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Kitto S, Fantaye AW, Zevin B, Fowler A, Sachdeva AK, Raiche I. A Scoping Review of the Literature on Entrustable Professional Activities in Surgery Residency Programs. JOURNAL OF SURGICAL EDUCATION 2024; 81:823-840. [PMID: 38679495 DOI: 10.1016/j.jsurg.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 02/20/2024] [Indexed: 05/01/2024]
Abstract
OBJECTIVE Entrustable professional activities (EPAs) are a crucial component of contemporary postgraduate medical education with many surgery residency programs having implemented EPAs as a competency assessment framework to assess and provide feedback on the performance of their residents. Despite broad implementation of EPAs, there is a paucity of evidence regarding the impact of EPAs on the learners and learning environments. A first step in improving understanding of the use and impact of EPAs is by mapping the rising number of EPA-related publications from the field of surgery. The primary objective of this scoping review is to examine the nature, extent, and range of articles on the development, implementation, and assessment of EPAs. The second objective is to identify the experiences and factors that influence EPA implementation and use in practice in surgical specialties. DESIGN Scoping review. Four electronic databases (Medline, Embase, Education Source, and ERIC) were searched on January 20, 2022, and then again on July 19, 2023. A quasi-statistical content analysis was employed to quantify and draw meaning from the information related to the development, implementation, assessment, validity, reliability, and experiences with EPAs in the workplace. PARTICIPANTS A total of 42 empirical and nonempirical articles were included. RESULTS Four thematic categories describe the topic areas in included articles related to: 1) the development and refinement of EPAs, including the multiple steps taken to develop and refine unique EPAs for surgery residency programs; 2) the methods for implementing EPAs; 3) outcomes of EPA use in practice; 4) barriers, facilitators, and areas for improvement for the implementation and use of EPAs in surgical education. CONCLUSIONS This scoping review highlights the key trends and gaps from the rapidly increasing number of publications on EPAs in surgery residency, from development to their use in the workplace. Existing EPA studies lack a theoretical and/or conceptual basis; future development and implementation studies should adopt implementation science frameworks to better structure and operationalize EPAs within surgery residency programs.
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Affiliation(s)
- Simon Kitto
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Arone W Fantaye
- Office of Continuing Professional Development, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Boris Zevin
- Department of Surgery, Queen's University, Kingston, Canada
| | - Amanda Fowler
- Department of Surgery, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Ajit K Sachdeva
- Division of Education, American College of Surgeons, Chicago, Illinios
| | - Isabelle Raiche
- Department of Surgery, University of Ottawa, Ottawa, Canada.
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Acker RC, Kelz RR. Cutting Through the Learning Curve: The New Surgeon Battle Between Inexperience and Competence. Ann Surg 2024; 279:561-562. [PMID: 38116655 DOI: 10.1097/sla.0000000000006186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Affiliation(s)
- Rachael C Acker
- Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Rachel R Kelz
- Department of Surgery, University of Pennsylvania, Philadelphia, PA
- Department of Surgery, Center for Surgery and Health Economics, University of Pennsylvania, Philadelphia, PA
- Leonard David Institute of Health Economics, Wharton School, University of Pennsylvania, Philadelphia, PA
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Pålsson P, Cederborg A, Johansson M, Hult HV, Naredi S, Jood K. Clinical supervisors' experience of a first-time application of entrustable professional activities in clinical supervision of medical students: findings from a Swedish pilot study. BMC MEDICAL EDUCATION 2024; 24:297. [PMID: 38491437 PMCID: PMC10943870 DOI: 10.1186/s12909-024-05211-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/22/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Recently, all medical universities in Sweden jointly developed a framework for Entrustable Professional Activities (EPAs) for work-based training and assessment. This framework is now being introduced nationally in the new 6-year undergraduate medical programme that directly lead to a licence to practise. When EPAs are introduced, it is of central importance to gain clinical supervisors' acceptance to apply the framework in their supervision of students. The aim of this study was therefore to investigate how clinical supervisors, not familiar with EPAs, experience clinical supervision using the framework for EPAs. METHODS We used a purposive sampling to recruit clinical supervisors. They were given written information on EPAs with a selection of suitable EPAs and the Swedish observation rating scale for assessment of autonomy, and they were offered to attend a 30-minute introductory web course. The participants were informed that EPAs were to be tested, and the students were asked to participate. After the study period the clinical supervisors participated in semi-structured interviews. Inductive qualitative content analysis was used to analyse the transcribed interviews. RESULTS Three general themes emerged in the qualitative analysis: Promoting Feedback, Trusting Assessments and Engaging Stakeholders. The participants described benefits from using EPAs, but pointed out a need for preparation and adaptation to facilitate implementation. The structure was perceived to provide structured support for feedback, student involvement, entrustment decisions, enabling supervisors to allow the students to do more things independently, although some expressed caution to rely on others' assessments. Another concern was whether assessments of EPAs would be perceived as a form of examination, steeling focus from formative feedback. To understand the concept of EPA, the short web-based course and written information was regarded as sufficient. However, concern was expressed whether EPA could be applied by all clinical supervisors. Involvement and adaption of the workplace was pointed out as important since more frequent observation and feedback, with documentation requirements, increase the time required for supervision. CONCLUSIONS EPAs were accepted as beneficial, promoting structured feedback and assessments of the students' autonomy. Preparation of supervisors and students as well as involvement and adaptation of the workplace was pointed out as important.
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Affiliation(s)
- Paul Pålsson
- Department of Education, Region Västra Götaland, NU-hospital group, 46185, Trollhättan, Sweden.
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Anna Cederborg
- Institute of Medicine, Department of Molecular and Clinical Medicine, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Department of Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Monica Johansson
- Department of Education and Special Education, University of Gothenburg, Gothenburg, Sweden
| | - Helena Vallo Hult
- Department of Education, Region Västra Götaland, NU-hospital group, 46185, Trollhättan, Sweden
- School of Business, Economics and IT, Department of Informatics, University West, Trollhättan, Sweden
| | - Silvana Naredi
- Institute of Clinical Sciences, Department of Anaesthesiology and Intensive Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Katarina Jood
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Pakkasjärvi N, Anttila H, Pyhältö K. What are the learning objectives in surgical training - a systematic literature review of the surgical competence framework. BMC MEDICAL EDUCATION 2024; 24:119. [PMID: 38321437 PMCID: PMC10848354 DOI: 10.1186/s12909-024-05068-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/17/2024] [Indexed: 02/08/2024]
Abstract
OBJECTIVE To map the landscape of contemporary surgical education through a competence framework by conducting a systematic literature review on learning outcomes of surgical education and the instructional methods applied to attain the outcomes. BACKGROUND Surgical education has seen a paradigm shift towards competence-based training. However, a gap remains in the literature regarding the specific components of competency taught and the instructional methods employed to achieve these outcomes. This paper aims to bridge this gap by conducting a systematic review on the learning outcomes of surgical education within a competence framework and the instructional methods applied. The primary outcome measure was to elucidate the components of competency emphasized by modern surgical curricula. The secondary outcome measure was to discern the instructional methods proven effective in achieving these competencies. METHODS A search was conducted across PubMed, Medline, ProQuest Eric, and Cochrane databases, adhering to PRISMA guidelines, limited to 2017-2021. Keywords included terms related to surgical education and training. Inclusion criteria mandated original empirical studies that described learning outcomes and methods, and targeted both medical students and surgical residents. RESULTS Out of 42 studies involving 2097 participants, most concentrated on technical skills within competency-based training, with a lesser emphasis on non-technical competencies. The effect on clinical outcomes was infrequently explored. CONCLUSION The shift towards competency in surgical training is evident. However, further studies on its ramifications on clinical outcomes are needed. The transition from technical to clinical competence and the creation of validated assessments are crucial for establishing a foundation for lifelong surgical learning.
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Affiliation(s)
- Niklas Pakkasjärvi
- Department of Pediatric Surgery, New Children's Hospital, Helsinki University Hospital, Helsinki, Finland.
- Department of Pediatric Surgery, Section of Urology, University Children's Hospital, Uppsala, Sweden.
| | - Henrika Anttila
- Faculty of Educational Sciences, University of Helsinki, Helsinki, Finland
| | - Kirsi Pyhältö
- Faculty of Educational Sciences, University of Helsinki, Helsinki, Finland
- Centre for Higher and Adult Education, Faculty of Education, Stellenbosch University, Stellenbosch, South Africa
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Sigurdsson V, Ten Cate O. Do summative entrustment decisions actually lead to entrustment? CLINICAL TEACHER 2024; 21:e13668. [PMID: 37817015 DOI: 10.1111/tct.13668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 09/05/2023] [Indexed: 10/12/2023]
Abstract
BACKGROUND Entrustable professional activities (EPAs) were introduced across Dutch postgraduate programmes between 2017 and 2019. We aimed to understand the extent to which residents actually were granted increased clinical responsibility upon receiving summative entrustment for an EPA, a critical feature of its use. METHODS A survey study was conducted among all Dutch residents who started dermatology training in 2018 and 2019 and all Dutch dermatology programme directors (PDs). We chose an EPA designed for early entrustment in residency (identification, treatment and care regarding a simple dermatological problem in the ambulatory setting). The survey contained two hypothetical clinical cases that aligned with this EPA. The questions were aimed to determine whether and when residents should request supervision. Similar questions were posed to PDs. FINDINGS Twenty four residents (56%) and 19 PDs (79%) completed the survey. The majority of the residents (65%) and PDs (63%) confirmed that competent dermatology residents (level 4) are generally allowed to perform EPA1 unsupervised, particularly when seeing patients from GPs. However, still a substantial proportion of the level 4 residents, working in University Medical Centers (36%) indicated that they had to request supervision in the assessment of these patients. For 2nd opinions, the results were typically the opposite. DISCUSSION AND CONCLUSION This study demonstrated that, at least in one specialty and one country, the introduction of EPAs and entrustment decision making procedure generally led to the intended autonomy of the resident.
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Affiliation(s)
- Vigfús Sigurdsson
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Olle Ten Cate
- Utrecht Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands
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McDaniel LM, Molloy MJ, Blanck J, Beck JB, Shilkofski NA. The Chief Residency in U.S. and Canadian Graduate Medical Education: A Scoping Review. TEACHING AND LEARNING IN MEDICINE 2024:1-10. [PMID: 38247430 DOI: 10.1080/10401334.2023.2298870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 12/15/2023] [Indexed: 01/23/2024]
Abstract
PHENOMENON Despite the nearly universal presence of chief residents within U.S. and Canadian residency programs and their critical importance in graduate medical education, to our knowledge, a comprehensive synthesis of publications about chief residency does not exist. An understanding of the current state of the literature can be helpful to program leadership to make evidence-based improvements to the chief residency and for medical education researchers to recognize and fill gaps in the literature. APPROACH We performed a scoping review of the literature about chief residency. We searched OVID Medline, PsycINFO, ERIC, and Web of Science databases through January 2023 for publications about chief residency. We included publications addressing chief residency in ACGME specialties in the U.S. and Canada and only those using the term "chief resident" to refer to additional responsibilities beyond the typical residency training. We excluded publications using chief residents as a convenience sample. We performed a topic analysis to identify common topics among studies. FINDINGS We identified 2,064 publications. We performed title and abstract screening on 1,306 and full text review on 208, resulting in 146 included studies. Roughly half of the publications represented the specialties of Internal Medicine (n = 37, 25.3%) and Psychiatry (n = 30, 20.5%). Topic analysis revealed six major topics: (1) selection of chief residents (2) qualities of chief residents (3) training of chief residents (4) roles of chief residents (5) benefits/challenges of chief residency (6) outcomes after chief residency. INSIGHTS After reviewing our topic analysis, we identified three key areas warranting increased attention with opportunity for future study: (1) addressing equity and bias in chief resident selection (2) establishment of structured expectations, mentorship, and training of chief residents and (3) increased attention to chief resident experience and career development, including potential downsides of the role.
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Affiliation(s)
- Lauren M McDaniel
- Department of Pediatrics, Division of Hospital Medicine, University of Washington, Seattle Children's Hospital, Seattle, Washington, USA
| | - Matthew J Molloy
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jaime Blanck
- Informationist Services, Welch Medical Library, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jimmy B Beck
- Department of Pediatrics, Division of Hospital Medicine, University of Washington, Seattle Children's Hospital, Seattle, Washington, USA
| | - Nicole A Shilkofski
- Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland, USA
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Czaja AS, Mink RB, Herman BE, Weiss P, Turner DA, Curran ML, Stafford DEJ, Myers AL, Langhan ML. Exploring Factors for Implementation of EPAs in Pediatric Subspecialty Fellowships: A Qualitative Study of Program Directors. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2024; 11:23821205231225011. [PMID: 38268726 PMCID: PMC10807342 DOI: 10.1177/23821205231225011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 12/19/2023] [Indexed: 01/26/2024]
Abstract
OBJECTIVE To understand fellowship program directors' (FPDs) perspectives on facilitators and barriers to using entrustable professional activities (EPAs) in pediatric subspecialty training. METHODS We performed a qualitative study of FPDs, balancing subspecialty, program size, geographic region and current uses of EPAs. A study coordinator conducted 1-on-1 interviews using a semistructured approach to explore EPA use or nonuse and factors supporting or preventing their use. Investigators independently coded transcribed interviews using an inductive approach and the constant comparative method. Group discussion informed code structure development and refinement. Iterative data collection and analysis continued until theoretical sufficiency was achieved, yielding a thematic analysis. RESULTS Twenty-eight FPDs representing 11 pediatric subspecialties were interviewed, of whom 16 (57%) reported current EPA use. Five major themes emerged: (1) facilitators including the intuitive nature and simple wording of EPAs; (2) barriers such as workload burden and lack of a regulatory requirement; (2) variable knowledge and training surrounding EPAs, leading to differing levels of understanding; (3) limited current use of EPAs, even among self-reported users; and (4) complementary nature of EPAs and milestones. FPDs acknowledged the differing strengths of both EPAs and milestones but sought additional knowledge about the value added by EPAs for assessing trainees, including the impact on outcomes. CONCLUSIONS Identified themes can inform effective and meaningful EPA implementation strategies: Supporting and educating FPDs, ongoing assessment of the value of EPAs in training, and practical integration with current workflow. Generating additional data and engaging stakeholders is critical for successful implementation for the pediatric subspecialties.
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Affiliation(s)
- Angela S. Czaja
- Department of Pediatrics, Section of Critical Care, University of Colorado School of Medicine, Aurora, CO, USA
| | - Richard B. Mink
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Department of Pediatrics, Harbor-UCLA Medical Center and The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Bruce E. Herman
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Pnina Weiss
- Department of Pediatrics, Section of Pulmonology, Allergy, Immunology and Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA
| | | | - Megan L. Curran
- Department of Pediatrics, Section of Rheumatology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Diane E. J. Stafford
- Department of Pediatrics, Division of Endocrinology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Angela L. Myers
- Department of Pediatrics, Children's Mercy, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Melissa L. Langhan
- Department of Pediatrics and Emergency Medicine, Section of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
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Mink RB, Carraccio CL, Herman BE, Weiss P, Turner DA, Stafford DEJ, McGann KA, Kesselheim J, Hsu DC, High PC, Fussell JJ, Curran ML, Chess PR, Sauer C, Pitts S, Myers AL, Mahan JD, Dammann CEL, Aye T, Schwartz A. Relationship between epa level of supervision with their associated subcompetency milestone levels in pediatric fellow assessment. BMC MEDICAL EDUCATION 2023; 23:720. [PMID: 37789289 PMCID: PMC10548580 DOI: 10.1186/s12909-023-04689-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/15/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND Entrustable Professional Activities (EPA) and competencies represent components of a competency-based education framework. EPAs are assessed based on the level of supervision (LOS) necessary to perform the activity safely and effectively. The broad competencies, broken down into narrower subcompetencies, are assessed using milestones, observable behaviors of one's abilities along a developmental spectrum. Integration of the two methods, accomplished by mapping the most relevant subcompetencies to each EPA, may provide a cross check between the two forms of assessment and uncover those subcompetencies that have the greatest influence on the EPA assessment. OBJECTIVES We hypothesized that 1) there would be a strong correlation between EPA LOS ratings with the milestone levels for the subcompetencies mapped to the EPA; 2) some subcompetencies would be more critical in determining entrustment decisions than others, and 3) the correlation would be weaker if the analysis included only milestones reported to the Accreditation Council for Graduate Medical Education (ACGME). METHODS In fall 2014 and spring 2015, the Subspecialty Pediatrics Investigator Network asked Clinical Competency Committees to assign milestone levels to each trainee enrolled in a pediatric fellowship for all subcompetencies mapped to 6 Common Pediatric Subspecialty EPAs as well as provide a rating for each EPA based upon a 5-point LOS scale. RESULTS One-thousand forty fellows were assessed in fall and 1048 in spring, representing about 27% of all fellows. For each EPA and in both periods, the average milestone level was highly correlated with LOS (rho range 0.59-0.74; p < 0.001). Correlations were similar when using a weighted versus unweighted milestone score or using only the ACGME reported milestones (p > 0.05). CONCLUSIONS We found a strong relationship between milestone level and EPA LOS rating but no difference if the subcompetencies were weighted, or if only milestones reported to the ACGME were used. Our results suggest that representative behaviors needed to effectively perform the EPA, such as key subcompetencies and milestones, allow for future language adaptations while still supporting the current model of assessment. In addition, these data provide additional validity evidence for using these complementary tools in building a program of assessment.
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Affiliation(s)
- Richard B Mink
- Department of Pediatrics, David Geffen School of Medicine at UCLA and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 West Carson Street, Torrance, CA, 90502, USA.
| | | | - Bruce E Herman
- University of Utah School of Medicine, Salt Lake, UT, USA
| | - Pnina Weiss
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | | | - Diane E J Stafford
- Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Kathleen A McGann
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Jennifer Kesselheim
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA
| | | | - Pamela C High
- Alpert Medical School of Brown University, Providence, RI, USA
- Developmental-Behavioral Pediatrics, Hasbro Children's Hospital, Providence, RI, USA
| | - Jill J Fussell
- University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, AR, USA
| | - Megan L Curran
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Cary Sauer
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Sarah Pitts
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Angela L Myers
- Center for Wellbeing, Children's Mercy Hospital and University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - John D Mahan
- Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH, USA
| | | | - Tandy Aye
- Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Alan Schwartz
- University of Illinois College of Medicine at Chicago, Chicago, IL, USA
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Huynh A, Nguyen A, Beyer RS, Harris MH, Hatter MJ, Brown NJ, de Virgilio C, Nahmias J. Fixing a Broken Clerkship Assessment Process: Reflections on Objectivity and Equity Following the USMLE Step 1 Change to Pass/Fail. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:769-774. [PMID: 36780667 DOI: 10.1097/acm.0000000000005168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Clerkship grading is a core feature of evaluation for medical students' skills as physicians and is considered by most residency program directors to be an indicator of future performance and success. With the transition of the U.S. Medical Licensing Examination Step 1 score to pass/fail, there will likely be even greater reliance on clerkship grades, which raises several important issues that need to be urgently addressed. This article details the current landscape of clerkship grading and the systemic discrepancies in assessment and allocation of honors. The authors examine not only objectivity and fairness in clerkship grading but also the reliability of clerkship grading in predicting residency performance and the potential benefits and drawbacks to adoption of a pass/fail clinical clerkship grading system. In the promotion of a more fair and equitable residency selection process, there must be standardization of grading systems with consideration of explicit grading criteria, grading committees, and/or structured education of evaluators and assessors regarding implicit bias. In addition, greater adherence and enforcement of transparency in grade distributions in the Medical Student Performance Evaluation is needed. These changes have the potential to level the playing field, foster equitable comparisons, and ultimately add more fairness to the residency selection process.
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Affiliation(s)
- Ashley Huynh
- A. Huynh is a first-year medical student, University of California, Irvine, School of Medicine, Irvine, California; ORCID: https://orcid.org/0000-0002-4413-6829
| | - Andrew Nguyen
- A. Nguyen is a first-year medical student, University of Florida College of Medicine, Gainesville, Florida; ORCID: https://orcid.org/0000-0002-8131-150X
| | - Ryan S Beyer
- R.S. Beyer is a second-year medical student, University of California, Irvine, School of Medicine, Irvine, California; ORCID: https://orcid.org/0000-0002-0283-3749
| | - Mark H Harris
- M.H. Harris is a second-year medical student, University of California, Irvine, School of Medicine, Irvine, California; ORCID: https://orcid.org/0000-0002-1598-225X
| | - Matthew J Hatter
- M.J. Hatter is a second-year medical student, University of California, Irvine, School of Medicine, Irvine, California; ORCID: https://orcid.org/0000-0003-2922-6196
| | - Nolan J Brown
- N.J. Brown is a fourth-year medical student, University of California, Irvine, School of Medicine, Irvine, California; ORCID: https://orcid.org/0000-0002-6025-346X
| | - Christian de Virgilio
- C. de Virgilio is professor of surgery, Harbor-UCLA Medical Center, Torrance, California
| | - Jeffry Nahmias
- J. Nahmias is professor of trauma, burns, surgical critical care, and acute care surgery, University of California, Irvine, School of Medicine, Irvine, California; ORCID: https://orcid.org/0000-0003-0094-571X
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Moore SJ, Egerton T, Merolli M, Lees J, La Scala N, Parry SM. Inconsistently reporting post-licensure EPA specifications in different clinical professions hampers fidelity and practice translation: a scoping review. BMC MEDICAL EDUCATION 2023; 23:372. [PMID: 37226147 DOI: 10.1186/s12909-023-04364-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 05/16/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Entrustable Professional Activities (EPAs) are defined units of professional practice entrusted to professionals once they have attained the specific competencies required to complete the end-to-end task. They provide a contemporary framework for capturing real-world clinical skillsets and integrating clinical education with practice. Our scoping review question was: how are post-licensure EPAs reported in peer reviewed literature, in different clinical professions? METHOD We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist, Arksey and O'Malley and Joanna Briggs Institute (JBI) methodology. Searching ten electronic databases returned 1622 articles, with 173 articles included. Data extracted included demographics, EPA discipline, titles and further specifications. RESULTS All articles were published between 2007-2021 across sixteen country contexts. The majority were from North America (n = 162, 73%) describing medical sub-specialty EPAs (n = 126, 94%). There were comparably few EPA frameworks reported in clinical professions other than medicine (n = 11, 6%). Many articles reported only EPA titles without further explanation and limited content validation. The majority did not include information about the EPA design process. Few EPAs and frameworks were reported according to all the recommended EPA attributes. There was unclear distinction between specialty-specific EPAs and those that could be useful across disciplines. DISCUSSION Our review highlights the large volume of EPAs reported in post-licensure medicine, including the volume disparity compared to other clinical professions. Basing our enquiry upon existing guidelines for EPA attributes and features, our experience in conducting the review and our primary finding demonstrated heterogeneity of EPA reporting according to these specifications. To promote EPA fidelity, and quality appraisal, and to reduce interpretation subjectivity, we advocate: diligently reporting EPA attributes and features; including reference or citation to EPA design and content validity information; and considering distinguishing EPAs as specialty-specific or transdisciplinary. CONCLUSION A large volume of post-licensure EPAs were identified in medicine relative to other clinical professions. EPA specifications were absent or variously reported in the literature, risking ambiguous interpretation. The authors recommend that future EPAs are reported with reference to established and evolving construct recommendations, which is integral to concept fidelity and translation to practice and education.
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Affiliation(s)
- Sonya J Moore
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Level 7, Alan Gilbert Building, Victoria, 3010, Australia.
| | - Thorlene Egerton
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Level 7, Alan Gilbert Building, Victoria, 3010, Australia
| | - Mark Merolli
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Level 7, Alan Gilbert Building, Victoria, 3010, Australia
| | - Jessica Lees
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Level 7, Alan Gilbert Building, Victoria, 3010, Australia
- Faculty of Health and Centre for Research in Assessment and Digital Learning, Deakin University, Deakin, Australia
| | - Nino La Scala
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Level 7, Alan Gilbert Building, Victoria, 3010, Australia
| | - Selina M Parry
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Level 7, Alan Gilbert Building, Victoria, 3010, Australia
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Nel D, Jonas E, Burch V, Nel A, Cairncross L, Alseidi A, George B, Ten Cate O. Entrustable professional activities in postgraduate general surgery training: a scoping review protocol. BMJ Open 2023; 13:e067322. [PMID: 36921948 PMCID: PMC10030674 DOI: 10.1136/bmjopen-2022-067322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
INTRODUCTION The competency-based medical education (CBME) movement continues to gain momentum in postgraduate physician training, resulting in increasing interest among surgical training programmes on how to implement it effectively. Entrustable professional activities (EPAs) were introduced to connect competencies (characteristics/abilities of learners) and the professional activities to be entrusted to them on qualification/graduation. Although reviews related to the field of general surgery have been published on specific aspects of CBME, for example, workplace-based assessment, there is a paucity of published guidance available for surgeon-educators to plan and implement CBME using an EPA framework. This scoping review aims to provide an overview of the current use of EPAs in general surgery. METHODS AND ANALYSIS This scoping review will be based on the original five-stage approach described by Arksey and O'Malley with the addition of protocol-specific items from the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols extension for scoping reviews. The primary research question focuses on describing how EPAs have been used in general surgery and where potential gaps remain that warrant further study. The review will include peer-reviewed journal publications and an extensive review of grey literature sources. The following databases will be searched for published literature from 1 January 2005 to 31 December 2022: PubMed; CINAHL, Africa-Wide Information, PsycInfo and ERIC (via EBSCOhost); Scopus; and SciELO (via Web of Science). Studies that describe the use of EPAs for curriculum design, teaching and/or assessment of competence in postgraduate general surgery training will be eligible for inclusion. ETHICS AND DISSEMINATION The institutional ethics board of the University of Cape Town has granted a waiver of formal approval requirement. The dissemination strategy includes publication of results in peer-reviewed journals, presentation at international conferences and presentation to relevant stakeholders as deemed appropriate.
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Affiliation(s)
- Daniel Nel
- Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Eduard Jonas
- Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Vanessa Burch
- Department of Medicine, Groote Schuur Hospital and University of Cape Town, and the Colleges of Medicine of South Africa, Cape Town, South Africa
| | - Amy Nel
- Department of Public Health, University of Cape Town, Cape Town, South Africa
| | - Lydia Cairncross
- Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Adnan Alseidi
- Department of Surgery, University of California San Francisco, San Francisco, California, USA
| | - Brian George
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Olle Ten Cate
- Center for Research and Development of Education, UMC Utrecht, Utrecht, Netherlands
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