Setting standards of performance expected in neurosurgery residency: A study on entrustable professional activities in competency-based medical education

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.

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Delivering on the promise of competency based medical education – an institutional approach

Canadian Medical Education Journal ◽

10.36834/cmej.43303 ◽

2019 ◽

Vol 10 (1) ◽

pp. e28-38 ◽

Cited By ~ 5

Author(s):

Damon Dagnone ◽

Denise Stockley ◽

Leslie Flynn ◽

Rylan Egan ◽

Richard Van Wylick ◽

...

Keyword(s):

Medical Education ◽

Diffusion Of Innovation ◽

Training Model ◽

Residency Education ◽

Transformative Change ◽

Competency Based Medical Education ◽

Professional Activities ◽

Competency Based ◽

Institutional Vision ◽

Proactive Measures

The Royal College of Physicians and Surgeons of Canada (RCPSC) adopted a plan to transform, over a seven-year horizon (2014-2021), residency education across all specialties to competency-based medical education (CBME) curriculum models. The RCPSC plan recommended implementing a more responsive and accountable training model with four discrete stages of training, explicit, specialty specific entrustable professional activities, with associated milestones, and a programmatic approach to assessment across residency education. Embracing this vision, the leadership at Queen’s University (in Kingston, Ontario, Canada) applied for and was granted special permission by the RCPSC to embark on an accelerated institutional path. Over a three-year period, Queen’s took CBME from concept to reality through the development and implementation of acomprehensive strategic plan. This perspective paper describes Queen’s University’s approach of creating a shared institutional vision, outlines the process of developing a centralized CBME executive team and twenty-nine CBME program teams, and summarizes proactive measures to ensure program readiness for launch. In so doing, Queen’s created a community of support and CBME expertise that reinforces shared values including fostering co-production, cultivating responsive leadership, emphasizing diffusion of innovation, and adopting a systems-based approach to transformative change.

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Analyzing the Administrative Burden of Competency Based Medical Education

Canadian Association of Radiologists Journal ◽

10.1177/08465371211038963 ◽

2021 ◽

pp. 084653712110389

Author(s):

Kevin Cheung ◽

Christina Rogoza ◽

Andrew D. Chung ◽

Benjamin Yin Ming Kwan

Keyword(s):

Medical Education ◽

Postgraduate Medical Education ◽

Assessment Process ◽

Full Time ◽

Equal Distribution ◽

Competency Based Medical Education ◽

Quantitative Evidence ◽

Administrative Burden ◽

Professional Activities ◽

Competency Based

Purpose: Postgraduate residency programs in Canada are transitioning to a competency-based medical education (CBME) system. Within this system, resident performance is documented through frequent assessments that provide continual feedback and guidance for resident progression. An area of concern is the perception by faculty of added administrative burden imposed by the frequent evaluations. This study investigated the time spent in the documentation and submission of required assessment forms through analysis of quantitative data from the Queen’s University Diagnostic Radiology program. Methods and Materials: Data regarding time taken to complete Entrustable Professional Activities (EPA) assessments was collected from 24 full-time and part-time radiologists over a period of 18 months. This data was analyzed using SPSS to determine mean time of completion by individuals, departments, and by experience with the assessment process. Results: The average time taken to complete an EPA assessment form was 3 minutes and 6 seconds. Assuming 3 completed EPA assessment forms per week for each resident (n = 12) and equal distribution among all staff, this averaged out to an additional 18 minutes of administrative burden per staff member over a 4 week block. Conclusions: This study investigated the perception by faculty of additional administrative burden for assessment in the CBME framework. The data provided quantitative evidence of administrative burden for the documentation and submission of assessments. The data indicated that the added administrative burden may be reasonable given mandate for CBME implementation and the advantages of adoption for postgraduate medical education.

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

Academic Pathology ◽

10.1177/23742895211041757 ◽

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.

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Trusting our trainees: competency-based training of cardiologists using Entrustable Professional Activities (EPA)

European Heart Journal ◽

10.1093/ehjci/ehaa946.3533 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

R Beeri ◽

F.C Tanner ◽

O Ten Cate ◽

M Ros ◽

P Kirchhof

Keyword(s):

Medical Education ◽

Core Curriculum ◽

Clinical Care ◽

Quality Care ◽

Entrustable Professional Activities ◽

Core Knowledge ◽

Specific Training ◽

Professional Activities ◽

Competency Based ◽

Education Conference

Abstract Assessment of trainees is a core activity of educators, ensuring that trainees can be trusted to provide high quality care with no supervision. Training and the demands on trainees have changed with specialization, need for more technical skills, digitization, needs for teamwork and greater communication skills. Competency-based medical education was introduced to capture these changing needs for trainees. The 7th ESC Education Conference – “From competence to good clinical care” – brought together national directors of training (39), young cardiology representatives (7), patients (7), ESC partners in education (10), and the ESC Education Committee (22) to discuss contemporary challenges in cardiology training and Entrustable Professional Activities (EPAs)-based solutions. Methods Pre- and post-conference surveys were conducted. The different issues were discussed in 4 workshops: core knowledge and evidence, skills and competence, performing into context, and training the trainers. Results Pre-conference, 90% of respondents believed that trainees should be certified only when they can be entrusted to perform in an unsupervised fashion, and 84% thought that specific training for educators should be required. From the workshops 4 themes emerged: 1) Core knowledge and evidence: rotations to different centres are needed to enable trainees to meet EPA requirements. 2) Skills and competence: a learning agreement between trainers and trainees should be established with protected time to achieve EPAs, and patient feedback on trainee performance should be obtained. 3) Performing into context (when is a trainee ready to practice): clinicians do informal assessment on a daily basis; EPAs formalize this with regular observation linked with progression in responsibility. 4) Train the trainer: good doctors are not automatically good trainers and should be required to undergo specific training themselves. We reviewed complex training frameworks such as the Canadian Medical Education Directives for Specialists (CanMEDS) that contains too many components to be useful for clinical teachers. EPAs were identified as a practical way to implement competency-based cardiology training across the ESC. The 2020 ESC Core Curriculum contains EPAs that a cardiologist should be able to perform independently by the end of training. Post-conference there was unanimous agreement (100%) that EPAs are a valuable concept in training. A majority of participants (69%) agreed that EPA's are applicable in practice today. Conclusion Trainee assessment is a daily challenge for educators. The ESC Education Conference identified distinct goals to be achieved before, during and at the completion of a training programs. The EPA concept was widely accepted as an efficient method to monitor trainees progress, while trusting them to perform activities in which they are proficient. Trusting our trainees should be a major educational goals for cardiologists in Europe. Funding Acknowledgement Type of funding source: None

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Examining Academic Leader’s work in implementing Competency-based Medical Education using Organizational Learning Theory

10.1101/438077 ◽

2018 ◽

Author(s):

Nicolas Fernandez ◽

Nicole Leduc ◽

Nathalie Caire Fon ◽

Louis-Georges Ste-Marie ◽

Dat Nguyen-Dinh ◽

...

Keyword(s):

Medical Education ◽

Organizational Learning ◽

Learning Theory ◽

Structured Interviews ◽

Academic Leaders ◽

Competency Based Medical Education ◽

Organizational Learning Theory ◽

Professional Activities ◽

Competency Based ◽

Implementation Progress

ContextCompetency-based medical education (CBME) implementation is being carried out in many medical schools worldwide. Academic Leadership is a strategy where selected Faculty act to influence peers to adopt change. The Université de Montréal medical school, has adopted this strategy to implement CBME.PurposeThis paper aims to describe the work of Academic Leaders in the process of CBME implementation and to explore relevance of the Nonaka and Toyama organizational learning theory to map implementation progress.MethodBecause knowledge creation model focuses on the relationships between leaders and social structures, embedded case study was selected. Diverse sampling method was used to select three departments: internal medicine, surgery and psychiatry, based on the number of CBME training activities. Data collection was at two intervals, two years apart. Semi-structured interviews (individual and group) were conducted with Department Heads and Academic Leaders. Thematic analysis was conducted on the 15 interview transcriptions.ResultsAs implementation begins, Leaders critically revisit accepted teaching routines and develop a common conception of CBME. This enables leaders to communicate with a wider audience and work within existing committees and working groups where they “break down” CBME into practical concepts. This practical understanding, disseminated through Entrustable Professional Activities, enables observable change.ConclusionLeaders’ roles evolved from an “expert” that disseminates knowledge about CBME through lectures, to a responsive and pragmatic supporting role by developing and writing practical tools in collaboration with peers and program directors.

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Could Entrustable Professional Activities mediate teaching-care integration services in the community?

Revista de la Facultad de Medicina ◽

10.15446/revfacmed.v69n2.83906 ◽

2020 ◽

Vol 69 (2) ◽

Author(s):

Ieda Francischetti ◽

José Bitu Moreno ◽

Harm Peters

Keyword(s):

Health Care ◽

Medical Education ◽

Primary Health Care ◽

Medical Training ◽

Entrustable Professional Activities ◽

Professional Activities ◽

Care Integration ◽

Primary Health ◽

Teaching Community ◽

Competency Based

Currently, competency-based medical education (CBME) is the most common type of curriculum used worldwide. However, its limitations include fragmented learning and difficulties to use properly the knowledge, skills, and attitudes acquired using this educational model. Having this in mind, Entrustable Professional Activities (EPA) emerge as a tool to mediate the transposition of the competency-based curriculum into physicians’ professional practice in graduate medical education. Therefore, based on a narrative review of the existing literature on EPA and the authors’ experience in teaching community-based healthcare integration services, the aim of this paper is to reflect on the possible use of these activities in undergraduate medical education for the development of a CBME model integrated with primary health care and community medicine. The reflections made here allow suggesting that, although it is a challenging process, the adoption of EPA in undergraduate medical training is appropriate to achieve a better provision of primary health care to individuals, families, and communities in general.

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An Entrustable Professional Activity Addressing Racism and Pediatric Health Inequities

PEDIATRICS ◽

10.1542/peds.2021-054604 ◽

2022 ◽

Author(s):

Ndidi I. Unaka ◽

Ariel Winn ◽

Adiaha Spinks-Franklin ◽

Patricia Poitevien ◽

Franklin Trimm ◽

...

Keyword(s):

Medical Education ◽

Health Care Systems ◽

Health Inequities ◽

Professional Activity ◽

Competency Based Medical Education ◽

Pediatric Health ◽

Professional Activities ◽

Care Systems ◽

Competency Based ◽

Pediatric Populations

Racism and discrimination are the root of many pediatric health inequities and are well described in the literature. Despite the pervasiveness of pediatric health inequities, we have failed to adequately educate and prepare general pediatricians and pediatric subspecialists to address them. Deficiencies within education across the entire continuum and in our health care systems as a whole contribute to health inequities in unacceptable ways. To address these deficiencies, the field of pediatrics, along with other specialties, has been on a journey toward a more competency-based approach to education and assessment, and the framework created for the future is built on entrustable professional activities (EPAs). Competency-based medical education is one approach to addressing the deficiencies within graduate medical education and across the continuum by allowing educators to focus on the desired equitable patient outcomes and then develop an approach to teaching and assessing the tasks, knowledge, skills, and attitudes needed to achieve the goal of optimal, equitable patient care. To that end, we describe the development and content of a revised EPA entitled: Use of Population Health Strategies and Quality Improvement Methods to Promote Health and Address Racism, Discrimination, and Other Contributors to Inequities Among Pediatric Populations. We also highlight the ways in which this EPA can be used to inform curricula, assessments, professional development, organizational systems, and culture change.

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The competency-based medical education evolution of Canadian emergency medicine specialist training

CJEM ◽

10.1017/cem.2019.417 ◽

2019 ◽

Vol 22 (1) ◽

pp. 95-102 ◽

Cited By ~ 7

Author(s):

Jonathan Sherbino ◽

Glen Bandiera ◽

Ken Doyle ◽

Jason R. Frank ◽

Brian R. Holroyd ◽

...

Keyword(s):

Emergency Medicine ◽

Medical Education ◽

Residency Education ◽

Multiple Sources ◽

High Stakes ◽

Competency Based Medical Education ◽

Professional Activities ◽

Local Resources ◽

Education Design ◽

Competency Based

ABSTRACTCanadian specialist emergency medicine (EM) residency training is undergoing the most significant transformation in its history. This article describes the rationale, process, and redesign of EM competency-based medical education. The rationale for this evolution in residency education includes 1) improved public trust by increasing transparency of the quality and rigour of residency education, 2) improved fiscal accountability to government and institutions regarding specialist EM training, 3) improved assessment systems to replace poor functioning end-of-rotation assessment reports and overemphasis on high-stakes, end-of-training examinations, and 4) and tailored learning for residents to address individualized needs. A working group with geographic and stakeholder representation convened over a 2-year period. A consensus process for decision-making was used. Four key design features of the new residency education design include 1) specialty EM-specific outcomes to be achieved in residency; 2) designation of four progressive stages of training, linked to required learning experiences and entrustable professional activities to be achieved at each stage; 3) tailored learning that provides residency programs and learner flexibility to adapt to local resources and learner needs; and 4) programmatic assessment that emphasizes systematic, longitudinal assessments from multiple sources, and sampling sentinel abilities. Required future study includes a program evaluation of this complex education intervention to ensure that intended outcomes are achieved and unintended outcomes are identified.

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