Entrustable Professional Activities: What, why, who, when, how, and what now?

A Modified Delphi Involving Laboratory Faculty to Define Essential Skills for Pharmacy Graduates

Objective. To define essential skills for Doctor of Pharmacy (PharmD) graduates that are needed in the four most common sectors of pharmacy practice as determined by expert faculty who instruct within pharmacy skills laboratories.Methods. A three-round Delphi method was used to establish consensus. In the first round, participants were asked what skills were needed by students at entry to practice in community, health-system, ambulatory care, and managed care pharmacy settings. In rounds two and three, participants were asked to rate each skill with a level of importance using a 10-point Likert scale (1=not important to 10=very important).Results. In round one, participants produced a collective list of 289 essential skills. These skill statements were sent to participants in rounds two and three to assign a level of importance. After the third round, participants reached consensus using a mean level of importance for a final list of 69 community pharmacy skills, 47 health-system, 60 ambulatory care, and 15 managed care skills. These skills were then mapped to entrustable professional activities domains for schools and colleges pharmacy to use as a resource when assessing core competency development in the curriculum.Conclusion. The Delphi technique was used successfully with expert pharmacy skills laboratory faculty to identify laboratory-focused essential skills that recent PharmD graduates should have prior to entering community, health-system, ambulatory care, or managed care pharmacy practice. These essential skills can be used to guide curriculum development, develop milestone markers, and help ensure students are practice ready.

A Program to Prepare Clinical Pharmacy Faculty Members to Use Entrustable Professional Activities in Experiential Education

Objective. To describe the design and evaluation of a program implemented to ready clinical faculty members to use entrustable professional activities (EPAs) for teaching and assessment in experiential education. Methods. The school adopted a set of EPAs for faculty members to implement in advanced pharmacy practice experiences (APPEs), and then delivered a two-session faculty development program to ensure faculty members' readiness to implement the EPAs. To determine the success of the faculty development program, qualitative analysis of the moderated discussion held during the program was conducted, post-program and follow-up surveys were administered, and the results of the pilot implementation of EPAs were analyzed. Results. Eleven faculty members participated in the development program, and 10 of them completed the pilot implementation of EPAs and the follow-up survey after completing three APPE blocks. All faculty members responded that the program prepared them to apply what they learned about EPAs to their practice setting in both the post-program and follow-up surveys. In the follow-up survey, 80% of faculty members reported that they were confident in correctly applying what they learned from the program to the EPA pilot, and 100% answered a hypothetical application question correctly. Forty students participated in the pilot implementation of EPAs. Of these, 95% were directly observed by faculty members before making an entrustment decision, and 100% received feedback on their performance. Conclusion. The faculty development program was effective in preparing faculty members to implement the EPA framework in experiential teaching and use the entrustment rubric.

Development and inclusion of an entrustable professional activity (EPA) scale in a simulation-based medicine dispensing assessment

BACKGROUND AND PURPOSE

Effective, safe, and patient-centred dispensing is a core task of community pharmacists. Entrustable professional activities (EPAs) offer a way of defining and assessing these daily practice activities. Although EPAs have become popular within competency-based medical education programs, their use is new to pharmacy education and assessment.

EDUCATIONAL ACTIVITY AND SETTING

A simulation-based assessment framework containing a scale of entrustment was developed to evaluate the readiness of Year 4 undergraduate pharmacy students to safely manage the supply of prescribed medicine(s) in a community pharmacy. The assessment framework was piloted in a fourth year "Transition to Practice" course with 28 simulation-based assessments conducted.

FINDINGS

An entrustment framework was developed and implemented successfully with Year 4 undergraduate pharmacy students. The EPA for medicine dispensing integrates competency domains that include information gathering, providing patient-centred care, clinical reasoning, medicine dispensing, and professional communications. On a scale ranging from level 1 to level 5, the majority (73%) of entrustment ratings were level 2 or level 3; and of the students who achieved different ratings between clinical scenarios, 75% of students improved on their second simulation attempt. There was a strong correlation between the global EPA ratings with the total score achieved across the domains.

SUMMARY

Using simulation-based assessment, entrustment decision making can be incorporated in "entry to profession" undergraduate and postgraduate pharmacy courses to assess students' readiness to transition between learning and professional practice.