scholarly journals An Entrustable Professional Activity Addressing Racism and Pediatric Health Inequities

PEDIATRICS ◽  
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.

scholarly journals Building a Shared Mental Model of Competence Across the Continuum: Trainee Perceptions of Subinternships for Residency Preparation

2021 ◽  
Vol 8 ◽  
pp. 238212052110633
Author(s):  
Johannah M. Scheurer ◽  
Cynthia Davey ◽  
Anne G. Pereira ◽  
Andrew P. J. Olson
Keyword(s):  
Medical Education ◽  
Response Rate ◽  
Professional Activity ◽  
University Of Minnesota ◽  
Competency Based Medical Education ◽  
Chi Squared ◽  
Competency Based ◽  
Kappa Agreement ◽  
Physician Competency ◽  
The Continuum

INTRODUCTION Toward a vision of competency-based medical education (CBME) spanning the undergraduate to graduate medical education (GME) continuum, University of Minnesota Medical School (UMMS) developed the Subinternship in Critical Care (SICC) offered across specialties and sites. Explicit course objectives and assessments focus on internship preparedness, emphasizing direct observation of handovers (Core Entrustable Professional Activity, “EPA,” 8) and cross-cover duties (EPA 10). METHODS To evaluate students’ perceptions of the SICC's and other clerkships’ effectiveness toward internship preparedness, all 2016 and 2017 UMMS graduates in GME training ( n = 440) were surveyed regarding skill development and assessment among Core EPAs 1, 4, 6, 8, 9, 10. Analysis included descriptive statistics plus chi-squared and Kappa agreement tests. RESULTS Respondents ( n = 147, response rate 33%) rated the SICC as a rotation during which they gained most competence among EPAs both more (#4, 57% rated important; #8, 75%; #10, 70%) and less explicit (#6, 53%; #9, 69%) per rotation objectives. Assessments of EPA 8 (80% rated important) and 10 (76%) were frequently perceived as important toward residency preparedness. Agreement between importance of EPA development and assessment was moderate (Kappa = 0.40-0.59, all surveyed EPAs). CONCLUSIONS Graduates’ perceptions support the SICC's educational utility and assessments. Based on this and other insight from the SICC, the authors propose implications toward collectively envisioning the continuum of physician competency.

scholarly journals Adapting Feedback to Individual Residents: An Examination of Preceptor Challenges and Approaches

2018 ◽  
Vol 10 (2) ◽  
pp. 168-175 ◽  
Author(s):  
Amanda Roze des Ordons ◽  
Adam Cheng ◽  
Jonathan Gaudet ◽  
James Downar ◽  
Jocelyn Lockyer
Keyword(s):  
Medical Education ◽  
Professional Activity ◽  
Framework Analysis ◽  
Competency Based Medical Education ◽  
Performance Levels ◽  
Skill Sets ◽  
Entrustable Professional Activity ◽  
Competency Based ◽  
Individualize Feedback ◽  
Insight Into

ABSTRACT Background  Feedback conversations between preceptors and residents usually occur in closed settings. Little is known about how preceptors address the challenges posed by residents with different skill sets, performance levels, and personal contexts. Objective  This study explored the challenges that preceptors experienced and approaches taken in adapting feedback conversations to individual residents. Methods  In 2015, 18 preceptors participated in feedback simulations portraying residents with variations in skill, insight, confidence, and distress, followed by debriefing of the feedback conversation with a facilitator. These interactions were recorded, transcribed, and analyzed using thematic and framework analysis. Results  The preceptors encountered common challenges with feedback conversations, including uncertainty in how to individualize feedback to residents and how to navigate tensions between resident- and preceptor-identified goals. Preceptors questioned their ability to enhance skills for highly performing residents, whether they could be directive when residents had insight gaps, how they could reframe the perceptions of the overly confident resident, and whether they should offer support to emotionally distressed residents or provide feedback about performance. Preceptors adapted their approach to feedback, drawing on techniques of coaching for highly performing residents, directing for residents with insight gaps, mediation with overly confident residents, and mentoring with emotionally distressed residents. Conclusions  Examining the feedback challenges preceptors encounter and the approaches taken to adapt feedback to individual residents can provide insight into how preceptors meet the challenges of competency-based medical education, in which frequent, focused feedback is essential for residents to achieve educational milestones and entrustable professional activity expectations.

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

2019 ◽  
Vol 10 (1) ◽  
pp. e28-38 ◽  
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. 

scholarly journals Analyzing the Administrative Burden of Competency Based Medical Education

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.

scholarly journals Sustainability of physical exam skills in a resident-led curriculum in a large internal medicine program with competency based medical education

2018 ◽  
Vol 9 (4) ◽  
pp. e78-92 ◽  
Author(s):  
Don Thiwanka Wijeratne ◽  
Siddhartha Srivastava ◽  
Barry Chan ◽  
Wilma Hopman ◽  
Benjamin Thomson
Keyword(s):  
Internal Medicine ◽  
Medical Education ◽  
Physical Examination ◽  
Peer Assessment ◽  
Physical Exam ◽  
Professional Activity ◽  
Faculty Assessment ◽  
Competency Based Medical Education ◽  
Competency Based ◽  
Faculty Assessments

Background: Competency Based Medical Education (CBME) designates physical examination competency as an Entrustable Professional Activity (EPA). Considerable concern persists regarding the increased time burden CBME may place on educators. We developed a novel physical examination curriculum that shifted the burden of physical examination case preparation and performance assessment from faculty to residents. Our first objective was to determine if participation led to sustainable improvements in physical examination skills. The second objective was to determine if resident peer assessment was comparable to faculty assessment.    Methods: We selected physical exam case topics based on the Objectives of Training in the Specialty of Internal Medicine as prescribed by the Royal College of Physicians and Surgeons of Canada. Internal Medicine residents compiled evidence-based physical exam checklists that faculty reviewed before distribution to all learners. Physical exam practice sessions with whole-group demonstration followed by small-group practice sessions were performed weekly. We evaluated this pilot curriculum with a formative OSCE, during which a resident peer and a faculty member simultaneously observed and assessed examinee performance by .Results: Participation in the novel curriculum practice sessions improved OSCE performance (faculty score mean 78.96 vs. 62.50, p<0.05). Peer assessment overestimated faculty scores (76.2 vs. 65.7, p<0.001), but peer and faculty assessments were highly correlated (R2 = 0.73 (95% CI 0.50-0.87).Conclusion: This novel physical examination curriculum leads to sustainable improvement of physical examination skills. Peer assessment correlated well with the gold standard faculty assessment. This resident-led physical examination curriculum enhanced physical examination skills in a CBME environment, with minimal time commitment from faculty members.

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 Teaching and assessing intra-operative consultations in competency-based medical education: development of a workplace-based assessment instrument

2021 ◽  
Author(s):  
Marcio M. Gomes ◽  
David Driman ◽  
Yoon Soo Park ◽  
Timothy J. Wood ◽  
Rachel Yudkowsky ◽  
...  
Keyword(s):  
Medical Education ◽  
Assessment Tools ◽  
Assessment Instrument ◽  
Professional Activity ◽  
Cultural Issues ◽  
Education Development ◽  
Competency Based Medical Education ◽  
Workplace Based Assessment ◽  
Competency Based ◽  
Validity Theory

AbstractCompetency-based medical education (CBME) is being implemented worldwide. In CMBE, residency training is designed around competencies required for unsupervised practice and use entrustable professional activities (EPAs) as workplace “units of assessment”. Well-designed workplace-based assessment (WBA) tools are required to document competence of trainees in authentic clinical environments. In this study, we developed a WBA instrument to assess residents’ performance of intra-operative pathology consultations and conducted a validity investigation. The entrustment-aligned pathology assessment instrument for intra-operative consultations (EPA-IC) was developed through a national iterative consultation and used clinical supervisors to assess residents’ performance at an anatomical pathology program. Psychometric analyses and focus groups were conducted to explore the sources of evidence using modern validity theory: content, response process, internal structure, relations to other variables, and consequences of assessment. The content was considered appropriate, the assessment was feasible and acceptable by residents and supervisors, and it had a positive educational impact by improving performance of intra-operative consultations and feedback to learners. The results had low reliability, which seemed to be related to assessment biases, and supervisors were reluctant to fully entrust trainees due to cultural issues. With CBME implementation, new workplace-based assessment tools are needed in pathology. In this study, we showcased the development of the first instrument for assessing resident’s performance of a prototypical entrustable professional activity in pathology using modern education principles and validity theory.

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

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.

Resident evaluations in the age of competency-based medical education: faculty perspectives on minimizing burdens

2020 ◽  
pp. 1-6
Author(s):  
Jessica E. Rabski ◽  
Ashirbani Saha ◽  
Michael D. Cusimano
Keyword(s):  
Medical Education ◽  
Mobile Application ◽  
Postgraduate Medical Education ◽  
Professional Activity ◽  
Successful Implementation ◽  
Neurosurgical Training ◽  
Complete Evaluation ◽  
Competency Based Medical Education ◽  
Main Challenge ◽  
Competency Based

OBJECTIVECompetency-based medical education (CBME), an outcomes-based approach to medical education, continues to be implemented across many postgraduate medical education programs worldwide, including a recent introduction into Canadian neurosurgical training programs (July 2019). The success of this educational paradigm shift requires frequent faculty observation and evaluation of residents performing defined tasks of the specialty. A main challenge involves providing residents with frequent performance evaluations and feedback that are feasible for faculty to complete. This study aims to define what is currently happening and what changes are needed to make CBME successful for the certification of neurosurgeons’ competence.METHODSA 55-item questionnaire was emailed nationwide to survey Canadian neurosurgical faculty.RESULTSFifty-two complete responses were received and achieved a distribution highly correlated with the number of faculty neurosurgeons practicing in each Canadian province (Pearson’s r = 0.94). Two-thirds (35/52) of faculty reported currently taking a median of 10 minutes to complete evaluation forms at the end of a resident’s rotation block. Regardless of the faculty’s province of practice (p = 0.50) or years of experience (p = 0.06), they reported 3 minutes (minimum 1 minute, maximum 10 minutes, interquartile range [IQR] 3 minutes) as a feasible amount of time to spend completing an evaluation form following an observation of a resident’s performance of an entrustable professional activity (EPA). If evaluation forms took 3 minutes to complete, 85% of respondents (44/52) would complete EPA evaluations weekly or daily. The faculty recommended 5 minutes as a feasible amount of time to provide oral feedback (minimum 1 minute, maximum 20 minutes, IQR 3.25 minutes), which was significantly higher (p = 0.00099) than their recommended amount of time for completing evaluation forms. The majority of faculty (71%) stated they would prefer to access resident evaluation forms through a mobile application compared to a paper form (12%), an evaluation website (8%), or through a URL link sent via email (10%; p = 0.0032).CONCLUSIONSTo facilitate the successful implementation of CBME into a neurosurgical training curriculum, resident EPA assessment forms should take 3 minutes or less to complete and be accessible through a mobile application.

Sign in / Sign up

Export Citation Format

Share Document