scholarly journals Entrustable Professional Activities in Family Medicine

2013 ◽  
Vol 5 (1) ◽  
pp. 112-118 ◽  
Author(s):  
Allen F. Shaughnessy ◽  
Jennifer Sparks ◽  
Molly Cohen-Osher ◽  
Kristen H. Goodell ◽  
Gregory L. Sawin ◽  
...  
Keyword(s):  
Family Medicine ◽  
Task Force ◽  
Delphi Process ◽  
Entrustable Professional Activities ◽  
Competency Assessment ◽  
Professional Activities ◽  
Starting Point ◽  
Competency Based ◽  
Resident Assessment ◽  
Resident Competence

Abstract Background The Accreditation Council for Graduate Medical Education Outcome Project intended to move residency education toward assessing and documenting resident competence in 6 dimensions of performance important to the practice of medicine. Although the project defined a set of general attributes of a good physician, it did not define the actual activities that a competent physician performs in practice in the given specialty. These descriptions have been called entrustable professional activities (EPAs). Objective We sought to develop a list of EPAs for ambulatory practice in family medicine to guide curriculum development and resident assessment. Methods We developed an initial list of EPAs over the course of 3 years, and we refined it further by obtaining the opinion of experts using a Delphi Process. The experts participating in this study were recruited from 2 groups of family medicine leaders: organizers and participants in the Preparing the Personal Physician for Practice initiative, and members of the Society of Teachers of Family Medicine Task Force on Competency Assessment. The experts participated in 2 rounds of anonymous, Internet-based surveys. Results A total of 22 experts participated, and 21 experts participated in both rounds of the Delphi Process. The Delphi Process reduced the number of competency areas from 91 to 76 areas, with 3 additional competency areas added in round 1. Conclusions This list of EPAs developed through our Delphi process can be used as a starting point for family medicine residency programs interested in moving toward a competency-based approach to resident education and assessment.

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.

scholarly journals Preparing for CBME: How often are faculty observing residents?

2020 ◽  
Author(s):  
Sheenagh J K George ◽  
Sarah Manos ◽  
Kenny K Wong
Keyword(s):  
Direct Observation ◽  
Assessment Tools ◽  
Inpatient Setting ◽  
Institutional Research ◽  
Professional Activities ◽  
Inpatient Settings ◽  
Competency Based ◽  
Resident Assessment ◽  
Outpatient Settings ◽  
Common Barriers

Abstract Background The Royal College of Physicians and Surgeons of Canada officially launched ‘Competence by Design’ in July 2017, moving from time-based to outcomes-based training. Transitioning to competency-based medical education (CBME) necessitates change in resident assessment. A greater frequency of resident observation will likely be required to adequately assess whether entrustable professional activities have been achieved. Purpose Characterize faculty and resident experiences of direct observation in a single paediatric residency program, pre-CBME implementation. Qualitatively describe participants’ perceived barriers and incentives to participating in direct observation. Methods Surveys were sent to paediatric residents and faculty asking for demographics, the frequency of resident observation during an average 4-week rotation, perceived ideal frequency of observation, and factors influencing observation frequency. Descriptive data were analyzed. Institutional research ethics board approval was received. Results The response rate was 54% (34/68 faculty and 16/25 residents). When asked the MAXIMUM frequency FACULTY observed a resident take a history, perform a physical examination, or deliver a plan, the median faculty reply was 1, 2, and 3, for outpatient settings and 0, 1, and 2, for inpatient settings. The median RESIDENT reply was 2, 4, and 10 for outpatient settings and 1, 2, and 20 for inpatient settings. When asked the MINIMUM frequency for each domain, the median FACULTY and RESIDENT reply was 0, except for delivering a plan in the inpatient setting. Faculty reported observing seniors delivering the plan more frequently than junior residents. Faculty and resident median replies for how frequently residents should be observed for each domain were the same, three to four, three to four, and five to six times. Four per cent of faculty reported regularly scheduling observations, and 77% of residents regularly ask to be observed. The most common barriers to observation were too many patients to see and both faculty and residents were seeing patients at the same time. Most faculty and resident responders felt that observation frequency could be improved if scheduled at the start of the rotation; faculty were provided a better tool for assessment; and if residents asked to be observed. Conclusions This study provides baseline data on how infrequent faculty observation is occurring and at a frequency lower than what faculty and residents feel is necessary. The time needed for observation competes with clinical service demands, but better scheduling strategies and assessment tools may help.

scholarly journals Use of Milestones and Development of Entrustable Professional Activities in 2 Hematology/Oncology Training Programs

2015 ◽  
Vol 7 (1) ◽  
pp. 101-104 ◽  
Author(s):  
Nathan M. Shumway ◽  
Jennifer J. Dacus ◽  
Kate I. Lathrop ◽  
Elizabeth P. Hernandez ◽  
Maria Miller ◽  
...  
Keyword(s):  
Program Directors ◽  
Assessment Tools ◽  
Entrustable Professional Activities ◽  
Clinical Competency ◽  
Clinical Faculty ◽  
Continuity Clinic ◽  
Professional Activities ◽  
Starting Point ◽  
Next Accreditation System ◽  
Clinical Competency Committee

Abstract Background The Next Accreditation System (NAS) increases the focus on educational outcomes and meaningful evaluation of learners. This requires that key clinical faculty develop new assessment formats such as entrustable professional activities (EPAs). Objectives To build and develop milestone-based assessment tools supporting 5 EPAs for a hematology/oncology fellow continuity clinic, and to educate key clinical faculty regarding the Clinical Competency Committee (CCC) and the NAS. Methods Program directors from 2 hematology/oncology fellowship programs developed 5 EPAs for continuity clinic evaluation supported by milestone-based assessment. The program directors met to create a unified CCC charter. Key clinical faculty helped to develop a milestone-based evaluation of fellow continuity clinic through creation of 5 hematology/oncology-specific EPAs. Formal entrustment regarding EPAs was deliberated by the CCC. Results A total of 18 fellows were evaluated. Clinical Competency Committee deliberation at each institution took approximately 10 minutes per fellow for discussion and decision regarding entrustment for all 5 EPAs supporting continuity clinic. One-third of postgraduate year (PGY)–4s, 50% of PGY-5s, and 100% of PGY-6s were deemed competent in all 5 EPAs by the CCC. Conclusions All hematology/oncology trainees in San Antonio were evaluated using milestone-based assessment for continuity clinic, and entrustment decisions regarding 5 EPAs were made by the CCC. This project may provide other programs with a sound basis for adoption and further development of the next generation of evaluation tools at their institutions. Entrustable professional activities that are rotation specific should be used as a starting point for linking to the competencies, subcompetencies, and the reporting milestones.

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 FROM FAMILY MEDICINE MILESTONES TO ENTRUSTABLE PROFESSIONAL ACTIVITIES (EPAS)

2014 ◽  
Vol 12 (4) ◽  
pp. 380-381 ◽  
Author(s):  
N. Bhuyan ◽  
W. F. Miser ◽  
G. M. Dickson ◽  
J. W. Jarvis ◽  
L. Maxwell ◽  
...  
Keyword(s):  
Family Medicine ◽  
Entrustable Professional Activities ◽  
Professional Activities

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.

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.

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