9; range: 4.0–5.0). Level 2: the overall significant decrease in self-assessed need for supervision before and after the clerkship was two supervision levels (direct to indirect supervision; p < 0.05). The most frequently documented admissions included schizophrenic disorders (n = 11; 28%), affective disorders (n = 10; 25%), substance abuse disorders (n = 5; 13%), and anxiety and stress-related disorders (n = 5; 13%). Level 3: clinical supervisors used history taking, assessing the mental status, and documentation and presentation for workplace-based assessments. According to supervisors’ ratings, there was a decreasing need for supervision from the first to last week of the clerkship. Conclusions Students reacted positively to the reformed clerkship curriculum. The workplace-based assessments with entrustment ratings appeared to support achievement of competency-based learning objectives. Better understanding of how to cover assessment of all core EPAs in the psychiatry clerkship is needed.

scholarly journals Introducing a clerkship curriculum based on entrustable professional activities: a pilot study

2020 ◽  
Author(s):  
Severin Pinilla ◽  
Andrea Cantisani ◽  
Stefan Klöppel ◽  
Werner Strik ◽  
Christoph Nissen ◽  
...  
Keyword(s):  
Pilot Study ◽  
Entrustable Professional Activities ◽  
Professional Activities ◽  
Wide Range ◽  
Level 3 ◽  
Self Assessments ◽  
Level 1 ◽  
Indirect Supervision ◽  
Level 2 ◽  
Patient Mix

Abstract BackgroundGeneral clerkship quality criteria have not been studied after introducing a curriculum based on entrustable professional activities (EPAs). Therefore, we conducted a pilot study to explore educational outcomes of an EPA-based clerkship curriculum reform.MethodsWe collected multiple self-assessment and evaluation data on levels 1-3 of the New World Kirkpatrick model (KPM). For level 1 (reaction) we analyzed curriculum evaluations and verbal and written students’ feedback. For level 2 (learning) pre- and post-clerkship self-assessments of perceived need for supervision for each EPA and students’ written learning reflections based on patient mix exposure were analyzed. For level 3 (behavior) we evaluated workplace-based assessments.ResultsThe first student cohort in the new EPA-based clerkship completed 180 self-assessments (18 per student) of need for supervision and 63 documented workplace-based assessments (average of 6.3 per student in four weeks). On KPM level 1 we saw a high overall satisfaction with the clerkship (average of 4.9, range: 4.0-5.0 on a 5-point Likert scale). In written evaluations and feedback rounds students pointed out the importance of structured bedside teaching in the first clerkship week. On KPM level 2 the overall decrease of self-assessed need for supervision before and after the clerkship was two supervision levels (from direct to indirect supervision) and statistically significant (p < 0.05). For three EPAs students reached indirect supervision levels. Learning reflections and patient mix analysis indicated that students were exposed to a wide range of diagnostic categories (ICD-10: F0 – F6) and received actionable feedback for communication skills. On KPM level 3 clinical supervisors predominantly used EPAs 1 (History taking), 2 (Assessing mental status) and 8 (Documentation and presentation) for workplace-based assessments. We saw a decreasing need for supervision from the first to the last week in the clerkship according to the supervisors’ judgements.ConclusionStudents reacted positively to introducing an EPA-based clerkship curriculum. The EPA-oriented formative self-assessments and workplace-based assessments seemed to support achievement of competency-based learning goals. However, more in-depth understanding of the entrustment process in the clerkship context is necessary to fully leverage the potential of an EPA-based clerkship.

scholarly journals Workplace-based assessments of entrustable professional activities in a psychiatry core clerkship: an observational study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Severin Pinilla ◽  
Alexandra Kyrou ◽  
Stefan Klöppel ◽  
Werner Strik ◽  
Christoph Nissen ◽  
...  
Keyword(s):  
Clinical Encounter ◽  
Entrustable Professional Activities ◽  
Written Feedback ◽  
Professional Activities ◽  
Quality Feedback ◽  
Observational Prospective Cohort Study ◽  
Competency Based ◽  
Patient’S History ◽  
Indirect Supervision ◽  
Clerkship Rotation

Abstract Background Entrustable professional activities (EPAs) in competency-based, undergraduate medical education (UME) have led to new formative workplace-based assessments (WBA) using entrustment-supervision scales in clerkships. We conducted an observational, prospective cohort study to explore the usefulness of a WBA designed to assess core EPAs in a psychiatry clerkship. Methods We analyzed changes in self-entrustment ratings of students and the supervisors’ ratings per EPA. Timing and frequencies of learner-initiated WBAs based on a prospective entrustment-supervision scale and resultant narrative feedback were analyzed quantitatively and qualitatively. Predictors for indirect supervision levels were explored via regression analysis, and narrative feedback was coded using thematic content analysis. Students evaluated the WBA after each clerkship rotation. Results EPA 1 (“Take a patient’s history”), EPA 2 (“Assess physical & mental status”) and EPA 8 (“Document & present a clinical encounter”) were most frequently used for learner-initiated WBAs throughout the clerkship rotations in a sample of 83 students. Clinical residents signed off on the majority of the WBAs (71%). EPAs 1, 2, and 8 showed the largest increases in self-entrustment and received most of the indirect supervision level ratings. We found a moderate, positive correlation between self-entrusted supervision levels at the end of the clerkship and the number of documented entrustment-supervision ratings per EPA (p < 0.0001). The number of entrustment ratings explained 6.5% of the variance in the supervisors’ ratings for EPA 1. Narrative feedback was documented for 79% (n = 214) of the WBAs. Most narratives addressed the Medical Expert role (77%, n = 208) and used reinforcement (59%, n = 161) as a feedback strategy. Students perceived the feedback as beneficial. Conclusions Using formative WBAs with an entrustment-supervision scale and prompts for written feedback facilitated targeted, high-quality feedback and effectively supported students’ development toward self-entrusted, indirect supervision levels.

Assessment of Entrustable Professional Activities Using an Online Simulation Platform During Transition to Emergency Medicine Residency: A Mixed Methods Pilot Study (Preprint)

2021 ◽  
Author(s):  
Cynthia R Peng ◽  
Kimberly A Schertzer ◽  
Holly A Caretta-Weyer ◽  
Stefanie S Sebok-Syer ◽  
William Lu ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Pilot Study ◽  
Final Diagnosis ◽  
Diagnostic Assessment ◽  
Entrustable Professional Activities ◽  
Simulation Platform ◽  
Professional Activities ◽  
Clinical Encounters ◽  
Critical Action ◽  
Competency Based

BACKGROUND The 13 Core Entrustable Professional Activities (EPAs) are key competency-based learning outcomes in the transition from undergraduate to graduate medical education. Five of these EPAs (EPA2: prioritizing differential, EPA3: recommending and interpreting tests, EPA4: entering orders and prescriptions, EPA5: documenting clinical encounters, and EPA10: recognizing urgent and emergent conditions) are uniquely suited for online assessment. OBJECTIVE For this pilot study, we created a web-based simulation platform for diagnostic assessment of these EPAs and examined its feasibility and acceptability. METHODS Four simulation cases underwent three rounds of consensus panels and pilot testing. Incoming emergency medicine interns (n=15) completed all cases, and up to 4 “look for” statements, which encompassed specific EPAs, were generated for each participant: 1) performing harmful or missing actions, 2) narrow differential or wrong final diagnosis, 3) having errors in documentation, and 4) lack of recognition and stabilization of urgent diagnoses. Finally, we interviewed a sample of interns (n=5) and residency leadership (n=5) and analyzed the responses using thematic analysis. RESULTS All participants had at least 1 missing critical action and 40% participants performed at least one harmful action across all 4 cases. The final diagnosis was not included in the differential diagnosis in more than half of assessments (53%). Other errors included choosing the incorrect documentation (40%) and indiscriminately applying oxygen (60%). The themes to the interviews included: psychological safety of the interface, ability to assess learning, and fidelity of cases. The most valuable feature cited was the ability to place orders in a realistic electronic medical record interface. CONCLUSIONS This study demonstrates the feasibility and acceptability of this platform for diagnostic assessment of specific EPAs. This approach rapidly identifies potential areas of concern for incoming interns using an asynchronous format, provides this feedback in a manner appreciated by residency leadership, and informs individualized learning plans.

scholarly journals An Updated Primer on Entrustable Professional Activities (EPAs)

2019 ◽  
Vol 43 (1 suppl 1) ◽  
pp. 712-720
Author(s):  
Olle ten Cate
Keyword(s):  
Undergraduate Students ◽  
Medical Training ◽  
Specific Activity ◽  
Two Dimensions ◽  
Entrustable Professional Activities ◽  
Turn Of The Millennium ◽  
Professional Activities ◽  
Competency Based ◽  
Almost All ◽  
Indirect Supervision

ABSTRACT Since the turn of the millennium, competency-based medical education (CBME) has become a new standard for medical training in many countries. CBME has been operationalized in detailed frameworks of competencies that every physician should demonstrate at graduation, and similar frameworks have been created for specialties. However, the competencies, describing qualities that physicians should possess, do not directly translate into everyday activities of physicians. For that reason, the Entrustable Professional Activities (EPAs) were introduced. EPAs are units of professional practice that may be entrusted to undergraduate students, once they show the competencies needed to perform them without supervision. EPAs have become a popular topic within CBME programs in many countries and hundreds of publications within only a few years. This paper was written to introduce the strengths and weaknesses of EPAs. After a brief historical overview, the reason why EPAs are a bridge between a competency framework and daily clinical practice is explained. While competencies are qualities of individuals, EPAs are units of work. The two can be seen as two dimensions of a matrix, showing that almost all activities in health care are based on multiple competencies, such as communication skill, collaboration, professional behavior, content knowledge. Next, entrustment decision-making as a form of assessment is created and a framework of levels of supervision is presented. Entrustment decisions focus on the level of supervision a student requires for a specific activity, divided into five levels (1: allowed to observe; 2; allowed to perform under direct supervision; 3: allowed to perform under indirect supervision; 4: allowed to perform the activity unsupervised; 5: allowed to supervise the activity performed by more junior learners). For readers interested in applying the concept to practice, a stepwise approach to the curriculum development is proposed. The paper concludes with an overview of the state-of-the-art of working with EPAs across disciplines, professions and countries.

scholarly journals A search for entrustable professional activities for the 1st year pathology postgraduate trainees

2018 ◽  
Vol 10 (01) ◽  
pp. 026-030 ◽  
Author(s):  
Pooja Sharma ◽  
Nadeem Tanveer ◽  
Aditi Goyal
Keyword(s):  
Medical Education ◽  
Training Program ◽  
Paradigm Shift ◽  
Entrustable Professional Activities ◽  
Average Score ◽  
Professional Activities ◽  
The Past ◽  
Cumulative Score ◽  
Competency Based ◽  
The Right

Abstract INTRODUCTION: During the past decade, there has been a paradigm shift in medical education from the problem-based learning to competency-based training. This has forced a rethink on the way we evaluate the residents and finally give them the right to handle patients independently. This study makes the first attempt towards designing competency-based training program for pathology residents by formulating the entrustable professional activities (EPAs) for the 1st year pathology residents. MATERIALS AND METHODS: A questionnaire comprising 18 potential EPAs in histopathology and 12 potential EPAs in cytology were circulated among the residents of Pathology Department. The respondents were asked to grade the EPAs on a scale of 0–4 based on how important they considered that activity as EPA. The cumulative score of each EPA was divided by the number of respondents to arrive at the average score. The EPAs with an average score of 3 or more qualified to be shortlisted as consensus EPAs. RESULTS: Five activities each of histopathology and cytopathology had an average score of 3 or above and were shortlisted as EPAs for the 1st year pathology postgraduates. Each of these was also mapped to their respective competencies. CONCLUSION: There is an urgent need to restructure the postgraduate pathology curriculum in line with competency-based training. This study is the first step in this direction.

scholarly journals Feasibility of an Entrustable Professional Activity for Pathology Resident Frozen Section Training

2021 ◽  
Vol 8 ◽  
pp. 237428952110417
Author(s):  
Bronwyn H. Bryant
Keyword(s):  
Medical Education ◽  
Frozen Section ◽  
Resident Training ◽  
Entrustable Professional Activities ◽  
Professional Activity ◽  
Clinical Competency ◽  
Professional Activities ◽  
Competency Based ◽  
The University ◽  
Clinical Competency Committee

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.

scholarly journals Entrustable Professional Activities: Correlation of Entrustment Assessments of Pediatric Residents With Concurrent Subcompetency Milestones Ratings

2020 ◽  
Vol 12 (1) ◽  
pp. 66-73
Author(s):  
Jerry G. Larrabee ◽  
Dewesh Agrawal ◽  
Franklin Trimm ◽  
Mary Ottolini
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pearson Correlation ◽  
Statistical Significance ◽  
Strong Association ◽  
Assessment Tools ◽  
Entrustable Professional Activities ◽  
Pediatric Residents ◽  
Professional Activities ◽  
Competency Based

ABSTRACT Background In competency-based medical education, subcompetency milestones represent a theoretical stepwise description for a resident to move from the level of novice to expert. Despite their ubiquitous use in the assessment of residents, they were not designed for that purpose. Because entrustable professional activities (EPAs) require observable behaviors, they could serve as a potential link between clinical observation of residents and competency-based assessment. Objective We hypothesized that global faculty-of-resident entrustment ratings would correlate with concurrent subcompetency milestones-based assessments. Methods This prospective study evaluated the correlation between concurrent entrustment assessments and subcompetency milestones ratings. Pediatric residents were assessed in 4 core rotations (pediatric intensive care unit, neonatal intensive care unit, general inpatient, and continuity clinic) at 3 different residency training programs during the 2014–2015 academic year. Subcompetencies were mapped to rotation-specific EPAs, and shared assessments were utilized across the 3 programs. Results We compared 29 143 pairs of entrustment levels and corresponding subcompetency levels from 630 completed assessments. Pearson correlation coefficients demonstrated statistical significance for all pairs (P &lt; .001). Multivariate linear regression models produced R-squared values that demonstrated strong correlation between mapped EPA levels and corresponding subcompetency milestones ratings (median R2 = 0.81; interquartile range 0.73–0.83; P &lt; .001). Conclusions This study demonstrates a strong association between assessment of EPAs and subcompetency milestones assessment, providing a link between entrustment decisions and assessment of competence. Our data support creating resident assessment tools where multiple subcompetencies can be mapped and assessed by a smaller set of rotation-specific EPAs.

Sign in / Sign up

Export Citation Format

Share Document