1
|
Bryant BH, Anderson SR, Brissette M, Childs JM, Gratzinger D, Johnson K, Powell DE, Zein-Eldin Powell S, Timmons CF, Chute D, Cummings TJ, Furlong MA, Hébert TM, Reeves HM, Rush D, Vitkovski T, McCloskey CB. National pilot of entrustable professional activities in pathology residency training. Acad Pathol 2024; 11:100110. [PMID: 38560425 PMCID: PMC10978478 DOI: 10.1016/j.acpath.2024.100110] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/25/2023] [Accepted: 01/21/2024] [Indexed: 04/04/2024] Open
Abstract
Entrustable professional activities (EPAs) are observable clinical skills and/or procedures that have been introduced into medical education at the student and resident levels in most specialties to determine readiness to advance into residency or independent practice, respectively. This publication describes the process and outcomes of a pilot study looking at the feasibility of using two anatomic pathology and two clinical pathology EPAs in pathology residency in 6 pathology residency programs that volunteered for the study. Faculty development on EPAs and their assessment was provided to pilot program faculty, and EPA assessment tools were developed and used by the pilot programs. Pre- and post-study surveys were given to participating residents, faculty, and program directors to gauge baseline practices and to gather feedback on the EPA implementation experience. Results demonstrated overall good feasibility in implementing EPAs. Faculty acceptance of EPAs varied and was less than that of program directors. Residents reported a significant increase in the frequency with which faculty provided formative assessments that included specific examples of performance and specific ways to improve, as well as increased frequency with which faculty provided summative assessments that included specific ways to improve. EPAs offered the most benefit in setting clear expectations for performance of each task, for providing more specific feedback to residents, and in increasing Program director's understanding of resident strengths abilities and weaknesses.
Collapse
Affiliation(s)
- Bronwyn H. Bryant
- University of Vermont Medical Center, Department of Pathology and Laboratory Medicine, Burlington, VT, USA
| | - Scott R. Anderson
- University of Vermont Medical Center, Department of Pathology and Laboratory Medicine, Burlington, VT, USA
| | - Mark Brissette
- University of Colorado Anschutz Medical Campus, Department of Pathology, Aurora, CO, USA
| | - John M. Childs
- Geisinger Medical Center, Department of Pathology, Danville, PA, USA
| | - Dita Gratzinger
- Stanford University School of Medicine, Department of Pathology, Stanford, CA, USA
| | | | - Deborah E. Powell
- University of Minnesota Medical School, Department of Laboratory Medicine and Pathology, Minneapolis, MN, USA
| | | | - Charles F. Timmons
- UT Southwestern Medical Center, Department of Pathology, Dallas, TX, USA
| | - Deborah Chute
- Cleveland Clinic, Department of Pathology and Laboratory Medicine, Cleveland, OH, USA
| | | | - Mary A. Furlong
- Georgetown University School of Medicine, Department of Pathology and Laboratory Medicine, Washington, DC, USA
| | - Tiffany M. Hébert
- Montefiore Health System/Albert Einstein College of Medicine, Department of Pathology, Bronx, NY, USA
| | - Hollie M. Reeves
- University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Department of Pathology, Cleveland, OH, USA
| | - Demaretta Rush
- University of Arizona College of Medicine, Department of Pathology, Tucson, AZ, USA
| | - Taisia Vitkovski
- Zucker School of Medicine at Hofstra/Northwell Health, Department of Pathology and Laboratory Medicine, Hempstead, NY, USA
| | - Cindy B. McCloskey
- University of Oklahoma College of Medicine, Department of Pathology, Oklahoma City, OK, USA
| |
Collapse
|
2
|
Brown DR, Moeller JJ, Grbic D, Andriole DA, Cutrer WB, Obeso VT, Hormann MD, Amiel JM. Comparing Entrustment Decision-Making Outcomes of the Core Entrustable Professional Activities Pilot, 2019-2020. JAMA Netw Open 2022; 5:e2233342. [PMID: 36156144 PMCID: PMC9513644 DOI: 10.1001/jamanetworkopen.2022.33342] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
IMPORTANCE Gaps in readiness for indirect supervision have been identified for essential responsibilities encountered early in residency, presenting risks to patient safety. Core Entrustable Professional Activities (EPAs) for entering residency have been proposed as a framework to address these gaps and strengthen the transition from medical school to residency. OBJECTIVE To assess progress in developing an entrustment process in the Core EPAs framework. DESIGN, SETTING, AND PARTICIPANTS In this quality improvement study in the Core EPAs for Entering Residency Pilot, trained faculty made theoretical entrustment determinations and recorded the number of workplace-based assessments (WBAs) available for each determination in 2019 and 2020. Four participating schools attempted entrustment decision-making for all graduating students or a randomly selected subset of students. Deidentified, individual-level data were merged into a multischool database. INTERVENTIONS Schools implemented EPA-related curriculum, WBAs, and faculty development; developed systems to compile and display data; and convened groups to make theoretical summative entrustment determinations. MAIN OUTCOMES AND MEASURES On an EPA-specific basis, the percentage of students for whom an entrustment determination could be made, the percentage of students ready for indirect supervision, and the volume of WBAs available were recorded. RESULTS Four participating schools made 4525 EPA-specific readiness determinations (2296 determinations in 2019 and 2229 determinations in 2020) for 732 graduating students (349 students in 2019 and 383 students in 2020). Across all EPAs, the proportion of determinations of "ready for indirect supervision" increased from 2019 to 2020 (997 determinations [43.4%] vs 1340 determinations [60.1%]; 16.7 percentage point increase; 95% CI, 13.8-19.6 percentage points; P < .001), as did the proportion of determinations for which there were 4 or more WBAs (456 of 2295 determinations with WBA data [19.9%] vs 938 [42.1%]; 22.2 percentage point increase; 95% CI, 19.6-24.8 percentage points; P < .001). The proportion of EPA-specific data sets considered for which an entrustment determination could be made increased from 1731 determinations (75.4%) in 2019 to 2010 determinations (90.2%) in 2020 (14.8 percentage point increase; 95% CI, 12.6-16.9 percentage points; P < .001). On an EPA-specific basis, there were 5 EPAs (EPA 4 [orders], EPA 8 [handovers], EPA 10 [urgent care], EPA 11 [informed consent], and EPA 13 [patient safety]) for which few students were deemed ready for indirect supervision and for which there were few WBAs available per student in either year. For example, for EPA 13, 0 of 125 students were deemed ready in 2019 and 0 of 127 students were deemed ready in 2020, while 0 determinations in either year included 4 or more WBAs. CONCLUSIONS AND RELEVANCE These findings suggest that there was progress in WBA data collected, the extent to which entrustment determinations could be made, and proportions of entrustment determinations reported as ready for indirect supervision. However, important gaps remained, particularly for a subset of Core EPAs.
Collapse
Affiliation(s)
- David R. Brown
- Division of Family and Community Medicine, Department of Humanities, Health, and Society, Florida International University Herbert Wertheim College of Medicine, Miami
| | - Jeremy J. Moeller
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
| | - Douglas Grbic
- Medical Education Research, Association of American Medical Colleges, Washington, District of Columbia
| | - Dorothy A. Andriole
- Medical Education Research, Association of American Medical Colleges, Washington, District of Columbia
| | - William B. Cutrer
- Department of Pediatrics, Division of Critical Care Medicine at Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Vivian T. Obeso
- Division of Internal Medicine, Department of Translational Medicine, Florida International University Herbert Wertheim College of Medicine, Miami
| | - Mark D. Hormann
- Division of Community and General Pediatrics, Department of Pediatrics, McGovern Medical School at UTHealth, Houston, Texas
| | - Jonathan M. Amiel
- Dean’s Office, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| |
Collapse
|
3
|
Roles and Responsibilities of Medicine Subinternship Directors : Medicine Subinternship Director Roles. J Gen Intern Med 2022; 37:2698-2702. [PMID: 34545467 PMCID: PMC9411493 DOI: 10.1007/s11606-021-07128-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/27/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND The internal medicine (IM) subinternship (also referred to as acting internship) plays a crucial part in preparing medical students for residency. The roles, responsibilities, and support provided to subinternship directors have not been described. OBJECTIVE We sought to describe the current role of IM subinternship directors with respect to their responsibilities, salary support, and reporting structure. DESIGN Nationally representative, annually recurring thematic survey of IM core clerkship directors with membership in an academic professional association as of September 2017. PARTICIPANTS A total of 129 core clinical medicine clerkship directors at Liaison Committee on Medical Education fully accredited U.S./U.S.-territory-based medical schools. MAIN MEASURES Responsibilities, salary support, and reporting structure of subinternship directors. KEY RESULTS The survey response rate was 83.0% (107/129 medical schools). Fifty-one percent (54/107) of respondents reported overseeing both core clerkship inpatient experiences and/or one or more subinternships. For oversight, 49.1% (28/53) of subinternship directors also reported that they were the clerkship director, 26.4% (14/53) that another faculty member directed all medicine subinternships, and 18.9% (10/53) that each subinternship had its own director. The most frequently reported responsibilities for the subinternship directors were administration, including scheduling, and logistics of student schedules (83.0%, 44/53), course evaluation (81.1%, 43/53), and setting grades 79.2% (42/53). The modal response for estimated FTE per course was 10-20% FTE, with 33.3% (16/48) reporting this level of support and 29.2% (14/54) reporting no FTE support. CONCLUSIONS The role of the IM subinternship director has become increasingly complex. Since the IM subinternship is critical to preparing students for residency, IM subinternship directors require standard expectations and adequate support. Future studies are needed to determine the appropriate level of support for subinternship directors and to define essential roles and responsibilities.
Collapse
|
4
|
Brown DR, Moeller JJ, Grbic D, Biskobing DM, Crowe R, Cutrer WB, Green ML, Obeso VT, Wagner DP, Warren JB, Yingling SL, Andriole DA. Entrustment Decision Making in the Core Entrustable Professional Activities: Results of a Multi-Institutional Study. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:536-543. [PMID: 34261864 DOI: 10.1097/acm.0000000000004242] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE In 2014, the Association of American Medical Colleges defined 13 Core Entrustable Professional Activities (EPAs) that all graduating students should be ready to do with indirect supervision upon entering residency and commissioned a 10-school, 5-year pilot to test implementing the Core EPAs framework. In 2019, pilot schools convened trained entrustment groups (TEGs) to review assessment data and render theoretical summative entrustment decisions for class of 2019 graduates. Results were examined to determine the extent to which entrustment decisions could be made and the nature of these decisions. METHOD For each EPA considered (4-13 per student), TEGs recorded an entrustment determination (ready, progressing but not yet ready, evidence against student progressing, could not make a decision); confidence in that determination (none, low, moderate, high); and the number of workplace-based assessments (WBAs) considered (0->15) per determination. These individual student-level data were de-identified and merged into a multischool database; chi-square analysis tested the significance of associations between variables. RESULTS The 2,415 EPA-specific determinations (for 349 students by 4 participating schools) resulted in a decision of ready (n = 997/2,415; 41.3%), progressing but not yet ready (n = 558/2,415; 23.1%), or evidence against student progression (n = 175/2,415; 7.2%). No decision could be made for the remaining 28.4% (685/2,415), generally for lack of data. Entrustment determinations' distribution varied across EPAs (chi-square P < .001) and, for 10/13 EPAs, WBA availability was associated with making (vs not making) entrustment decisions (each chi-square P < .05). CONCLUSIONS TEGs were able to make many decisions about readiness for indirect supervision; yet less than half of determinations resulted in a decision of readiness to perform this EPA with indirect supervision. More work is needed at the 10 schools to enable authentic summative entrustment in the Core EPAs framework.
Collapse
Affiliation(s)
- David R Brown
- D.R. Brown is professor, chief, Division of Family and Community Medicine, and interim chair, Department of Humanities, Health, and Society, Florida International University Herbert Wertheim College of Medicine, Miami, Florida; ORCID: http://orcid.org/0000-0002-5361-6664
| | - Jeremy J Moeller
- J.J. Moeller is associate professor and residency program director, Department of Neurology, Yale University School of Medicine, New Haven, Connecticut; ORCID: https://orcid.org/0000-0002-6135-5572
| | - Douglas Grbic
- D. Grbic is lead research analyst, Medical Education Research, Association of American Medical Colleges, Washington, DC
| | - Diane M Biskobing
- D.M. Biskobing is professor of medicine and associate dean of medical education, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Ruth Crowe
- R. Crowe is director of integrated clinical skills, director of practice of medicine, Office of Medical Education, and associate professor of medicine, New York University Grossman School of Medicine, New York, New York
| | - William B Cutrer
- W.B. Cutrer is associate dean for undergraduate medical education and associate professor of pediatrics (critical care medicine), Vanderbilt University School of Medicine, Nashville, Tennessee; ORCID: https://orcid.org/0000-0003-1538-9779
| | - Michael L Green
- M.L. Green is professor of medicine and director of student assessment, Teaching and Learning Center, Yale University School of Medicine, New Haven, Connecticut
| | - Vivian T Obeso
- V.T. Obeso is associate dean for curriculum and medical education and associate professor, Division of Internal Medicine, Department of Translational Medicine, Florida International University Herbert Wertheim College of Medicine, Miami, Florida
| | - Dianne P Wagner
- D.P. Wagner is associate dean for undergraduate medical education and professor of medicine, Michigan State University College of Human Medicine, East Lansing, Michigan
| | - Jamie B Warren
- J.B. Warren is associate professor, Division of Neonatology, and clinical vice chair, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon; ORCID: https://orcid.org/0000-0003-4422-1502
| | - Sandra L Yingling
- S.L. Yingling is associate dean for educational planning and quality improvement, University of Illinois College of Medicine (Chicago, Peoria, Rockford, and Urbana), Chicago, Illinois
| | - Dorothy A Andriole
- D.A. Andriole is senior director, Medical Education Research, Association of American Medical Colleges, Washington, DC; ORCID: https://orcid.org/0000-0001-8902-1227
| |
Collapse
|
5
|
Obeso V, Grbic D, Emery M, Parekh K, Phillipi C, Swails J, Jayas A, Andriole DA. Core Entrustable Professional Activities (EPAs) and the Transition from Medical School to Residency: the Postgraduate Year One Resident Perspective. MEDICAL SCIENCE EDUCATOR 2021; 31:1813-1822. [PMID: 34956699 PMCID: PMC8651854 DOI: 10.1007/s40670-021-01370-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/14/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The Association of American Medical Colleges (AAMC) proposed thirteen core Entrustable Professional Activities (EPAs) that all graduates should be able to perform under indirect supervision upon entering residency. As an underlying premise is that graduates ready to do so will be better prepared to transition to the responsibilities of residency, we explored the relationship between postgraduate year (PGY)-1 residents' self-assessed preparedness to perform core EPAs under indirect supervision at the start of residency with their ease of transition to residency. METHODS Using response data to a questionnaire administered in September 2019 to PGY-1 residents who graduated from AAMC core EPA pilot schools, we examined between-group differences and independent associations for each of PGY-1 position type, specialty, and "EPA-preparedness" score (proportion of EPAs the resident reported as prepared to perform under indirect supervision at the start of residency) and ease of transition to residency (from 1 = much harder to 5 = much easier than expected). RESULTS Of 274 questionnaire respondents (19% of 1438 graduates), 241 (88% of 274) had entered PGY-1 training and completed all questionnaire items of interest. EPA-preparedness score (mean 0.71 [standard deviation 0.26]) correlated with ease of transition (3.1 [0.9]; correlation = .291, p < .001). In linear regression controlling for specialty (among other variables), EPA-preparedness score (β-coefficient 1.08; 95% confidence interval .64-1.52; p < .001) predicted ease of transition to residency. CONCLUSION Graduates who felt prepared to perform many of the core EPAs under indirect supervision at the start of PGY-1 training reported an easier-than-expected transition to residency. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40670-021-01370-3.
Collapse
Affiliation(s)
- Vivian Obeso
- Florida International University Herbert Wertheim College of Medicine, Miami, FL USA
| | - Douglas Grbic
- Association of American Medical Colleges, 655 K Street, N.W., Washington, DC 20001-2399 USA
| | - Matthew Emery
- Michigan State University College of Human Medicine, Grand Rapids, MI USA
| | - Kendra Parekh
- Vanderbilt University School of Medicine, Nashville, TN USA
| | - Carrie Phillipi
- Oregon Health & Science University School of Medicine, Portland, OR USA
| | - Jennifer Swails
- McGovern Medical School at the University of Texas Health Science Center, Houston, TX USA
| | - Amy Jayas
- Association of American Medical Colleges, 655 K Street, N.W., Washington, DC 20001-2399 USA
| | - Dorothy A. Andriole
- Association of American Medical Colleges, 655 K Street, N.W., Washington, DC 20001-2399 USA
| | | |
Collapse
|
6
|
Maggio LA, Ninkov A, Costello JA, Driessen EW, Artino AR. Knowledge Syntheses in Medical Education: Examining Authors' Gender, Geographic Location, and Institutional Affiliation. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:S201. [PMID: 34705701 DOI: 10.1097/acm.0000000000004276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Lauren A Maggio
- Author affiliations: L.A. Maggio, J.A. Costello, Uniformed Services University of the Health Sciences
| | | | - Joseph A Costello
- Author affiliations: L.A. Maggio, J.A. Costello, Uniformed Services University of the Health Sciences
| | | | - Anthony R Artino
- A.R. Artino Jr, the George Washington University School of Medicine and Health Sciences
| |
Collapse
|
7
|
Brown DR, Moeller JJ, Grbic D, Andriole DA, Cutrer WB, Obeso VT, Hormann MD, Amiel JM. The First 2 Years of Entrustment Decisions in the Core Entrustable Professional Activities (Core EPAs) Pilot. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:S201-S202. [PMID: 34705702 DOI: 10.1097/acm.0000000000004275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- David R Brown
- Author affiliations: D.R. Brown, V.T. Obeso, Florida International University Herbert Wertheim College of Medicine
| | | | - Douglas Grbic
- D. Grbic, D.A. Andriole, Association of American Medical Colleges
| | | | | | - Vivian T Obeso
- Author affiliations: D.R. Brown, V.T. Obeso, Florida International University Herbert Wertheim College of Medicine
| | | | - Jonathan M Amiel
- J.M. Amiel, Columbia University College of Physicians and Surgeons
| |
Collapse
|
8
|
Amiel JM, Andriole DA, Biskobing DM, Brown DR, Cutrer WB, Emery MT, Mejicano GC, Ryan MS, Swails JL, Wagner DP. Revisiting the Core Entrustable Professional Activities for Entering Residency. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:S14-S21. [PMID: 34183597 DOI: 10.1097/acm.0000000000004088] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The Core EPAs for Entering Residency Pilot project aimed to test the feasibility of implementing 13 entrustable professional activities (EPAs) at 10 U.S. medical schools and to gauge whether the use of the Core EPAs could improve graduates' performance early in residency. In this manuscript, the authors (members of the pilot institutions and Association of American Medical Colleges staff supporting the project evaluation) describe the schools' capacity to collect multimodal evidence about their students' performance in each of the Core EPAs and the ability of faculty committees to use those data to make decisions regarding learners' readiness for entrustment. In reviewing data for each of the Core EPAs, the authors reflected on how each activity performed as an EPA informed by how well it could be assessed and entrusted. For EPAs that did not perform well, the authors examined whether there are underlying practical and/or theoretical issues limiting its utility as a measure of student performance in medical school.
Collapse
Affiliation(s)
- Jonathan M Amiel
- J.M. Amiel is associate professor of psychiatry, senior associate dean for curricular affairs, and interim co-vice dean for education, Columbia University Vagelos College of Physicians & Surgeons, New York, New York; ORCID: https://orcid.org/0000-0003-4027-6397
| | - Dorothy A Andriole
- D.A. Andriole is senior director, Medical Education Research, Association of American Medical Colleges, Washington, DC; ORCID: https://orcid.org/0000-0001-8902-1227
| | - Diane M Biskobing
- D.M. Biskobing is professor of medicine and associate dean for pre-clinical medical education, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - David R Brown
- D.R. Brown is associate professor, chief, Family and Community Medicine, and interim chair, Humanities, Health, and Society, Florida International University Herbert Wertheim College of Medicine, Miami, Florida; ORCID: https://orcid.org/0000-0002-5361-6664
| | - William B Cutrer
- W.B. Cutrer is associate dean for undergraduate medical education and associate professor of pediatrics, Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee; ORCID: https://orcid.org/0000-0003-1538-9779
| | - Matthew T Emery
- M.T. Emery is associate professor of emergency medicine and medical director for simulation, Michigan State University College of Human Medicine, East Lansing, Michigan
| | - George C Mejicano
- G.C. Mejicano is professor of medicine and senior associate dean for Education, Oregon Health & Science University School of Medicine, Portland, Oregon; ORCID: https://orcid.org/0000-0002-6087-3730
| | - Michael S Ryan
- M.S. Ryan is associate professor of pediatrics and assistant dean for clinical medical education, Virginia Commonwealth University School of Medicine, Richmond, Virginia; ORCID: https://orcid.org/0000-0003-3266-9289
| | - Jennifer L Swails
- J.L. Swails is associate professor of internal medicine, McGovern Medical School, University of Texas Health Science Center, Houston, Texas; ORCID: https://orcid.org/0000-0002-6102-831X
| | - Dianne P Wagner
- D.P. Wagner is professor of medicine, associate dean for undergraduate medical education, and interim senior associate dean for academic affairs, Michigan State University College of Human Medicine, East Lansing, Michigan
| |
Collapse
|
9
|
Ten Cate O, Balmer DF, Caretta-Weyer H, Hatala R, Hennus MP, West DC. Entrustable Professional Activities and Entrustment Decision Making: A Development and Research Agenda for the Next Decade. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:S96-S104. [PMID: 34183610 DOI: 10.1097/acm.0000000000004106] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
To establish a research and development agenda for Entrustable Professional Activities (EPAs) for the coming decade, the authors, all active in this area of investigation, reviewed recent research papers, seeking recommendations for future research. They pooled their knowledge and experience to identify 3 levels of potential research and development: the micro level of learning and teaching; the meso level of institutions, programs, and specialty domains; and the macro level of regional, national, and international dynamics. Within these levels, the authors categorized their recommendations for research and development. The authors identified 14 discrete themes, each including multiple questions or issues for potential exploration, that range from foundational and conceptual to practical. Much research to date has focused on a variety of issues regarding development and early implementation of EPAs. Future research should focus on large-scale implementation of EPAs to support competency-based medical education (CBME) and on its consequences at the 3 levels. In addition, emerging from the implementation phase, the authors call for rigorous studies focusing on conceptual issues. These issues include the nature of entrustment decisions and their relationship with education and learner progress and the use of EPAs across boundaries of training phases, disciplines and professions, including continuing professional development. International studies evaluating the value of EPAs across countries are another important consideration. Future studies should also remain alert for unintended consequences of the use of EPAs. EPAs were conceptualized to support CBME in its endeavor to improve outcomes of education and patient care, prompting creation of this agenda.
Collapse
Affiliation(s)
- Olle Ten Cate
- O. ten Cate is professor of medical education and senior scientist, Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, the Netherlands; ORCID: https://orcid.org/0000-0002-6379-8780
| | - Dorene F Balmer
- D.F. Balmer is associate professor, Department of Pediatrics, The Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania; ORCID: http://orcid.org/0000-0001-6805-4062
| | - Holly Caretta-Weyer
- H. Caretta-Weyer is assistant professor, Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California; ORCID: https://orcid.org/0000-0002-9783-5797
| | - Rose Hatala
- R. Hatala is professor, Department of Medicine, University of British Columbia, Vancouver, Canada; ORCID: https://orcid.org/0000-0003-0521-2590
| | - Marije P Hennus
- M.P. Hennus is a pediatric intensivist and program director, pediatric intensive care fellowship, University Medical Center Utrecht, Utrecht, the Netherlands; ORCID: https://orcid.org/0000-0003-1508-0456
| | - Daniel C West
- D.C. West is professor and senior director of medical education, Department of Pediatrics, Children's Hospital of Philadelphia and The Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; ORCID: https://orcid.org/0000-0002-0909-4213
| |
Collapse
|