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Schumacher DJ, Michelson C, Winn AS, Turner DA, Martini A, Kinnear B. A realist synthesis of prospective entrustment decision making by entrustment or clinical competency committees. MEDICAL EDUCATION 2024; 58:812-824. [PMID: 38088227 DOI: 10.1111/medu.15296] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 11/03/2023] [Accepted: 11/21/2023] [Indexed: 06/04/2024]
Abstract
INTRODUCTION The real-world mechanisms underlying prospective entrustment decision making (PEDM) by entrustment or clinical competency committees (E/CCCs) are poorly understood. To advance understanding in this area, the authors conducted a realist synthesis of the published literature to address the following research question: In E/CCC efforts to make defensible prospective entrustment decisions (PEDs), what works, for whom, under what circumstances and why? METHODS Realist work seeks to understand the contexts (C), mechanisms (M) and outcomes (O) that explain how and why things work (or do not). In the authors' study, contexts included individual E/CCC members, E/CCC structures and processes, and training programmes. The outcome (i.e. desired outcome) was a PED. Mechanisms were a substantial focus of the analysis and informed the core findings. To define a final corpus of 52 included papers, the authors searched four databases, screened all results from those searches and performed a full-text review of a subset of screened papers. Data extraction focused on developing context-mechanism-outcome configurations from the papers, which were used to create a theory for how PEDM leads to PEDs. RESULTS PEDM is often driven by default (non-deliberate) decision making rather than a deliberate process of deciding whether a trainee should be entrusted or not. When defaulting, some E/CCCs find red flags that sometimes lead to being more deliberate with decision making. E/CCCs that seek to be deliberate describe PEDM that can be effortful (when data are insufficient or incongruent) or effortless (when data are robust and tell a congruent story about a trainee). Both information about trainee trustworthiness and the sufficiency of data about trainee performance influence PEDM. Several moderators influence what is considered to be sufficient data, how trustworthiness data are viewed and how PEDM is carried out. These include perceived consequences and associated risks, E/CCC member trust propensity, E/CCC member personal knowledge of and experience with trainees and E/CCC structures and processes. DISCUSSION PEDM is rarely deliberate but should be. Data about trainee trustworthiness are foundational to making PEDs. Bias, equity and fairness are nearly absent from the papers in this synthesis, and future efforts must seek to advance understanding and practice regarding the roles of bias, equity and fairness in PEDM.
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Affiliation(s)
- Daniel J Schumacher
- Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Catherine Michelson
- Ann and Robert H. Lurie Children's Hospital of Chicago/Northwestern University, Chicago, Illinois, USA
| | - Ariel S Winn
- Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - David A Turner
- American Board of Pediatrics, Chapel Hill, North Carolina, USA
| | - Abigail Martini
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Benjamin Kinnear
- Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Monti M, Pittet V, Frick S, Gachoud D. A multi-method approach to drafting candidate entrustable professional activities for a general internal medicine residency programme. Swiss Med Wkly 2024; 154:3592. [PMID: 38801750 DOI: 10.57187/s.3592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Abstract
INTRODUCTION Entrustable professional activities (EPAs) are units of concrete daily clinical tasks that trainee physicians should be able to handle with increasing autonomy during their postgraduate training. EPAs are gaining international recognition as an essential component of competency-based medical training programmes. The process of developing EPAs for a nationwide training programme is complex and requires an in-depth understanding of EPAs as a concept and good knowledge of appropriate development processes. This article provides a detailed description of the methodology and results of a multi-step approach for developing a list of candidate EPAs for Switzerland's postgraduate training programme in general internal medicine (GIM). METHODS We took a multi-step approach including a systematic review of international literature, four national focus groups, a national consensus process using a RAND appropriateness method, and a quality check of the selected candidate EPAs using EQual criteria. RESULTS These steps generated a final list of 247 candidate EPAs in general internal medicine that were submitted for the national consensus process. After two rounds of rating, experts agreed on the appropriateness for general internal medicine postgraduate training of 225 candidate EPAs. Twenty-two were deemed inappropriate, and disagreement persisted only for two EPAs. DISCUSSION This multi-step programme is one of the few describing in detail the process of developing a list of EPAs and providing evidence of validity at each step. The clinical breadth of our candidate EPAs, together with the detailed description of our methodology, could serve as a useful starting point from which medical education specialists or clinicians could develop or revise applicable lists of EPAs, particularly for postgraduate training programmes in either general internal medicine or family medicine.
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Affiliation(s)
- Matteo Monti
- Division of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
- Medical Education Unit, School of Medicine, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Valérie Pittet
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Sonia Frick
- Postgraduate Education Committee, Swiss Society of General Internal Medicine, Bern, Switzerland
- Swiss Institute for Postgraduate and Continuing Education in Medicine, Bern, Switzerland
| | - David Gachoud
- Division of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
- Medical Education Unit, School of Medicine, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
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Andreou V, Peters S, Eggermont J, Schoenmakers B. Co-designing Entrustable Professional Activities in General Practitioner's training: a participatory research study. BMC MEDICAL EDUCATION 2024; 24:549. [PMID: 38760773 PMCID: PMC11100052 DOI: 10.1186/s12909-024-05530-y] [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: 12/25/2023] [Accepted: 05/07/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND In medical education, Entrustable Professional Activities (EPAs) have been gaining momentum for the last decade. Such novel educational interventions necessitate accommodating competing needs, those of curriculum designers, and those of users in practice, in order to be successfully implemented. METHODS We employed a participatory research design, engaging diverse stakeholders in designing an EPA framework. This iterative approach allowed for continuous refinement, shaping a comprehensive blueprint comprising 60 EPAs. Our approach involved two iterative cycles. In the first cycle, we utilized a modified-Delphi methodology with clinical competence committee (CCC) members, asking them whether each EPA should be included. In the second cycle, we used semi-structured interviews with General Practitioner (GP) trainers and trainees to explore their perceptions about the framework and refine it accordingly. RESULTS During the first cycle, 14 CCC members agreed that all the 60 EPAs should be included in the framework. Regarding the formulation of each EPAs, 20 comments were given and 16 adaptations were made to enhance clarity. In the second cycle, the semi-structured interviews with trainers and trainees echoed the same findings, emphasizing the need of the EPA framework for improving workplace-based assessment, and its relevance to real-world clinical scenarios. However, trainees and trainers expressed concerns regarding implementation challenges, such as the large number of EPAs to be assessed, and perception of EPAs as potentially high-stakes. CONCLUSION Accommodating competing stakeholders' needs during the design process can significantly enhance the EPA implementation. Recognizing users as experts in their own experiences empowers them, enabling a priori identification of implementation barriers and potential pitfalls. By embracing a collaborative approach, wherein diverse stakeholders contribute their unique viewpoints, we can only create effective educational interventions to complex assessment challenges.
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Affiliation(s)
- Vasiliki Andreou
- Academic Centre for General Practice, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
- Department of Public Health and Primary Care, KU Leuven, Box 7001, Kapucijnenvoer 7, Leuven, 3000, Belgium.
| | - Sanne Peters
- Academic Centre for General Practice, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Jan Eggermont
- Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Birgitte Schoenmakers
- Academic Centre for General Practice, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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Schmidbauer ML, Pinilla S, Kunst S, Biesalski AS, Bösel J, Niesen WD, Schramm P, Wartenberg K, Dimitriadis K. Fit for Service: Preparing Residents for Neurointensive Care with Entrustable Professional Activities: A Delphi Study. Neurocrit Care 2024; 40:645-653. [PMID: 37498455 PMCID: PMC10959831 DOI: 10.1007/s12028-023-01799-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/30/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Although the relevance of neurointensive medicine and high-quality training of corresponding physicians is increasingly recognized, there is high heterogeneity in the nature, duration, and quality of neurointensive care curricula around the world. Thus, we aimed to identify, define, and establish validity evidence for entrustable professional activities (EPAs) for postgraduate training in neurointensive care to determine trainees' readiness for being on-call. METHODS After defining EPAs through an iterative process by an expert group, we used a modified Delphi approach with a single-center development process followed by a national consensus and a single-center validation step. EPAs were evaluated by using the EQual rubric (Queen's EPA Quality Rubric). Interrater reliability was measured with Krippendorff's α. RESULTS The expert group defined seven preliminary EPAs for neurointensive care. In two consecutive Delphi rounds, EPAs were adapted, and consensus was reached for level of entrustment and time of expiration. Ultimately, EPAs reached a high EQual score of 4.5 of 5 and above. Interrater reliability for the EQual scoring was 0.8. CONCLUSIONS Using a multistep Delphi process, we defined and established validity evidence for seven EPAs for neurointensive medicine with a high degree of consensus to objectively describe readiness for on-call duty in neurointensive care. This operationalization of pivotal clinical tasks may help to better train clinical residents in neurointensive care across sites and health care systems and has the potential to serve as a blueprint for training in general intensive care medicine. It also represents a starting point for further research and development of medical curricula.
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Affiliation(s)
| | - Severin Pinilla
- University Hospital for Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Institute for Medical Education (IML), University of Bern, Bern, Switzerland
| | - Stefan Kunst
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Anne-Sophie Biesalski
- Department of Neurology, Ruhr-Universität Bochum, St. Josef Hospital, Bochum, Germany
| | - Julian Bösel
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Wolf-Dirk Niesen
- Department of Neurology and Neurophysiology, University Medical Center Freiburg, Freiburg, Germany
| | - Patrick Schramm
- Department of Neurology, Universitätsklinikum Giessen und Marburg, Standort Giessen, Justus-Liebig-University, Giessen, Germany
| | - Katja Wartenberg
- Department of Neurology, University of Leipzig, Leipzig, Germany
| | - Konstantinos Dimitriadis
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany.
- Institute for Stroke and Dementia Research (ISD), LMU University Hospital, LMU Munich, Munich, Germany.
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Cifra N, Pitts S, Mink R, Schwartz A, Herman B, Turner DA, Yussman S. Analysis of fellowship program director opinions of entrustable professional activities in adolescent medicine fellowship. Int J Adolesc Med Health 2024; 0:ijamh-2023-0154. [PMID: 38522004 DOI: 10.1515/ijamh-2023-0154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 03/08/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVES This study aimed to explore the minimum entrustable professional activity (EPA) supervision levels at which pediatric fellowship program directors (FPDs) would be willing to graduate fellows and the levels deemed necessary for safe and effective practice for each of the common pediatric subspecialty and the four adolescent medicine-specific EPAs. METHODS This cross-sectional study utilized survey data from pediatric FPDs in 2017. FPDs indicated the minimum level of supervision (LOS) for fellows at graduation and for safe and effective practice. RESULTS 82 percent (23/28) of adolescent medicine FPDs completed the survey. For each EPA, there were differences (p<0.05) between LOS expected for graduation and for safe and effective practice. There was also variability in the level at which FPDs would graduate fellows. CONCLUSIONS This study summarizes pediatric FPD opinions regarding the minimum levels of supervision required for fellows at the time of graduation as well as the levels deemed necessary for safe and effective practice. The difference between the minimum LOS at which FPDs would graduate a fellow and that deemed appropriate for safe and effective practice, along with variability in minimum LOS for graduation, highlight the need for clearer standards for fellowship graduation as well as more structured early career support for ongoing learning. These data highlight variability in FPD opinion regarding such expectations and both the need to better define desired training outcomes and potential need for post-graduation supervision in clinical practice.
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Affiliation(s)
- Nicole Cifra
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Sarah Pitts
- Department of Pediatrics, Boston Children's Hospital, Boston, USA
| | | | - Alan Schwartz
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, USA
| | | | | | - Susan Yussman
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, USA
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Frank JR, Hall AK, Oswald A, Dagnone JD, Brand PLP, Reznick R. From Competence by Time to Competence by Design: Lessons From A National Transformation Initiative. PERSPECTIVES ON MEDICAL EDUCATION 2024; 13:224-228. [PMID: 38550713 PMCID: PMC10976982 DOI: 10.5334/pme.1342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/06/2024] [Indexed: 04/02/2024]
Affiliation(s)
- Jason R. Frank
- Centre for Innovation in Medical Education, and Professor, Department of Emergency Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Andrew K. Hall
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
| | - Anna Oswald
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Competency Based Medical Education, and Professor, Division of Rheumatology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - J. Damon Dagnone
- Department of Emergency Medicine, Queen’s University, Kingston, ON, Canada
- Standards and Accreditation, Royal College of Physicians & Surgeons of Canada, Ottawa, ON, Canada
| | - Paul L. P. Brand
- Clinical Medical Education, University Medical Centre and University of Groningen, the Netherlands
- Medical Education and Faculty Development, Isala Hospital, Zwolle, The Netherlands
| | - Richard Reznick
- Queen’s University, Immediate Past President Royal College of Physicians and Surgeons of Canada, Canada
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Frank JR, Karpinski J, Sherbino J, Snell LS, Atkinson A, Oswald A, Hall AK, Cooke L, Dojeiji S, Richardson D, Cheung WJ, Cavalcanti RB, Dalseg TR, Thoma B, Flynn L, Gofton W, Dudek N, Bhanji F, Wong BMF, Razack S, Anderson R, Dubois D, Boucher A, Gomes MM, Taber S, Gorman LJ, Fulford J, Naik V, Harris KA, St. Croix R, van Melle E. Competence By Design: a transformational national model of time-variable competency-based postgraduate medical education. PERSPECTIVES ON MEDICAL EDUCATION 2024; 13:201-223. [PMID: 38525203 PMCID: PMC10959143 DOI: 10.5334/pme.1096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 02/16/2024] [Indexed: 03/26/2024]
Abstract
Postgraduate medical education is an essential societal enterprise that prepares highly skilled physicians for the health workforce. In recent years, PGME systems have been criticized worldwide for problems with variable graduate abilities, concerns about patient safety, and issues with teaching and assessment methods. In response, competency based medical education approaches, with an emphasis on graduate outcomes, have been proposed as the direction for 21st century health profession education. However, there are few published models of large-scale implementation of these approaches. We describe the rationale and design for a national, time-variable competency-based multi-specialty system for postgraduate medical education called Competence by Design. Fourteen innovations were bundled to create this new system, using the Van Melle Core Components of competency based medical education as the basis for the transformation. The successful execution of this transformational training system shows competency based medical education can be implemented at scale. The lessons learned in the early implementation of Competence by Design can inform competency based medical education innovation efforts across professions worldwide.
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Affiliation(s)
- Jason R. Frank
- Centre for Innovation in Medical Education and Professor, Department of Emergency Medicine, Faculty of Medicine, University of Ottawa, ON, Canada
| | - Jolanta Karpinski
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Competency Based Medical Education, University of Ottawa, Ottawa, ON, Canada
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
| | | | - Linda S. Snell
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Medicine and Health Sciences Education, McGill University, Montreal, QC, Canada
| | - Adelle Atkinson
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Anna Oswald
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- Competency Based Medical Education, University of Alberta, Edmonton, AB, Canada
| | - Andrew K. Hall
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Lara Cooke
- Division of Neurology, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Susan Dojeiji
- Physical Medicine and Rehabilitation, University of Ottawa, Ottawa, ON, Canada
| | - Denyse Richardson
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Department of Physical Medicine and Rehabilitation, Queen’s University, Kingston, ON, Canada
| | - Warren J. Cheung
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Rodrigo B. Cavalcanti
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- HoPingKong Centre, University Health Network, Toronto, ON, Canada
| | - Timothy R. Dalseg
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Division of Emergency Medicine, University of Toronto, Toronto, ON, Canada
| | - Brent Thoma
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Emergency Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Leslie Flynn
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Departments of Psychiatry and Family Medicine, and Co-Director Master of Health Sciences Education, Queen’s University, Kingston, ON, Canada
| | - Wade Gofton
- Department of Surgery (Division of Orthopedic Surgery), The Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada
| | - Nancy Dudek
- Department of Medicine (Division of Physical Medicine & Rehabilitation) and The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Farhan Bhanji
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Brian M.-F. Wong
- Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Canada
| | - Saleem Razack
- Centre for Health Education Scholarship, University of British Columbia and BC Children’s Hospital, Vancouver, BC, Canada
| | - Robert Anderson
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Northern Ontario School of Medicine University, Sudbury, ON, Canada
| | - Daniel Dubois
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Andrée Boucher
- Department of Medicine (Division of Endocrinology), Universitéde Montréal, Montréal, QC, Canada
| | - Marcio M. Gomes
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Sarah Taber
- Office of Standards and Assessment, Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
| | - Lisa J. Gorman
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
| | - Jane Fulford
- Canadian Internet Registration Authority, Canada
| | - Viren Naik
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
- Medical Council of Canada, Ottawa, ON, Canada
| | - Kenneth A. Harris
- Royal College of Physicians and Surgeons of Canada, Canada
- Emeritus, Western University, Canada
| | - Rhonda St. Croix
- Learning and Connecting at the Royal College of Physicians and Surgeons of Canada, Canada
| | - Elaine van Melle
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Department of Family Medicine, Queen’s University, Kingston, ON, Canada
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Hall AK, Oswald A, Frank JR, Dalseg T, Cheung WJ, Cooke L, Gorman L, Brzezina S, Selvaratnam S, Wagner N, Hamstra SJ, Van Melle E. Evaluating Competence by Design as a Large System Change Initiative: Readiness, Fidelity, and Outcomes. PERSPECTIVES ON MEDICAL EDUCATION 2024; 13:95-107. [PMID: 38343556 PMCID: PMC10854467 DOI: 10.5334/pme.962] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 08/17/2023] [Indexed: 02/15/2024]
Abstract
Program evaluation is an essential, but often neglected, activity in any transformational educational change. Competence by Design was a large-scale change initiative to implement a competency-based time-variable educational system in Canadian postgraduate medical education. A program evaluation strategy was an integral part of the build and implementation plan for CBD from the beginning, providing insights into implementation progress, challenges, unexpected outcomes, and impact. The Competence by Design program evaluation strategy was built upon a logic model and three pillars of evaluation: readiness to implement, fidelity and integrity of implementation, and outcomes of implementation. The program evaluation strategy harvested from both internally driven studies and those performed by partners and invested others. A dashboard for the program evaluation strategy was created to transparently display a real-time view of Competence by Design implementation and facilitate continuous adaptation and improvement. The findings of the program evaluation for Competence by Design drove changes to all aspects of the Competence by Design implementation, aided engagement of partners, supported change management, and deepened our understanding of the journey required for transformational educational change in a complex national postgraduate medical education system. The program evaluation strategy for Competence by Design provides a framework for program evaluation for any large-scale change in health professions education.
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Affiliation(s)
- Andrew K. Hall
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
| | - Anna Oswald
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Division of Rheumatology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Jason R. Frank
- Department of Emergency Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Tim Dalseg
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Department of Medicine, Division of Emergency Medicine, University of Toronto, Toronto, ON, Canada
| | - Warren J. Cheung
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Lara Cooke
- Neurology, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Lisa Gorman
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
| | - Stacey Brzezina
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
| | | | - Natalie Wagner
- Queen’s Health Sciences Office of Professional Development and Educational Scholarship, Queen’s University, Kingston, ON, Canada
| | - Stanley J. Hamstra
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Department of Milestones Research and Evaluation, Accreditation Council for Graduate Medical Education, Chicago, IL, USA
- Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Elaine Van Melle
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Department of Family Medicine, Queen’s University, Kingston, ON, Canada
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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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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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Brasel KJ, Lindeman B, Jones A, Sarosi GA, Minter R, Klingensmith ME, Whiting J, Borgstrom D, Buyske J, Mellinger JD. Implementation of Entrustable Professional Activities in General Surgery: Results of a National Pilot Study. Ann Surg 2023; 278:578-586. [PMID: 37436883 DOI: 10.1097/sla.0000000000005991] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
OBJECTIVE The ongoing complexity of general surgery training has led to an increased focus on ensuring the competence of graduating residents. Entrustable professional activities (EPAs) are units of professional practice that provide an assessment framework to drive competency-based education. The American Board of Surgery convened a group from the American College of Surgeons, Accreditation Council for Graduate Medical Education (ACGME) Surgery Review Committee, and Association of Program Directors in Surgery to develop and implement EPAs in a pilot group of residency programs across the country. The objective of this pilot study was to determine the feasibility and utility of EPAs in general surgery resident training. METHODS 5 EPAs were chosen based on the most common procedures reported in ACGME case logs and by practicing general surgeons (right lower quadrant pain, biliary disease, inguinal hernia), along with common activities covering additional ACGME milestones (performing a consult, care of a trauma patient). Levels of entrustment assigned (1 to 5) were observation only, direct supervision, indirect supervision, unsupervised, and teaching others. Participating in site recruitment and faculty development occurred from 2017 to 2018. EPA implementation at individual residency programs began on July 1, 2018, and was completed on June 30, 2020. Each site was assigned 2 EPAs to implement and collected EPA microassessments on residents for those EPAs. The site clinical competency committees (CCC) used these microassessments to make summative entrustment decisions. Data submitted to the independent deidentified data repository every 6 months included the number of microassessments collected per resident per EPA and CCC summative entrustment decisions. RESULTS Twenty-eight sites were selected to participate in the program and represented geographic and size variability, community, and university-based programs. Over the course of the 2-year pilot programs reported on 14 to 180 residents. Overall, 6,272 formative microassessments were collected (range, 0 to 1144 per site). Each resident had between 0 and 184 microassessments. The mean number of microassessments per resident was 5.6 (SD = 13.4) with a median of 1 [interquartile range (IQR) = 6]. There were 1,763 summative entrustment ratings assigned to 497 unique residents. The average number of observations for entrustment was 3.24 (SD 3.61) with a median of 2 (IQR 3). In general, PGY1 residents were entrusted at the level of direct supervision and PGY5 residents were entrusted at unsupervised practice or teaching others. For each EPA other than the consult EPA, the degree of entrustment reported by the CCC increased by resident level. CONCLUSIONS These data provide evidence that widespread implementation of EPAs across general surgery programs is possible, but variable. They provide meaningful data that graduating chief residents are entrusted by their faculty to perform without supervision for several common general surgical procedures and highlight areas to target for the successful widespread implementation of EPAs.
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Affiliation(s)
- Karen J Brasel
- Department of Surgery, Oregon Health and Science University, Portland, OR
| | - Brenessa Lindeman
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | | | - George A Sarosi
- Department of Surgery, University of Florida, Gainesville, FL
| | - Rebecca Minter
- Department of Surgery, University of Wisconsin, Madison, WI
| | - Mary E Klingensmith
- Accreditation Council for Graduate Medical Education, Chicago, IL
- Department of Surgery, Washington University in St. Louis, St. Louis, MO
| | - James Whiting
- Department of Surgery, Maine Medical Center, Portland, ME
| | - David Borgstrom
- Department of Surgery, University of West Virginia, Morgantown, WV
| | - Jo Buyske
- American Board of Surgery, Philadelphia, PA
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12
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Chen JX, Thorne MC, Galaiya D, Campisi P, Gray ST. Competency-based medical education in the United States: What the otolaryngologist needs to know. Laryngoscope Investig Otolaryngol 2023; 8:827-831. [PMID: 37621294 PMCID: PMC10446250 DOI: 10.1002/lio2.1095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 05/29/2023] [Accepted: 06/04/2023] [Indexed: 08/26/2023] Open
Abstract
Competency-based medical education (CBME) is an outcomes-focused approach to educating medical professionals that will be central to future efforts to improve resident training in otolaryngology. The transition to CBME for otolaryngology in the United States will require the development of specialty-specific assessments and benchmarks, the financial and administrative support for implementation, the professional development of faculty and learners, and the cooperation of all major stakeholders in graduate medical education. In this article, we describe the need for evidence-based innovation in surgical training, the history of CBME in the United States, and the progress towards defining "entrustable professional activities" as the building blocks of assessments for CBME. We explore what such a paradigm shift in surgical education could mean for academic otolaryngologists by examining innovative educational practices in other surgical specialties and discussing foreseeable challenges in implementation for the American healthcare system.
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Affiliation(s)
- Jenny X. Chen
- Department of Otolaryngology—Head and Neck SurgeryJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Marc C. Thorne
- Department of Otolaryngology—Head and Neck SurgeryUniversity of MichiganAnn ArborMichiganUSA
| | - Deepa Galaiya
- Department of Otolaryngology—Head and Neck SurgeryJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Paolo Campisi
- Department of Otolaryngology—Head and Neck SurgeryUniversity of TorontoTorontoOntarioCanada
| | - Stacey T. Gray
- Department of Otolaryngology—Head and Neck SurgeryHarvard Medical SchoolBostonMassachusettsUSA
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Langhan ML, Stafford DEJ, Myers AL, Herman BE, Curran ML, Czaja AS, Turner DA, Weiss P, Mink R. Clinical competency committee perceptions of entrustable professional activities and their value in assessing fellows: A qualitative study of pediatric subspecialty program directors. MEDICAL TEACHER 2023; 45:650-657. [PMID: 36420760 DOI: 10.1080/0142159x.2022.2147054] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
OBJECTIVES To examine the composition and processes of Clinical Competency Committees (CCCs) assigning entrustable professional activity (EPA) levels of supervision for pediatric subspecialty fellows and to examine fellowship program director (FPD) perspectives about using EPAs to determine fellows' graduation readiness. METHODS A qualitative study was performed using one-on-one interviews with a purposeful sample of pediatric subspecialty FPDs to yield a thematic analysis. Semi-structured interview guides were used for participants who self-identified as EPA users or non-users. Inductive analysis and coding were performed on transcripts until theoretical sufficiency was attained. RESULTS Twenty-eight FPDs were interviewed. There was significant variability in the composition and processes of CCCs across subspecialties. FPDs felt that CCCs intuitively understand what entrustment means, allowing for ease of application of level of supervision (LOS) scales and consensus. FPDs perceived that EPAs provided a global assessment of fellows and are one tool to determine graduation readiness. CONCLUSIONS Although there was variability in the makeup and processes of CCCs across subspecialties, FPDs believe EPAs are intuitive and relatively easy to implement. Consensus can be reached easily using EPA-specific LOS scales focusing on entrustment. FPDs desire a better understanding of how EPAs should be used for graduation.
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Affiliation(s)
- Melissa L Langhan
- Department of Pediatrics and Emergency Medicine, Section of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Diane E J Stafford
- Department of Pediatrics, Division of Endocrinology, Stanford University School of Medicine, Stanford, CA, USA
| | - Angela L Myers
- Department of Pediatrics, Children's Mercy, Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Bruce E Herman
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Megan L Curran
- Department of Pediatrics, Section of Rheumatology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Angela S Czaja
- Department of Pediatrics, Section of Critical Care, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Pnina Weiss
- Department of Pediatrics, Section of Pulmonology, Allergy, Immunology and Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Richard 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, Torrance, CA, USA
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Wang M, Wang Y, Fang M, Zhang S, Li Y, Cao D, Jin Y. Style and influencing factors of tutors-postgraduates' interactions in Chinese medical colleges: a cross-sectional survey in Heilongjiang Province. BMC MEDICAL EDUCATION 2023; 23:305. [PMID: 37131172 PMCID: PMC10152608 DOI: 10.1186/s12909-023-04291-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 04/22/2023] [Indexed: 05/04/2023]
Abstract
OBJECTIVES This study assesses the style of tutor-postgraduate interactions in Chinese medical colleges and explores the association between postgraduates' demographic factors and tutors' demographic characteristics. METHODS With the stratified sampling method, a cross-sectional online survey was used. A total of 813 medical postgraduates were recruited as participants, with an effective response rate of 85.49%. The two dimensions of "Professional Ability Interaction" and "Comprehensive Cultivation Interaction" in the self-developed "Instructor-Graduate Interaction Scale for Medical Colleges" were used as dependent variables. And tutors' demographic characteristics and postgraduates' demographic characteristics were taken as independent variables. Logistic regression analysis was used to explore the influencing factors of Tutor-Postgraduates Interactions in medical colleges. RESULTS The Tutor-Postgraduates Interaction scale consists of 14 items from the two dimensions of "Professional Ability Interaction" and "Comprehensive Cultivation Interaction". The results of the logistic regression analysis show the reasons for selecting the mentor students (industry recognition, the tutor's research direction, charm in attracting mentors, and recommendations for mentor selection); student to mentor satisfaction; student to study life satisfaction; and regular academic seminars. Indirect guidance and a high postgraduate grade high are the protective factors of interaction between tutors and postgraduates of medical colleges and universities postgraduates. Older mentors and more graduate tutors are the risk factors for Tutor-Postgraduates Interaction in medical colleges (P < 0.05). CONCLUSION The current study proposes that managers should pay more attention to the double-track promotion of "Professional Ability Interaction" and "Comprehensive Cultivation Interaction". We should not only pay attention to the cultivation of postgraduates' professional ability but also pay more attention to the comprehensive cultivation including postgraduates' mental and psychological aspects. The interaction between tutors and postgraduates in medical colleges is generally good, but much attention should be given to the dual-track promotion mentioned above. Regular academic seminars play an important role in the process of postgraduate training. The research findings, including the influencing factors regarding tutor-postgraduate interactions, the Professional Ability Interaction and Comprehensive Cultivation Interaction, are very informative and can contribute to strategies for postgraduate management systems that enhance this relationship.
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Affiliation(s)
- Mingsi Wang
- Graduate School of Harbin Medical University, 157# Bao Jian Road, Harbin, 150081, China
- Department of Health Economics, College of Health Management of Harbin Medical University, 157# Bao Jian Road, Harbin, 150081, China
| | - Yanping Wang
- Department of Health Management, School of Health Management, Harbin Medical University, 157# Bao Jian Road, Harbin, 150081, China
| | - Ming Fang
- Graduate School of Harbin Medical University, 157# Bao Jian Road, Harbin, 150081, China
| | - Shue Zhang
- Department of Health Management, School of Health Management, Harbin Medical University, 157# Bao Jian Road, Harbin, 150081, China
| | - Yilan Li
- Department of Cardiology, the Second Affiliated Hospital of Harbin Medical University, 148# Bao Jian Road, Harbin, 150000, China
| | - Depin Cao
- Department of Health Management, School of Health Management, Harbin Medical University, 157# Bao Jian Road, Harbin, 150081, China.
| | - Yan Jin
- Graduate School of Harbin Medical University, 157# Bao Jian Road, Harbin, 150081, China.
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Valding B, Monti M, Junod Perron N, Frick S, Jaques C, Nendaz M, Gachoud D. Entrustable professional activities for residency in general internal medicine: a systematic review. Swiss Med Wkly 2022; 152:40002. [PMID: 36473152 DOI: 10.57187/smw.2022.40002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
CONTEXT Entrustable Professional Activities (EPAs) are observable tasks that are regular parts of a physician's daily clinical work. Before being permitted to accomplish these tasks independently, trainees must gain their supervisors' trust. Defining the list of EPAs that should be mastered by the end of a residency is critical to setting clear expectations about autonomous practice. OBJECTIVE To collect all the lists of EPAs defined for residencies in general internal medicine and synthesise them into a reference work useful for developing new lists of EPAs or improving existing ones. METHOD This systematic review searched five databases and relevant grey literature using keywords related to EPAs and postgraduate education, from 2005, when the first article on EPAs was published, to April 2022. Inclusion criteria were the availability of an EPAs list and a focus on general internal medicine. Two reviewers independently selected the studies, extracted data and performed a quality assessment using QATSDD and AACODS tools. Mean values and inter-rater reliability were calculated. RESULTS The review yielded 3292 records, with 16 articles meeting the inclusion criteria, mostly from North America. Synthesising their 16 lists generated 395 EPAs. The reviewers then inductively categoried those EPAs, 308 of which fell into 6 domains, 14 themes and 24 subthemes. The domains were: (1) care and management of the general adult population (n = 103 EPAs); (2) care and management of patients with specific needs (n = 67); (3) care coordination and communication (n = 52); (4) management and leadership (N = 21); (5) healthcare quality, education, and research (n = 41); and (6) miscellaneous (n = 24). The remaining 87 EPAs were disease-specific and did not fit into this categorisation. CONCLUSIONS Categorising EPAs created a unique synthesis of the existing lists of EPAs for educating residents in general internal medicine. This synthesis could be used as a reference for anyone tasked with developing new lists of EPAs or improving existing ones.
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Affiliation(s)
- Bastien Valding
- Department of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Matteo Monti
- Department of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland.,Medical Education Unit, University of Lausanne, Switzerland
| | - Noëlle Junod Perron
- Institute of Primary Care, Geneva University Hospitals, Geneva, Switzerland.,Unit for Development and Research in Medical Education, Faculty of Medicine, Geneva, Switzerland
| | - Sonia Frick
- Department of Internal Medicine, Lachen Hospital, Lachen, Switzerland.,School of Medicine, University of Zürich, Switzerland
| | - Cécile Jaques
- Medical Library, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Mathieu Nendaz
- Unit for Development and Research in Medical Education, Faculty of Medicine, Geneva, Switzerland.,Division of Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - David Gachoud
- Department of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland.,Medical Education Unit, University of Lausanne, Switzerland
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Dabbagh A, Fadaeizadeh L, Gharaei B, Ghasemi M, Kamranmanesh M, Khorasanizadeh S, Massoudi N, Mahdavi SA, Memary E, Moshari M, Nashibi M, Sezari P, Vosoughian M. The Role of Entrustable Professional Activities in Competency-based Medical Education for Anesthesiology Residents: A Pilot Phase. Anesth Pain Med 2022; 12:e130176. [PMID: 36937177 PMCID: PMC10016108 DOI: 10.5812/aapm-130176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 10/31/2022] [Accepted: 11/08/2022] [Indexed: 12/26/2022] Open
Abstract
Background After graduation, physicians should be able to provide professional and safe services without the need for supervision by their clinical professors, mandating a competency-based medical education (CBME) approach. Objectives This study aimed to develop a national model of entrustable professional activities (EPAs) based on our experiences in the Department of Anesthesiology and Critical Care (DACC), Shahid Beheshti University of Medical Sciences (SBMU). Methods The primary EPA design plan was designed in a 10-step model as a career roadmap for the project. The texts were prepared according to a consensus-based approach. On the other hand, the texts were reviewed and revised by a broad team of faculty in a daily workshop. Results The final product included 14 topics for EPA as the first round of targeting topics for anesthesiology residents. The texts were developed using previous studies and were standardized considering national standards. Conclusions We described a clear path toward designing and implementing EPAs in anesthesiology residency programs to improve the quality of the graduated residents. Though the basic theory is the same, each country needs its formula for implementing the process.
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Affiliation(s)
- Ali Dabbagh
- Anesthesiology Department, Anesthesiology Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Corresponding Author: Anesthesiology Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Lida Fadaeizadeh
- Department of Anesthesiology, School of Medicine, Telemedicine Research Center, National Research Institute of Tuberculosis and Lung Diseases, Dr. Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Babak Gharaei
- Anesthesiology Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahshid Ghasemi
- Anesthesiology Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Kamranmanesh
- Anesthesiology Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shayesteh Khorasanizadeh
- Anesthesiology Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nilofar Massoudi
- Anesthesiology Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Alireza Mahdavi
- Anesthesiology Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elham Memary
- Anesthesiology Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Moshari
- Anesthesiology Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoud Nashibi
- Anesthesiology Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parissa Sezari
- Anesthesiology Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Vosoughian
- Anesthesiology Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Corrigan C, Moran K, Kesten K, Conrad D, Manderscheid A, Beebe SL, Pohl E. Entrustable Professional Activities in Clinical Education: A Practical Approach for Advanced Nursing Education. Nurse Educ 2022; 47:261-266. [PMID: 35324497 DOI: 10.1097/nne.0000000000001184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Competency attainment is foremost in the ethos of this project that provides a practical guide to implementing entrustable professional activities (EPAs) as one approach to competency acquisition in the clinical education component of a health care program. EPAs are units of work that provide evidence of required competencies for the clinical education component of a program of study for educators, preceptors, and students. PROBLEM The American Association of Colleges of Nursing has raised the importance of competency-based education and need for a practical approach to assess clinical competency challenges (eg, EPAs) in nursing education. APPROACH The implementation of EPAs in the clinical component of advanced nursing education is detailed as an example in this article. Prioritizing a systematic approach, the Knowledge to Action framework, was chosen to guide the process. CONCLUSION Nursing must act now to put in place a robust competency acquisition and validation system.
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Affiliation(s)
- Catherine Corrigan
- Researcher, Centre for eIntegrated Care, ICNP Research & Development Centre, Dublin City University, Ireland (Dr Corrigan); Associate Professor and Associate Dean for Graduate Nursing Programs and Research (Dr Moran), Associate Professor (Dr Manderscheid), Kirkhof College of Nursing, and Adjunct Faculty (Dr Conrad), Grand Valley State University, Allendale, Michigan; PhD Student and Graduate Research Assistant (Ms Beebe), School of Nursing, and Associate Professor and Director of Doctor of Nursing Practice Scholarly Projects (Dr Kesten), The George Washington University, Washington, District of Columbia; Conrad Health Consultants, P.C., Allendale, Michigan (Dr Conrad); and Nurse Practitioner, Cancer & Hematology Centers of Western Michigan, P.C., Grand Rapids, Michigan (Dr Pohl)
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18
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Hennus MP, van Dam M, Gauthier S, Taylor DR, ten Cate O. The logic behind entrustable professional activity frameworks: A scoping review of the literature. MEDICAL EDUCATION 2022; 56:881-891. [PMID: 35388517 PMCID: PMC9542438 DOI: 10.1111/medu.14806] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 03/21/2022] [Accepted: 03/29/2022] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Entrustable professional activities (EPAs), discrete profession-specific tasks requiring integration of multiple competencies, are increasingly used to help define and inform curricula of specialty training programmes. Although guidelines exist to help guide the developmental process, deciding what logic to use to draft a preliminary EPA framework poses a crucial but often difficult first step. The logic of an EPA framework can be defined as the perspective used by its developers to break down the practice of a profession into units of professional work. This study aimed to map dominant logics and their rationales across postgraduate medical education and fellowship programmes. METHODS A scoping review using systematic searches within five electronic databases (Medline, Embase, Google Scholar, Scopus and Web of Science) was performed. Dominant logics of included papers were identified using inductive coding and iterative analysis. RESULTS In total, 42 studies were included. Most studies were conducted in the United States (n = 22; 52%), Canada (n = 6; 14%) and the Netherlands (n = 4; 10%). Across the reported range of specialties, family medicine (n = 4; 10%), internal medicine (n = 4; 10%), paediatrics (n = 3; 7%) and psychiatry (n = 3; 7%) were the most common. Three dominant logics could be identified, namely, 'service provision', 'procedures' and/or 'disease or patient categories'. The majority of papers (n = 37; 88%) used two or more logics when developing EPA frameworks (median = 3, range = 1-4). Disease or patient groups and service provision were the most common logics used (39% and 37%, respectively). CONCLUSIONS Most programmes used a combination of logics when trying to capture the essential tasks of a profession in EPAs. For each of the three dominant logics, the authors arrived at a definition and identified benefits, limitations and examples. These findings may potentially inform best practice guidelines for EPA development.
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Affiliation(s)
- Marije P. Hennus
- Department of Pediatric Intensive CareUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Marjel van Dam
- Intensive Care CenterUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Stephen Gauthier
- Department of MedicineQueen's University School of MedicineKingstonOntarioCanada
| | - David R. Taylor
- Department of MedicineQueen's University School of MedicineKingstonOntarioCanada
| | - Olle ten Cate
- Center for Research and Development of EducationUniversity Medical Center UtrechtUtrechtThe Netherlands
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Cate OT. How can Entrustable Professional Activities serve the quality of health care provision through licensing and certification? CANADIAN MEDICAL EDUCATION JOURNAL 2022; 13:8-14. [PMID: 36091739 PMCID: PMC9441117 DOI: 10.36834/cmej.73974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This paper about Entrustable Professional Activities (EPAs) was solicited to support the discussion about the future of licensing within the Medical Council of Canada. EPAs, units of professional practice to be entrusted to learners or professionals once they have shown to possess sufficient competence, were proposed in 2005 to operationalize competency-based postgraduate medical education and have become widely popular for various health professions education programs in many countries. EPAs break the breadth of competence for license down to units of practice that can be overseen, assessed, monitored, documented, and entrusted. EPAs together may constitute an individual's portfolio of qualifications, and define a scope of practice. A medical license and a specialty certification can then be defined as the required combination of EPAs for which one is qualified at any specific moment in time. That 'snapshot' could change over time and reflect the professional development of the individual, both in their competence and in their privileges to practice. Micro-credentialing and digital badges might become an adequate option to show-case one's scope of practice at any time and operationalize the idea of a dynamic portfolio of EPAs.
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Zumstein-Shaha M, Grace PJ. Competency frameworks, nursing perspectives, and interdisciplinary collaborations for good patient care: Delineating boundaries. Nurs Philos 2022; 24:e12402. [PMID: 35761762 PMCID: PMC10078421 DOI: 10.1111/nup.12402] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 04/29/2022] [Accepted: 06/17/2022] [Indexed: 11/29/2022]
Abstract
To enhance patient care in the inevitable conditions of complexity that exist in contemporary healthcare, collaboration among healthcare professions is critical. While each profession necessarily has its own primary focus and perspective on the nature of human healthcare needs, these alone are insufficient for meeting the complex needs of patients (and potential patients). Persons are inevitably contextual entities, inseparable from their environments, and are subject to institutional and social barriers that can detract from good care or from accessing healthcare. These are some of the reasons behind current movements to develop competency frameworks that can enhance cross-disciplinary communication and collaboration. No single profession can claim the big picture. Effective teamwork is essential and requires members of diverse professions to understand the nature of each other's knowledge, skills, roles, perspectives, and perceived responsibilities so that they are optimally utilized on behalf of patients and their families. Interdisciplinary approaches to care permit different aspects of a person's needs to be addressed seamlessly and facilitate the removal of obstacles by engaging the range of resources exemplified by the different professions. Additionally, collaborative efforts are needed to influence policy changes on behalf of individual and social good and to address root causes of poor health especially as these impact society's most vulnerable. Here, we explore both the benefits and the risks of an uncritical acceptance of competency frameworks as a way to enhance interdisciplinary communication. We highlight the importance of anchoring proposed competency domains in the reason for being of a given profession and exemplify one way this has been accomplished for advanced practice nursing. Additionally, we argue that having this mooring, permits integration of the various competencies that both enhances professional moral agency and facilitates interdisciplinary collaboration to further the mutual goals of the healthcare professions on behalf of quality patient care.
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Affiliation(s)
- Maya Zumstein-Shaha
- Department of Health, Master of Science in Nursing Program, Adjunct Head of Program, Bern University of Applied Sciences, Bern, Switzerland.,Department of Nursing, Faculty for Health, University of Witten/Herdecke, Witten, Germany
| | - Pamela J Grace
- Boston College, William F. Connell School of Nursing, Boston, Massachusetts, USA
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21
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Zaeri R, Gandomkar R. Developing entrustable professional activities for doctoral graduates in health professions education: obtaining a national consensus in Iran. BMC MEDICAL EDUCATION 2022; 22:424. [PMID: 35655194 PMCID: PMC9164418 DOI: 10.1186/s12909-022-03469-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 05/17/2022] [Indexed: 05/31/2023]
Abstract
BACKGROUND The number of doctoral programs in health professions education (HPE) is expanding. Entrustable professional activities (EPAs) can be a mechanism to define the expected activities of the HPE doctorate to inform training and assessment processes. The purpose of this study was to develop and reach a consensus on EPAs for HPE doctoral graduates. METHODS We used a modified Nominal Group Technique (NGT) to elicit EPA titles followed by two rounds of a modified Delphi survey to seek consensus on the EPAs among groups of experts (HPE doctoral graduates and Board of HPE Examiners members) at the national level in Iran between July 2019 and July 2020. RESULTS A total number of 92 initial EPA titles, which emerged from brainstorming in the NGT meeting, was reduced to 27 titles during the clarification process. The final EPA framework consisted of 24 EPA titles with descriptions, arranged in three categories: Research and scholarship (6 EPAs), Educational development (11 EPAs) and Educational management (7 EPAs). All final EPAs scored ≥80% agreement at the national level. CONCLUSIONS The proposed EPAs framework can be used to improve the HPE doctorate training and to inform employment decisions. A future international consensus procedure could use these EPA outcomes as a starting point.
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Affiliation(s)
- Reza Zaeri
- Department of Medical Education, School of Medicine, Tehran University of Medical Sciences, No. 57, Hojjatdust Alley, Naderi St., Keshavarz Blvd, Tehran, 141663591, Iran
| | - Roghayeh Gandomkar
- Department of Medical Education, School of Medicine, Tehran University of Medical Sciences, No. 57, Hojjatdust Alley, Naderi St., Keshavarz Blvd, Tehran, 141663591, Iran.
- Health Professions Education Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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22
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Harendza S. Taking responsibility. GMS JOURNAL FOR MEDICAL EDUCATION 2022; 39:Doc27. [PMID: 35692366 PMCID: PMC9174074 DOI: 10.3205/zma001548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 03/11/2022] [Accepted: 03/11/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Sigrid Harendza
- Universitätsklinikum Hamburg-Eppendorf, III. Medizinische Klinik, Hamburg, Germany
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23
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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.
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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
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Schumacher DJ, Turner DA. Entrustable Professional Activities: Reflecting on Where We Are to Define a Path for the Next Decade. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:S1-S5. [PMID: 34183594 DOI: 10.1097/acm.0000000000004097] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Daniel J Schumacher
- D.J. Schumacher is associate professor of pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - David A Turner
- D.A. Turner is vice president for competency-based medical education, American Board of Pediatrics, Chapel Hill, North Carolina
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