The Development of Entrustable Professional Activities for Competency-Based Veterinary Education in Farm Animal Health

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.

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

Journal of Laboratory Physicians ◽

10.4103/jlp.jlp_51_17 ◽

2018 ◽

Vol 10 (01) ◽

pp. 026-030 ◽

Cited By ~ 3

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.

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Development of a Novel Competency-Based Evaluation System for HIV Primary Care Training: the HIV Entrustable Professional Activities

Journal of General Internal Medicine ◽

10.1007/s11606-019-04956-1 ◽

2019 ◽

Vol 35 (1) ◽

pp. 331-335

Author(s):

Dana Dunne ◽

Michael Green ◽

Jeanette Tetrault ◽

Lydia Aoun Barakat

Keyword(s):

Primary Care ◽

Evaluation System ◽

Entrustable Professional Activities ◽

Professional Activities ◽

Primary Care Training ◽

Hiv Primary Care ◽

Competency Based ◽

Care Training

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

10.2196/preprints.32356 ◽

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.

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Building a competency-based workplace curriculum around entrustable professional activities: The case of physician assistant training

Medical Teacher ◽

10.3109/0142159x.2010.513719 ◽

2010 ◽

Vol 32 (10) ◽

pp. e453-e459 ◽

Cited By ~ 86

Author(s):

Hanneke Mulder ◽

Olle Ten Cate ◽

Rieneke Daalder ◽

Josephine Berkvens

Keyword(s):

Physician Assistant ◽

Entrustable Professional Activities ◽

Professional Activities ◽

Competency Based

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

Journal of Graduate Medical Education ◽

10.4300/jgme-d-19-00408.1 ◽

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 < .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 < .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.

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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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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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