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Al-Moteri M. OWIED System to Facilitate the Entrustment Decision in EPA Implementation. J Nurs Educ 2024; 63:356-365. [PMID: 38900268 DOI: 10.3928/01484834-20240404-02] [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: 06/21/2024]
Abstract
BACKGROUND Entrustable professional activities (EPAs) are gaining attention as an approach for adequate implementation of a competency-based evaluation framework in nursing education. This study sought to develop an Online Web-assessment Interface for Entrustment Decision (OWIED) to facilitate the entrustment decision in EPA implementation. METHOD A participatory qualitative action research design consisting of two phases was used for this study. The exploration phase was conducted in close collaboration with stakeholders. Following the exploration phase, the primary researcher and a team of subject-matter experts in academic and information technology developed the OWIED system according to the exploration phase results. RESULTS The necessary features that met the expectations of the stakeholders were identified and assisted in developing the OWIED system. CONCLUSION OWIED may provide a valid tool to track and validate nursing student acquisition of core competencies and assist in making entrustment decisions as students fulfill their training requirements in their academic program. [J Nurs Educ. 2024;63(6):356-365.].
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Bryant BH, Anderson SR, Brissette M, Childs JM, Gratzinger D, Johnson K, Powell DE, Zein-Eldin Powell S, Timmons CF, McCloskey CB. Leveraging faculty development to support validation of entrustable professional activities assessment tools in anatomic and clinical pathology training. Acad Pathol 2024; 11:100111. [PMID: 38560424 PMCID: PMC10978475 DOI: 10.1016/j.acpath.2024.100111] [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: 10/25/2023] [Revised: 01/26/2024] [Accepted: 02/03/2024] [Indexed: 04/04/2024] Open
Abstract
Entrustable professional activities (EPAs) are observable activities that define the practice of medicine and provide a framework of evaluation that has been incorporated into US medical school curricula in both undergraduate and graduate medical education. This manuscript describes the development of an entrustment scale and formative and summative evaluations for pathology EPAs, outlines a process for faculty development that was employed in a pilot study implementing two Anatomic Pathology and two Clinical Pathology EPAs in volunteer pathology residency programs, and provides initial validation data for the proposed pathology entrustment scales. Prior to implementation, faculty development was necessary to train faculty on the entrustment scale for each given activity. A "train the trainer" model used performance dimension training and frame of reference training to train key faculty at each institution. The session utilized vignettes to practice determination of entrustment ratings and development of feedback for trainees as to strengths and weaknesses in the performance of these activities. Validity of the entrustment scale is discussed using the Messick framework, based on concepts of content, response process, and internal structure. This model of entrustment scales, formative and summative assessments, and faculty development can be utilized for any pathology EPA and provides a roadmap for programs to design and implement EPA assessments into pathology residency training.
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Affiliation(s)
- Bronwyn H. Bryant
- University of Vermont Medical Center, Department of Pathology and Laboratory Medicine, Burlington, VT, USA
| | - Scott R. Anderson
- University of Vermont Medical Center, Department of Pathology and Laboratory Medicine, Burlington, VT, USA
| | - Mark Brissette
- University of Colorado Anschutz Medical Campus, Department of Pathology, Aurora, CO, USA
| | - John M. Childs
- Geisinger Medical Center, Department of Pathology, Danville, PA, USA
| | - Dita Gratzinger
- Stanford University School of Medicine, Department of Pathology, Stanford, CA, USA
| | | | - Deborah E. Powell
- University of Minnesota Medical School, Department of Laboratory Medicine and Pathology, Minneapolis, MN, USA
| | | | - Charles F. Timmons
- UT Southwestern Medical Center, Department of Pathology, Dallas, TX, USA
| | - Cindy B. McCloskey
- University of Oklahoma College of Medicine, Department of Pathology, Oklahoma City, OK, USA
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Bryant BH, Anderson SR, Brissette M, Childs JM, Gratzinger D, Johnson K, Powell DE, Zein-Eldin Powell S, Timmons CF, Chute D, Cummings TJ, Furlong MA, Hébert TM, Reeves HM, Rush D, Vitkovski T, McCloskey CB. National pilot of entrustable professional activities in pathology residency training. Acad Pathol 2024; 11:100110. [PMID: 38560425 PMCID: PMC10978478 DOI: 10.1016/j.acpath.2024.100110] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/25/2023] [Accepted: 01/21/2024] [Indexed: 04/04/2024] Open
Abstract
Entrustable professional activities (EPAs) are observable clinical skills and/or procedures that have been introduced into medical education at the student and resident levels in most specialties to determine readiness to advance into residency or independent practice, respectively. This publication describes the process and outcomes of a pilot study looking at the feasibility of using two anatomic pathology and two clinical pathology EPAs in pathology residency in 6 pathology residency programs that volunteered for the study. Faculty development on EPAs and their assessment was provided to pilot program faculty, and EPA assessment tools were developed and used by the pilot programs. Pre- and post-study surveys were given to participating residents, faculty, and program directors to gauge baseline practices and to gather feedback on the EPA implementation experience. Results demonstrated overall good feasibility in implementing EPAs. Faculty acceptance of EPAs varied and was less than that of program directors. Residents reported a significant increase in the frequency with which faculty provided formative assessments that included specific examples of performance and specific ways to improve, as well as increased frequency with which faculty provided summative assessments that included specific ways to improve. EPAs offered the most benefit in setting clear expectations for performance of each task, for providing more specific feedback to residents, and in increasing Program director's understanding of resident strengths abilities and weaknesses.
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Affiliation(s)
- Bronwyn H. Bryant
- University of Vermont Medical Center, Department of Pathology and Laboratory Medicine, Burlington, VT, USA
| | - Scott R. Anderson
- University of Vermont Medical Center, Department of Pathology and Laboratory Medicine, Burlington, VT, USA
| | - Mark Brissette
- University of Colorado Anschutz Medical Campus, Department of Pathology, Aurora, CO, USA
| | - John M. Childs
- Geisinger Medical Center, Department of Pathology, Danville, PA, USA
| | - Dita Gratzinger
- Stanford University School of Medicine, Department of Pathology, Stanford, CA, USA
| | | | - Deborah E. Powell
- University of Minnesota Medical School, Department of Laboratory Medicine and Pathology, Minneapolis, MN, USA
| | | | - Charles F. Timmons
- UT Southwestern Medical Center, Department of Pathology, Dallas, TX, USA
| | - Deborah Chute
- Cleveland Clinic, Department of Pathology and Laboratory Medicine, Cleveland, OH, USA
| | | | - Mary A. Furlong
- Georgetown University School of Medicine, Department of Pathology and Laboratory Medicine, Washington, DC, USA
| | - Tiffany M. Hébert
- Montefiore Health System/Albert Einstein College of Medicine, Department of Pathology, Bronx, NY, USA
| | - Hollie M. Reeves
- University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Department of Pathology, Cleveland, OH, USA
| | - Demaretta Rush
- University of Arizona College of Medicine, Department of Pathology, Tucson, AZ, USA
| | - Taisia Vitkovski
- Zucker School of Medicine at Hofstra/Northwell Health, Department of Pathology and Laboratory Medicine, Hempstead, NY, USA
| | - Cindy B. McCloskey
- University of Oklahoma College of Medicine, Department of Pathology, Oklahoma City, OK, USA
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Amare EM, Siyoum MT, Abubeker FA, Tufa TH, Hailemeskel AT. Designing the Future of Medical Education: The EPA Framework as a Catalyst to Inform Family Planning and Reproductive Health Fellowship Training Program in Ethiopia Medical Education: An Exploratory Sequential Mixed Method Study. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2024; 15:189-200. [PMID: 38505496 PMCID: PMC10949272 DOI: 10.2147/amep.s438315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 03/02/2024] [Indexed: 03/21/2024]
Abstract
Introduction Entrustable Professional Activities (EPAs) are tasks or responsibilities within a specific field that can be given to a learner once they are competent to perform them independently. EPAs are being used in various specialty programs and serving as valuable tool to inform educational program. However, due to disparities in professional practice between different contexts, the automatic transfer of a set of core EPAs is not feasible. Hence, our study aims to develop an EPA framework to inform the Family Planning and Reproductive Health Fellowship Program in the local context of Ethiopia. Methods We employed an exploratory mixed-method design, which involved the collection of qualitative data using the Nominal Group Technique and quantitative data through a nationwide survey in all residency training institutions across the country. Qualitative data analysis involved several steps, including compiling a list of tasks, removing duplicate tasks, reviewing EPAs using criteria and an equal rubric tool. For quantitative data analysis, descriptive statistics, validity index analysis, and intra-class correlation coefficients, were used. Results Seven senior panelists were able to propose a total of 57 EPAs, with 17 remaining after qualitative data analysis. The panelist evaluated the relevance of each EPA in the second phase. As a result, 17 EPAs received a content validity index of >0.83, indicating satisfactory relevance. In the national survey, experts reached a high level of final agreement regarding the relevance and representativeness of all 17 EPAs (ICC = 0.815, 95% CI [0.0.756,0.865], p.0001). Conclusion The final set of 17 end-of-training EPAs is valid, acceptable and representative of the discipline, and they can be used as a framework to inform Family planning and Reproductive Health Fellowship Program in Ethiopian medical education once these core EPA statements are described in sufficient detail. This can contribute to raise the quality of training and hence the quality of patient care.
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Affiliation(s)
| | - Mekdim Tadesse Siyoum
- Department of Surgery, St. Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Ferid Abbas Abubeker
- Department of Obstetrics & Gynecology, St. Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Tesfaye Hurissa Tufa
- Department of Obstetrics & Gynecology, St. Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Azeb Tamrat Hailemeskel
- Educational Development Center, St. Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia
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Gorania R, Hunter K, Hall G, Brierley DJ. Independent reporting in oral and maxillofacial pathology. J Clin Pathol 2023; 76:822-826. [PMID: 37977652 DOI: 10.1136/jcp-2022-208495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 08/26/2022] [Indexed: 11/04/2022]
Abstract
AIMS To understand the current practice, extent of use and barriers related to independent reporting (IR) in oral and maxillofacial pathology (OMFP) training in the UK. METHODS A questionnaire was created containing questions about the experiences and opinions surrounding IR in OMFP. The target participants were (1) consultants in OMFP who had been involved in training OMFP trainees in the last 5 years and (2) current OMFP trainees. The questionnaire was delivered via Google Forms and disseminated using a link in an invitation email sent to the participants. RESULTS A total of 13 consultant responses (response rate of 81%) and 12 trainee responses (response rate of 92%) were received. Of these, three consultants and five trainees were using IR at the time of the study. Several themes emerged highlighting the perceived benefits and concerns regarding IR. CONCLUSIONS This study suggests that there is a disparity in the way IR is used in OMFP training across the UK. There was shared concern between consultants and trainees regarding the lack of clear guidance and subsequent fear of litigation. These are issues that need to be addressed if trainees are to have a similar experience across the country and be prepared for independent practice on completion of training.
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Affiliation(s)
- Riddhi Gorania
- Academic Unit of Oral and Maxillofacial Pathology, The University of Sheffield, Sheffield, UK
| | - Keith Hunter
- Liverpool Head and Neck Centre, University of Liverpool, Liverpool, Merseyside, UK
| | - Gillian Hall
- Head and Neck Pathology, Guy's and Saint Thomas' NHS Foundation Trust, London, UK
| | - Daniel J Brierley
- Academic Unit of Oral and Maxillofacial Pathology, The University of Sheffield, Sheffield, UK
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Felicelli C, Gama A, Chornenkyy Y, Choy B, Blanco LZ, Novo JE. From principles to practice: Implementation of entrustable professional activities (EPAs) for surgical pathology residency education in a large academic hospital. Acad Pathol 2023; 10:100097. [PMID: 38025045 PMCID: PMC10679497 DOI: 10.1016/j.acpath.2023.100097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 07/29/2023] [Accepted: 09/21/2023] [Indexed: 12/01/2023] Open
Abstract
Over the past decade, competency-based medical education (CBME) has gained momentum in the United States to develop trainees into independent and confident physicians by the end of their training. Entrustable professional activities (EPAs) are an established methodology for assessing trainee development through an outcomes-driven rather than a time-based model. While EPAs have been utilized as an assessment tool for CBME in Europe and Canada, their validation and implementation in some medical specialties has occurred more recently in the United States. Pediatrics was the first specialty in the US to conduct a large-scale UME-GME pilot. Pathology Residency EPAs were published in 2018; however, implementation in training programs has been slow. We have piloted EPAs in our residency program's surgical pathology rotation and propose a unique set of 4 surgical pathology EPAs to track trainee preparedness for independent practice.
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Affiliation(s)
| | - Alcino Gama
- Corresponding author. Northwestern University Feinberg School of Medicine, Department of Pathology, 303 E. Chicago Ave. Ward 3-140 W127, Chicago, IL 60611, USA.
| | - Yevgen Chornenkyy
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Bonnie Choy
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Luis Z. Blanco
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jorge E. Novo
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Lai WS, Liu LC, Chen HM, Anna A. Integrated immediate postmortem and acute bereavement care: Competency-based entrustable professional activities for nursing. NURSE EDUCATION TODAY 2023; 126:105812. [PMID: 37119620 DOI: 10.1016/j.nedt.2023.105812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 03/22/2023] [Accepted: 04/05/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND Integrated immediate postmortem and acute bereavement care alleviates emotional distress due to losing a loved one; however, the provision of effective nursing care remains insufficient. Therefore, preparing nursing students with such skills is essential in end-of-life care education, and entrustable professional activities (EPAs) offer potential to address this gap. OBJECTIVES To establish EPAs concerning immediate postmortem and acute bereavement care with a seven-category description for EPAs, milestones, and assessment tools. DESIGN We used a modified Delphi method and four-step consensus-building approach to i) identifying the list of possible EPA items related to immediate postmortem and acute bereavement care based on a literature review and clinical experiences, ii) select an expert panel, iii) pool, review, and revise the EPAs, and iv) validate EPA quality using the Queen's EPA Quality rubric. Data analysis was performed via modes and quartile deviations. RESULTS The following four major EPA components were identified: i) cultural and religious ritual assessment; ii) death preparation; iii) postmortem care; and iv) acute bereavement care. Three essential competencies were identified as highly correlated: general clinical skills, communication and teamwork capabilities, and caring. Consensus was achieved after three survey rounds. A 100 % questionnaire response rate was obtained. In the third round, all items received 4 or 5 points from >95 % of the panel members and were found to meet the quartile deviation cutoff score of <0.6, indicating that a high consensus level was established. The average Queen's EPA Quality rubric score was 62.5, with an average item score of 4.46, which was higher than the cut-off score of 4.07. Three major parts of EPAs were developed: task descriptions, milestones, and the assessment tool. CONCLUSION The development of EPAs assessments concerning immediate postmortem and acute bereavement care may guide nursing curricula planning to bridge the gap between competencies and clinical practice.
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Affiliation(s)
- Wei-Shu Lai
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Li-Chen Liu
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hsing-Mei Chen
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Anastasia Anna
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Faculty of Nursing, Universitas Padjadjaran, Bandung, West Java, Indonesia
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Rau TT, Neppl C, Esposito I. [A European comparison of continuing education in pathology]. PATHOLOGIE (HEIDELBERG, GERMANY) 2022; 43:106-110. [PMID: 36378288 DOI: 10.1007/s00292-022-01153-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/12/2022] [Indexed: 11/16/2022]
Abstract
In the coming years, the shortage of pathologists will become internationally evident. In addition, the increase in knowledge, technical transformation processes, and the attractiveness of working conditions pose clear challenges for the field of pathology. A bi-directional opening for international mobility of pathologists could be a potential solution.In this analysis, the European training concept of the European Union of Medical Specialists (UEMS) was compared with its implementation in the 27 countries of the EU plus its 4 associated countries with regard to nationally differentiated concepts, type and implementation of the specialist examination, and additional qualifications. Subsequently, questions regarding the recognition of exams, titles, and specialist exams were elicited.The duration of training ranges between 4 and 6 years. The number of cases also varies considerably. Obtaining the specialist title can be done by simply completing the specifications up to a structured examination. In the EU, exams are mutually recognized, but this does not necessarily apply to academic titles and additional qualifications. Increasingly, on-site training centers are also subject to auditing procedures.The European agreements allow a high degree of permeability. However, national regulations pose hurdles for international mobility. The UEMS is therefore focusing on harmonization, including the certification of training centers. The so-called European Pathology Progress Test of the European Society of Pathology (ESP) is a further step towards the development of a future European specialist title. It remains the joint responsibility of residents and institutes to shape the future of the next generation of pathologists from the variety of different concepts.
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Affiliation(s)
- Tilman T Rau
- Institut für Pathologie, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland.
| | - Christina Neppl
- Institut für Pathologie, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
| | - Irene Esposito
- Institut für Pathologie, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
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Katsakhyan L, Preciado C, Baloch ZW. Pathology Residency Curricula. Am J Clin Pathol 2022; 158:331-337. [PMID: 35704427 DOI: 10.1093/ajcp/aqac069] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/06/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To perform a systematic review of the published literature on pathology graduate medical education, with a focus on novel educational curricula. METHODS We systematically searched the PubMed and Embase databases for relevant articles published between 2000 and 2021. RESULTS We analyzed 612 articles and selected 19 peer-reviewed, full-length, English language articles published between 2003 and 2021 describing unique curricula for final review. Details on the general characteristics, conceptualization, design, implementation, and assessment were collected and discussed. CONCLUSIONS This systematic review highlights a recent increase in published curricular endeavors specifically addressing topics of educational need that are otherwise not commonly taught in traditional residency training. Curricula are diverse in their teaching methods, implementation, and originating institutions. The lack of meaningful evaluated outcomes and available curricular materials may hinder wider use of such curricula; these should be considered by future pathology educators undertaking their design.
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Affiliation(s)
- Levon Katsakhyan
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania , Philadelphia, PA , USA
| | - Christopher Preciado
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania , Philadelphia, PA , USA
| | - Zubair W Baloch
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania , Philadelphia, PA , USA
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Katsakhyan L, Jacobson AM, Budina A, Baloch ZW. Practical Scientific Writing and Publishing in Anatomic Pathology. Am J Clin Pathol 2022; 157:451-456. [PMID: 34596207 DOI: 10.1093/ajcp/aqab144] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 07/29/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To develop a structured, introductory curriculum in scientific writing and publishing for residents in anatomic pathology. METHODS We assessed the need for this curriculum by using an online questionnaire sent to anatomic pathology residents in our program and tailored content to address areas of least familiarity. The curriculum consisted of 4 virtual lectures delivered by select experts in the field. Curriculum evaluation was assessed through a postcurriculum questionnaire. RESULTS In total, 27 of 31 (87%) residents responded to the initial questionnaire. The major educational need was identified in the following topics: "responsibilities of a corresponding author"; "selecting a journal for publication"; "editor's approach to evaluating a manuscript"; "correspondence with editors and reviewers"; and "open access, cost and increasing exposure to manuscript." Eight residents participated in at least 3 of 4 lectures and completed the pre- and postcurriculum survey. The postcurriculum survey demonstrated statistically significant interval increases in familiarity with 7 of 18 topics, and the leading increases were noted in topics of most significant educational need. CONCLUSIONS Development of novel curricula is vital to the ever-changing landscape of pathology resident education. This study proposes a generalizable algorithmic approach to assessing new areas of educational need and effectively addressing them through targeted curricula.
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Affiliation(s)
- Levon Katsakhyan
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Alec M Jacobson
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Anna Budina
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Zubair W Baloch
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, USA
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OUP accepted manuscript. Am J Clin Pathol 2022; 158:426-442. [DOI: 10.1093/ajcp/aqac065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
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Yun Z, Jing L, Junfei C, Wenjing Z, Jinxiang W, Tong Y, Aijun Z. Entrustable Professional Activities for Chinese Standardized Residency Training in Pediatric Intensive Care Medicine. Front Pediatr 2022; 10:919481. [PMID: 35859946 PMCID: PMC9289143 DOI: 10.3389/fped.2022.919481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/10/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Entrustable professional activities (EPAs) were first introduced by Olle ten Cate in 2005. Since then, hundreds of applications in medical research have been reported worldwide. However, few studies discuss the use of EPAs for residency training in pediatric intensive care medicine. We conducted a pilot study of EPA for pediatric intensive care medicine to evaluate the use of EPAs in this subspecialty. MATERIALS AND METHODS A cross-sectional study was implemented in pediatric intensive care medicine standardized residency training at the Qilu Hospital of Shandong University. An electronic survey assessing EPA performance using eight scales composed of 15 categories were distributed among residents and directors. RESULTS A total of 217 director-assessment and 44 residents' self-assessment questionnaires were collected, both demonstrating a rising trend in scores across postgraduate years. There were significant differences in PGY1-vs.-PGY2 and PGY1-vs.-PGY3 director-assessment scores, while there were no differences in PGY2-vs.-PGY3 scores. PGY had a significant effect on the score of each EPA, while position significantly affected the scores of all EPAs except for EPA1 (Admit a patient) and EPA2 (Select and interpret auxiliary examinations). Gender only significantly affected the scores of EPA6 (Report a case), EPA12 (Perform health education), and EPA13 (Inform bad news). CONCLUSION This study indicates that EPA assessments have a certain discriminating capability among different PGYs in Chinese standardized residency training in pediatric intensive care medicine. Postgraduate year, gender, and resident position affected EPA scores to a certain extent. Given the inconsistency between resident-assessed and director-assessed scores, an improved feedback program is needed in the future.
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Affiliation(s)
- Zhang Yun
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, China
| | - Liu Jing
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Chen Junfei
- Department of Pediatric Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Zhang Wenjing
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China
| | - Wu Jinxiang
- Department of Pulmonary and Critical Care Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Yue Tong
- Medical Training Office, Qilu Hospital of Shandong University, Jinan, China
| | - Zhang Aijun
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, China
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Amare EM, Siebeck M, Sendekie TY, Fischer MR, Berndt M. Development of an Entrustable Professional Activities (EPA) Framework to Inform Surgical Residency Training Programs in Ethiopia: A Three-round National Delphi Method Study. JOURNAL OF SURGICAL EDUCATION 2022; 79:56-68. [PMID: 34294572 DOI: 10.1016/j.jsurg.2021.06.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 06/15/2021] [Accepted: 06/27/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Entrustable Professional Activities (EPAs) have been proposed as a means to translate competencies into clinical practice. Although EPAs for residency training have become available, 1 set of core EPAs cannot automatically be transferred from one context to another due to cultural variability. Further, there is a lack of African- and Asian-based EPA development and implementation studies. We developed an end-of-training EPAs framework to inform surgical residency training programs in the local context of Ethiopian medical education. METHODS A three-round Delphi method was used to establish consensus about important surgical EPAs among experts. A total of 136 experts representing all surgical residency training institutions in Ethiopia were invited to participate. Round 1 & 2 consisted of senior expert panelists (n = 8) to identify potential EPAs and determine the content validity. Round 3 consisted of a survey (n = 128) to further validate the identified EPAs by attending surgeons who work with them. Each EPA had to achieve at least 80% or higher agreement among experts to be considered having acceptable content validity. RESULTS In round 1, a total of 272 EPAs were proposed, reduced, and grouped to 39 consented EPAs. In round 2, the same experts rated each EPA's relevance, resulting in 32 EPAs with a satisfactory item-level content validity index (I-CVI > 0.83). Overall, in the survey in round 3, 29 EPAs met the standard criterion for acceptability (S-CVI/Ave = 0.90) and achieved a high degree of final consensus (ICC = 0.998, 95% CI [0.996, 0.999]; (F = 439.2, p < 0.0001). CONCLUSIONS The framework of 29 validated and accepted EPAs can guide future surgical residency training programs in the Ethiopian medical education context. The framework allows programs to move from a time-dependent to an outcome-based model and transforms traditional assessment into entrustment decisions. Thus, the use of the framework can improve the quality of training and patient care in Ehtiopia.
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Affiliation(s)
| | - Matthias Siebeck
- Institute of Medical Education, University Hospital, LMU Munich, Munich, Germany
| | | | - Martin R Fischer
- Institute of Medical Education, University Hospital, LMU Munich, Munich, Germany
| | - Markus Berndt
- Institute of Medical Education, University Hospital, LMU Munich, Munich, Germany
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Anderson HL, Kurtz J, West DC. Implementation and Use of Workplace-Based Assessment in Clinical Learning Environments: A Scoping Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:S164-S174. [PMID: 34406132 DOI: 10.1097/acm.0000000000004366] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE Workplace-based assessment (WBA) serves a critical role in supporting competency-based medical education (CBME) by providing assessment data to inform competency decisions and support learning. Many WBA systems have been developed, but little is known about how to effectively implement WBA. Filling this gap is important for creating suitable and beneficial assessment processes that support large-scale use of CBME. As a step toward filling this gap, the authors describe what is known about WBA implementation and use to identify knowledge gaps and future directions. METHOD The authors used Arksey and O'Malley's 6-stage scoping review framework to conduct the review, including: (1) identifying the research question; (2) identifying relevant studies; (3) study selection; (4) charting the data; (5) collating, summarizing, and reporting the results; and (6) consulting with relevant stakeholders. RESULTS In 2019-2020, the authors searched and screened 726 papers for eligibility using defined inclusion and exclusion criteria. One hundred sixty-three met inclusion criteria. The authors identified 5 themes in their analysis: (1) Many WBA tools and programs have been implemented, and barriers are common across fields and specialties; (2) Theoretical perspectives emphasize the need for data-driven implementation strategies; (3) User perceptions of WBA vary and are often dependent on implementation factors; (4) Technology solutions could provide useful tools to support WBA; and (5) Many areas of future research and innovation remain. CONCLUSIONS Knowledge of WBA as an implemented practice to support CBME remains constrained. To remove these constraints, future research should aim to generate generalizable knowledge on WBA implementation and use, address implementation factors, and investigate remaining knowledge gaps.
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Affiliation(s)
- Hannah L Anderson
- H.L. Anderson is research associate, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; ORCID: http://orcid.org/0000-0002-9435-1535
| | - Joshua Kurtz
- J. Kurtz is a first-year resident, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Daniel C West
- D.C. West is professor of pediatrics, The Perelman School of Medicine at the University of Pennsylvania, and associate chair for education and senior director of medical education, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; ORCID: http://orcid.org/0000-0002-0909-4213
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15
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Cotta CV, Ondrejka SL, Nakashima MO, Theil KS. Pathology Residents as Testing Personnel in the Hematology Laboratory. Arch Pathol Lab Med 2021; 146:894-902. [PMID: 34619751 DOI: 10.5858/arpa.2020-0630-oa] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Clinical laboratories and the training of pathology residents are tightly regulated environments. Compliance with regulatory requirements must be addressed when developing entrustable professional activities (EPAs) for pathology residents. OBJECTIVE.— To describe the development of EPAs for peripheral blood and body fluid review in compliance with Clinical Laboratory Improvement Amendments and College of American Pathologists personnel and testing requirements. To examine the impact of EPA implementation on the workflow in a busy hematology laboratory. DESIGN.— A training program was designed to prepare pathology residents to function as independent testing personnel in compliance with Clinical Laboratory Improvement Amendments. After a series of lectures, hands-on microscopy sessions, self-assessment quizzes, and achievement of a passing score on a training assessment exam, residents were deemed competent to release certain results independently. The volume and the turnaround time of hematology tests were compared before and after residents were integrated into the laboratory workflow. Faculty and residents were surveyed to assess satisfaction with the training. RESULTS.— Empowering residents to independently release noncritical results from peripheral blood and body fluid reviews had no adverse impact on test turnaround time. The resident contribution to workflow resulted in a corresponding decrease in the number of cases that required attending pathologist review. Faculty and residents viewed the EPAs as beneficial to service and education. CONCLUSIONS.— The implementation of the EPAs had a beneficial effect on the laboratory, the trainees, and faculty. Our experience may be helpful to other training programs as EPAs become more widely implemented in residency training.
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Affiliation(s)
- Claudiu V Cotta
- Department of Laboratory Medicine, R.J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sarah L Ondrejka
- Department of Laboratory Medicine, R.J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Megan O Nakashima
- Department of Laboratory Medicine, R.J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Karl S Theil
- Department of Laboratory Medicine, R.J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
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16
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Bryant BH. Feasibility of an Entrustable Professional Activity for Pathology Resident Frozen Section Training. Acad Pathol 2021; 8:23742895211041757. [PMID: 34485691 PMCID: PMC8411628 DOI: 10.1177/23742895211041757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/28/2021] [Accepted: 07/18/2021] [Indexed: 11/23/2022] Open
Abstract
Entrustable professional activities are an intuitive form of workplace-based
assessment that can support competency-based medical education. Many entrustable
professional activities have been written and published, but few studies
describe the feasibility or implementation of entrustable professional
activities in graduate medical education. The frozen section entrustable
professional activit was introduced into the pathology residency training at the
University of Vermont for postgraduate year 1 at the start of their training in
frozen section. The feasibility of the entrustable professional activit was
evaluated based on 3 criteria: (a) utilization, (b) support of frozen section
training, and (c) generating data to support entrustment decision about
residents’ readiness to take call. The entrustable professional activit was well
utilized and satisfactory to residents, faculty, pathologists’ assistants, and
Clinical Competency Committee members. Most members of the Clinical Competency
Committee agreed they had sufficient data and noted higher confidence in
assessing resident readiness to take call with the addition of entrustable
professional activit to the residents’ assessment portfolio. Residents did not
endorse it helped them prepare for call; however, the interruption to frozen
section training due to the COVID-19 pandemic was a significant contributing
factor. The frozen section entrustable professional activit is a feasible
addition to pathology resident training based on utilization, support of
training, and generation of data to support entrustment decisions for graduated
responsibilities. The implementation and integration of the entrustable
professional activit into pathology training at our institution is described
with discussion of adjustments for future use.
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Affiliation(s)
- Bronwyn H Bryant
- University of Vermont Medical Center, Larner College of Medicine, Burlington, VT, USA
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17
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Wake LM, Allison DB, Ware AD, Hooper JE, Baras AS, Bloch EM, Clarke W, Burns KH, Sfanos KS, Borowitz MJ, Steenbergen C, Hruban RH, White MJ. Pathology Residency Program Special Expertise Tracks Meet the Needs of an Evolving Field. Acad Pathol 2021; 8:23742895211037034. [PMID: 34485688 PMCID: PMC8411632 DOI: 10.1177/23742895211037034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/17/2021] [Accepted: 07/06/2021] [Indexed: 11/16/2022] Open
Abstract
Pathologists who enter the workforce must have a diverse skill set beyond that of clinical diagnostics alone. Anticipating this need, the Johns Hopkins Pathology Residency Program developed Special Expertise Tracks to enhance training in relevant subspecialty domains. Using a combination of discussions and surveys, we assessed: (1) our current resident curriculum; (2) perceived curricular strengths and needs; (3) resident career preferences and ultimate career paths; (4) perceived barriers to implementing an advanced elective curriculum; and (5) available departmental/institutional resources. Additionally, we utilized the Accreditation Council for Graduate Medical Education Pathology Milestones as a curricular guide. Six professional residency training Special Expertise Tracks were established: Education, Physician-Scientist Research, Informatics, Quality Improvement/Quality Assurance/Value-Based Care, Health Policy/Hospital Management and Global Health. After implementation in 2017, the Education track has had 4 residents complete the curriculum successfully; the Physician-Scientist Research track has had 2 residents and the Informatics and Global Health tracks have each had one resident successfully complete their respective curricula. Currently, 5 residents are pursuing the Education track, one is pursuing the Physician-Scientist Research track, one is pursuing the Informatics track, and 2 residents are pursuing the Global Health track. Five residents have completed long-term projects including developing several e-learning modules, an online free digital cytopathology atlas, peer-reviewed articles, book chapters, and books. The Johns Hopkins Pathology Resident Special Expertise Track program provides pathology residents an opportunity to gain meaningful experience and additional skills tailored to their individual career interests.
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Affiliation(s)
- Laura M Wake
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Derek B Allison
- Department of Pathology, University of Kentucky, Lexington, USA
| | - Alisha D Ware
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jody E Hooper
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alex S Baras
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Evan M Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - William Clarke
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kathleen H Burns
- Department of Pathology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Karen S Sfanos
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael J Borowitz
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Charles Steenbergen
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ralph H Hruban
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Marissa J White
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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18
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Koch LK, Chang OH, Dintzis SM. Medical Education in Pathology: General Concepts and Strategies for Implementation. Arch Pathol Lab Med 2021; 145:1081-1088. [PMID: 34086852 DOI: 10.5858/arpa.2020-0463-ra] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2021] [Indexed: 02/05/2023]
Abstract
CONTEXT.— Pathology education must evolve as medical knowledge expands and disruptive technologies emerge. The evolution in pathology teaching practices accelerated as traditional teaching modalities were suspended in March 2020 during the coronavirus disease 2019 (COVID-19) pandemic. OBJECTIVES.— To provide pathologists an overview of established teaching paradigms and practical examples of how these paradigms may be applied to pathology education, emphasizing differences in graduate and undergraduate medical education as well as the challenges and promises of remote learning, as revealed by the COVID-19 pandemic. DATA SOURCES.— Selected peer-reviewed publications representing the field of educational social science. CONCLUSIONS.— Evidence-based methods described in education and social sciences can be effectively deployed in pathology education and especially remote learning, as necessitated by the current COVID-19 pandemic. Understanding established principles, such as cognitive load, competency-based learning, peer-assisted learning, and flipped classrooms may prove useful in developing effective, learner-centric content for pathology education.
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Affiliation(s)
- Lisa K Koch
- From the Department of Laboratory Medicine and Pathology, University of Washington, Seattle
| | - Oliver H Chang
- From the Department of Laboratory Medicine and Pathology, University of Washington, Seattle
| | - Suzanne M Dintzis
- From the Department of Laboratory Medicine and Pathology, University of Washington, Seattle
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19
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Nayar R, Chute D, Douglas A, Sandersfeld T, Johnson R. Harmonization of training, training program requirements, board certification, and the practice of cytopathology: data from the American Board of Pathology surveys. J Am Soc Cytopathol 2021; 10:447-458. [PMID: 34454871 DOI: 10.1016/j.jasc.2021.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/31/2021] [Accepted: 06/04/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION The American Board of Pathology (ABPath) has ongoing efforts to better align certification with graduate medical education, training program requirements, and pathology practice. The present study focused on the subspecialty of cytopathology. We evaluated the current content and scope of fellowship programs, practice patterns and needs of diplomates, and program director (PD) and diplomate perceptions of the ABPath certification examination to identify gaps and provide an evidence base to guide harmonization in these areas. METHODS Two surveys were administered: one directed to PDs of all 93 Accreditation Council for Graduate Medical Education (ACGME) cytopathology fellowship programs and the other to cytopathology diplomates submitting continuing certification reporting to the ABPath. RESULTS Most (86%) cytopathology diplomates work in smaller groups. Only 11% do >50% cytopathology in practice. Diplomates' cytopathology-related practice tasks varied, as did their perception of the content of fellowship training aligning with practice needs. In fellowship training programs, the specimen types, volumes, techniques of specimen acquisition, and graduated responsibility varied significantly. We identified areas in which current training and certification requirements are challenging for some programs. Diplomates and PDs had differing perceptions of the cytopathology examination; diplomates regarded image-based and microscopic glass slide questions as the best assessment of their knowledge. CONCLUSIONS First, fellowship training programs could benefit from shared resources and should provide more graduated responsibility for fellows. Second, the ACGME Review Committee could consider this data in future program requirement revisions. Finally, information from these surveys will be useful as the ABPath adjusts certification examination content and delivery.
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Affiliation(s)
- Ritu Nayar
- Professor and Vice Chair, Departments of Pathology and Medical Education, Northwestern University Feinberg School of Medicine and Northwestern Memorial Hospital, Chicago, Illinois.
| | - Deborah Chute
- Associate Professor and Residency Program Director, Department of Pathology, Cleveland Clinic, Cleveland, Ohio
| | - Aaron Douglas
- Former Psychometrician, American Board of Pathology, Tampa, Florida
| | - Tyler Sandersfeld
- Current Psychometrician, American Board of Pathology, Tampa, Florida
| | - Rebecca Johnson
- Chief Executive Officer, American Board of Pathology, Tampa, Florida
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20
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Bellini C, Cinci F, Scapellato C, Guerranti R. A computer model for professional competence assessment according to ISO 15189. Clin Chem Lab Med 2021; 58:1242-1249. [PMID: 32092038 DOI: 10.1515/cclm-2019-1018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 01/29/2020] [Indexed: 11/15/2022]
Abstract
Background As defined by ISO 15189 competence is the "demonstrated ability to apply knowledge and skills" thus, its assessment is fundamental for ensuring the quality of the total testing process in order to reduce the risk for the patient. We have developed a functional software for the measurement of professional competences in order to standardize the procedure and to collect all the data in a single platform, avoiding redundancy and dispersion. Methods Our model objectively assesses the skills, as they become measurable and comparable with appropriate standards and involves both managers and operators, to increase their active engagement. The assessment concerns everyone, but the standards to be met (numerical values) can vary according to the responsibilities. Several subjective and objective criteria are evaluated: each parameter can contribute in a variable proportion to the total skills measured according to the needs of the organization. Results The data are automatically analyzed and can be easily monitored in real time in the form of indicators, thanks to dashboards. The comparison between the skills required and those measured allows highlighting the gap useful for planning personalized training paths. Conclusions Our tool is reliable and highly adaptable to laboratories about competences to track criteria, standards and monitored indicators. The computerized management is a strategic action as it fulfills the requirements of registration, traceability, communication, data analysis and indicators development, which are the tenets of continuous improvement, and allows planning to be made on the basis of the actual training needs.
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Affiliation(s)
- Claudia Bellini
- Medical Biotechnologies Department, University of Siena, Siena, Italy.,Clinical Pathology Unit, Innovation, Experimentation and Clinical and Translational Research Department, University Hospital of Siena, Siena, Italy
| | - Francesca Cinci
- Medical Biotechnologies Department, University of Siena, Siena, Italy.,Clinical Pathology Unit, Innovation, Experimentation and Clinical and Translational Research Department, University Hospital of Siena, Siena, Italy
| | - Carlo Scapellato
- Clinical Pathology Unit, Innovation, Experimentation and Clinical and Translational Research Department, University Hospital of Siena, Siena, Italy
| | - Roberto Guerranti
- Medical Biotechnologies Department, University of Siena, Siena, Italy.,Clinical Pathology Unit, Innovation, Experimentation and Clinical and Translational Research Department, University Hospital of Siena, Siena, Italy
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21
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Hassell LA, Afzal A. Flattening the World of Pathology Education and Training and Shortening the Curve of Pathology Learning. Am J Clin Pathol 2021; 156:176-184. [PMID: 33978156 DOI: 10.1093/ajcp/aqab034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES We review how the pandemic-related education disruption may interplay with pathology manpower worldwide and shifts in disease burden to identify workable solutions. METHODS Literature related to pathology education, pathology services in low-resource settings, and application of digital tools to pathology education was reviewed for trends and training gaps. Publications covering pathology manpower and cancer incidence worldwide were also included to assess needs. RESULTS Pandemic-related virtual teaching has produced abundant online training materials. Pathology learning resources in low- to middle-income countries remain considerably constrained and dampen pathology manpower growth to meet current needs. Projected increases in disease burden toward the developing world thus pose a major challenge. Digital pathology resources have expanded and are beginning to appear beyond the developed countries. CONCLUSIONS This circumstance offers a unique opportunity to leverage digital teaching resources to enhance and equitize training internationally, potentially sufficient to meet the rising wave of noncommunicable diseases. We propose four next steps to take advantage of the current opportunity: curate and organize digital training materials, invest in the digital pathology infrastructure for education and clinical care, expand student exposure to pathology through virtual electives, and develop further competency-based certification pathways.
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Affiliation(s)
- Lewis A Hassell
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Anoshia Afzal
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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22
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Lindeman B, Brasel K, Minter RM, Buyske J, Grambau M, Sarosi G. A Phased Approach: The General Surgery Experience Adopting Entrustable Professional Activities in the United States. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:S9-S13. [PMID: 34183596 DOI: 10.1097/acm.0000000000004107] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Entrustable professional activities (EPAs) have been increasingly used as an assessment framework to formally capture the myriad ad hoc entrustment decisions that occur on a daily basis in clinical settings with learners present. Following the definition of Core EPAs for Entering Residency by the Association of American Medical Colleges in 2014, the American Board of Surgery (ABS) began to explore the utility of EPAs as a framework to support competency-based resident education within general surgery in 2016. As the complement of EPAs drafted for a specialty serve to define the core tasks of a professional within that discipline, initial efforts to define the entire scope of general surgery were fraught with difficulty as no commonly accepted definition of a general surgeon currently exists. Opting to prioritize a pilot of the EPA conceptual framework within surgical training rather than defining the entirety of the specialty, ABS leaders identified 5 EPAs that represent a core of general surgery with which to begin. This article details the process of choosing the initial set of EPAs and provides a roadmap for other disciplines interested in testing the feasibility of this assessment framework while garnering buy-in among the community of educators. Future steps, including implementation of the existing 5 EPAs beyond the initial pilot sites and drafting and implementation of the additional complement of EPAs, are also described.
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Affiliation(s)
- Brenessa Lindeman
- B. Lindeman is assistant professor, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Karen Brasel
- K. Brasel is professor, Department of Surgery, Oregon Health and Science University, Portland, Oregon
| | - Rebecca M Minter
- R.M. Minter is professor, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Jo Buyske
- J. Buyske is president and chief executive officer, American Board of Surgery, Philadelphia, Pennsylvania
| | - Marni Grambau
- M. Grambau is director of examination development, American Board of Surgery, Philadelphia, Pennsylvania
| | - George Sarosi
- G. Sarosi is professor, Department of Surgery, University of Florida, Gainesville, Florida
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23
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Han R, Keith J, Slodkowska E, Nofech-Mozes S, Djordjevic B, Parra-Herran C, Shachar S, Mirkovic J, Sherman C, Hsieh E, Ismiil N, Lu FI. Hot Seat Diagnosis: Competency-Based Tool Is Superior to Time-Based Tool for the Formative In-Service Assessment of Pathology Trainees. Arch Pathol Lab Med 2021; 146:123-131. [PMID: 34133708 DOI: 10.5858/arpa.2020-0702-ep] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2021] [Indexed: 01/09/2023]
Abstract
CONTEXT.— Competency-based medical education relies on frequent formative in-service assessments to ascertain trainee progression. Currently at our institution, trainees receive a summative end-of-rotation In-Training Evaluation Report based on feedback collected from staff pathologists. There is no method of simulating report sign-out. OBJECTIVE.— To develop a formative in-service assessment tool that is able to simulate report sign-out and provide case-by-case feedback to trainees. Further, to compare time- versus competency-based assessment models. DESIGN.— Twenty-one pathology trainees were assessed for 20 months. Hot Seat Diagnosis by trainees and trainee assessment by pathologists were recorded in the Laboratory Information System. In the first iteration, trainees were assessed by using a time-based assessment scale on their ability to diagnose, report, use ancillary testings, comment on clinical implications, provide intraoperative consultation and/or gross cases. The second iteration used a competency-based assessment scale. Trainees and pathologists completed surveys on the effectiveness of the In-Training Evaluation Report versus the Hot Seat Diagnosis tool. RESULTS.— Scores from both iterations correlated significantly with other assessment tools including the Resident In-Service Examination (r = 0.93, P = .04 and r = 0.87, P = .03). The competency-based model was better able to demonstrate improvement over time and stratify junior versus senior trainees than the time-based model. Trainees and pathologists rated Hot Seat Diagnosis as significantly more objective, detailed, and timely than the In-Training Evaluation Report, and effective at simulating report sign-out. CONCLUSIONS.— Hot Seat Diagnosis is an effective tool for the formative in-service assessment of pathology trainees and simulation of report sign-out, with the competency-based model outperforming the time-based model.
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Affiliation(s)
- Rachel Han
- From the Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada (Han, Keith, Slodkowska, Nofech-Mozes, Djordjevic, Shachar, Mirkovic, Sherman, Lu)
| | - Julia Keith
- From the Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada (Han, Keith, Slodkowska, Nofech-Mozes, Djordjevic, Shachar, Mirkovic, Sherman, Lu).,The Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (Keith, Slodkowska, Nofech-Mozes, Djordjevic, Shachar, Mirkovic, Sherman, Lu)
| | - Elzbieta Slodkowska
- From the Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada (Han, Keith, Slodkowska, Nofech-Mozes, Djordjevic, Shachar, Mirkovic, Sherman, Lu).,The Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (Keith, Slodkowska, Nofech-Mozes, Djordjevic, Shachar, Mirkovic, Sherman, Lu)
| | - Sharon Nofech-Mozes
- From the Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada (Han, Keith, Slodkowska, Nofech-Mozes, Djordjevic, Shachar, Mirkovic, Sherman, Lu).,The Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (Keith, Slodkowska, Nofech-Mozes, Djordjevic, Shachar, Mirkovic, Sherman, Lu)
| | - Bojana Djordjevic
- From the Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada (Han, Keith, Slodkowska, Nofech-Mozes, Djordjevic, Shachar, Mirkovic, Sherman, Lu).,The Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (Keith, Slodkowska, Nofech-Mozes, Djordjevic, Shachar, Mirkovic, Sherman, Lu)
| | - Carlos Parra-Herran
- The Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Parra-Herran)
| | - Sade Shachar
- From the Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada (Han, Keith, Slodkowska, Nofech-Mozes, Djordjevic, Shachar, Mirkovic, Sherman, Lu).,The Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (Keith, Slodkowska, Nofech-Mozes, Djordjevic, Shachar, Mirkovic, Sherman, Lu)
| | - Jelena Mirkovic
- From the Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada (Han, Keith, Slodkowska, Nofech-Mozes, Djordjevic, Shachar, Mirkovic, Sherman, Lu).,The Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (Keith, Slodkowska, Nofech-Mozes, Djordjevic, Shachar, Mirkovic, Sherman, Lu)
| | - Christopher Sherman
- From the Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada (Han, Keith, Slodkowska, Nofech-Mozes, Djordjevic, Shachar, Mirkovic, Sherman, Lu).,The Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (Keith, Slodkowska, Nofech-Mozes, Djordjevic, Shachar, Mirkovic, Sherman, Lu)
| | - Eugene Hsieh
- The Department of Pathology, Dynacare, Brampton, Ontario, Canada (Hsieh)
| | - Nadia Ismiil
- The Department of Pathology, Lakeridge Health Ajax Pickering Hospital, Ajax, Ontario, Canada (Ismiil)
| | - Fang-I Lu
- From the Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada (Han, Keith, Slodkowska, Nofech-Mozes, Djordjevic, Shachar, Mirkovic, Sherman, Lu).,The Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (Keith, Slodkowska, Nofech-Mozes, Djordjevic, Shachar, Mirkovic, Sherman, Lu)
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24
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Senthilkumaran S, Arathisenthil SV, Jena NN, Thirumalaikolundusubramanian P. Multidimensional aspects of spurious elevation of serum creatinine- Chasing the Unicorn. Am J Emerg Med 2021; 55:188. [PMID: 34147326 DOI: 10.1016/j.ajem.2021.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
| | - S V Arathisenthil
- Department of Emergency & Critical Care, Manian Medical Centre, Erode, Tamil Nadu, India
| | - Narendra Nath Jena
- Department of Emergency Medicine, Meenakshi Mission Hospital and Research Centre, Madurai, Tamil Nadu, India
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25
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Gomes MM, Driman D, Park YS, Wood TJ, Yudkowsky R, Dudek NL. Teaching and assessing intra-operative consultations in competency-based medical education: development of a workplace-based assessment instrument. Virchows Arch 2021; 479:803-813. [PMID: 33966099 PMCID: PMC8516791 DOI: 10.1007/s00428-021-03113-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/22/2021] [Accepted: 04/27/2021] [Indexed: 02/02/2023]
Abstract
Competency-based medical education (CBME) is being implemented worldwide. In CMBE, residency training is designed around competencies required for unsupervised practice and use entrustable professional activities (EPAs) as workplace “units of assessment”. Well-designed workplace-based assessment (WBA) tools are required to document competence of trainees in authentic clinical environments. In this study, we developed a WBA instrument to assess residents’ performance of intra-operative pathology consultations and conducted a validity investigation. The entrustment-aligned pathology assessment instrument for intra-operative consultations (EPA-IC) was developed through a national iterative consultation and used clinical supervisors to assess residents’ performance at an anatomical pathology program. Psychometric analyses and focus groups were conducted to explore the sources of evidence using modern validity theory: content, response process, internal structure, relations to other variables, and consequences of assessment. The content was considered appropriate, the assessment was feasible and acceptable by residents and supervisors, and it had a positive educational impact by improving performance of intra-operative consultations and feedback to learners. The results had low reliability, which seemed to be related to assessment biases, and supervisors were reluctant to fully entrust trainees due to cultural issues. With CBME implementation, new workplace-based assessment tools are needed in pathology. In this study, we showcased the development of the first instrument for assessing resident’s performance of a prototypical entrustable professional activity in pathology using modern education principles and validity theory.
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Affiliation(s)
- Marcio M Gomes
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Canada.
- Royal College of Physicians and Surgeons of Canada, Ottawa, Canada.
- The Ottawa Hospital, Ottawa, Canada.
| | - David Driman
- Department of Pathology and Laboratory Medicine, Western University, London, Canada
| | - Yoon Soo Park
- Department of Medical Education, University of Illinois At Chicago, Chicago, IL, USA
| | - Timothy J Wood
- Department of Innovation in Medical Education, University of Ottawa, Ottawa, Canada
| | - Rachel Yudkowsky
- Department of Medical Education, University of Illinois At Chicago, Chicago, IL, USA
| | - Nancy L Dudek
- Royal College of Physicians and Surgeons of Canada, Ottawa, Canada
- The Ottawa Hospital, Ottawa, Canada
- Department of Medicine, University of Ottawa, Ottawa, Canada
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Black-Schaffer WS, Robboy SJ, Gross DJ, Crawford JM, Johnson K, Austin M, Karcher DS, Johnson RL, Powell SZ, Sanfrancesco J, Cohen MB. Evidence-Based Alignment of Pathology Residency With Practice II: Findings and Implications. Acad Pathol 2021; 8:23742895211002816. [PMID: 33889716 PMCID: PMC8040604 DOI: 10.1177/23742895211002816] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 01/15/2021] [Accepted: 02/06/2021] [Indexed: 11/18/2022] Open
Abstract
This article presents findings from a 4-year series of surveys of new-in-practice pathologists, and a survey of physician employers of new pathologists, assessing how pathology graduate medical education prepares its graduates for practice. Using the methodology described in our previous study, we develop evidence for the importance of residency training for various practice areas, comparing findings over different practice settings, sizes, and lengths of time in practice. The principal findings are (1) while new-in-practice pathologists and their employers report residency generally prepared them well for practice, some areas—billing and coding, laboratory management, molecular pathology, and pathology informatics—consistently were identified as being important in practice but inadequately prepared for in residency; (2) other areas—autopsy pathology, and subspecialized apheresis and blood donor center blood banking services—consistently were identified as relatively unimportant in practice and excessively prepared for in residency; (3) the notion of a single comprehensive model for categorical training in residency is challenged by the disparity between broad general practice in some settings and narrower subspecialty practice in others; and (4) the need for preparation in some areas evolves during practice, raising questions about the appropriate mode and circumstance for training in these areas. The implications of these findings range from rebalancing the emphasis among practice areas in residency, to reconsidering the structure of graduate medical education in pathology to meet present and evolving future practice needs.
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Affiliation(s)
- W Stephen Black-Schaffer
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - David J Gross
- College of American Pathologists, Washington, DC, USA
| | - James M Crawford
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | | | - Melissa Austin
- Uniformed Services, University of the Health Sciences, Bethesda, MD, USA
| | - Donald S Karcher
- George Washington University Medical Center, Washington, DC, USA
| | | | - Suzanne Z Powell
- Weill Cornell Medical College Houston, TX, USA.,Houston Methodist Hospital, Houston, TX, USA
| | | | - Michael B Cohen
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Vinagre R, Tanaka P, Tardelli MA. Competency-based anesthesiology teaching: comparison of programs in Brazil, Canada and the United States. Braz J Anesthesiol 2021; 71:162-170. [PMID: 33781575 PMCID: PMC9373559 DOI: 10.1016/j.bjane.2020.12.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 12/12/2020] [Accepted: 12/24/2020] [Indexed: 11/25/2022] Open
Abstract
In 2017, the Brazilian Society of Anesthesiology (SBA) and the National Medical Residency Committee (CNRM) presented a joint competence matrix to train and evaluate physicians specializing in Anesthesiology, which was enforced in 2019. The competency-based curriculum aims to train residents in relation to certain results, in that residents are considered capable when they are able to act in an appropriate and effective manner within certain standards of performance. Canada and the United States (US) also use competency-based curriculum to train their professionals. In Canada, the format is the basis for using an evaluation method known as Entrustable Professional Activities (EPA), in which the mentor assesses residents’ capacity to perform certain tasks, classified in 5 levels. The US, in turn, uses Milestones as evaluation, in which competencies and sub-competencies are assessed according to residents’ progress during training. The present article aims to describe and compare the different competency-based curriculum and the evaluation methods used in the three countries, and proposes a reflection on future paths for medical education in Anesthesiology in Brazil.
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Affiliation(s)
- Rafael Vinagre
- Stanford University, School of Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford, California, USA; Lincoln Medical and Health Care Center, Department of Internal Medicine, Bronx, New York, USA.
| | - Pedro Tanaka
- Stanford University, School of Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford, California, USA
| | - Maria Angela Tardelli
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Departamento de Cirurgia, Disciplina de Anestesiologia, Dor e Medicina Intensiva, São Paulo, SP, Brazil
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White K, Qualtieri J, Courville EL, Beck RC, Alobeid B, Czuchlewski DR, Teruya-Feldstein J, Soma LA, Prakash S, Gratzinger D. Entrustable Professional Activities in Hematopathology Pathology Fellowship Training: Consensus Design and Proposal. Acad Pathol 2021; 8:2374289521990823. [PMID: 33644302 PMCID: PMC7894592 DOI: 10.1177/2374289521990823] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/24/2020] [Accepted: 12/20/2020] [Indexed: 12/16/2022] Open
Abstract
Hematopathology fellowship education has grown in complexity as patient-centered treatment plans have come to depend on integration of clinical, morphologic, immunophenotypic, molecular, and cytogenetic variables. This complexity is in competition with the need for timely hematopathology care with stewardship of patient, laboratory, and societal resources. Accreditation Council for Graduate Medical Education Milestones provide a guidance document for hematopathology training, but fellows and their educators are in need of a simple framework that allows assessment and feedback of growth toward independent hematopathology practice. Entrustable professional activities provide one such framework, and herein, we provide proposed Hematopathology Fellowship Entrustable Professional Activities based on review of pertinent guidelines and literature, with multiple rounds of expert and stakeholder input utilizing a modified mini-Delphi approach. Ten core entrustable professional activities deemed essential for graduating hematopathology fellows were developed together with skills and knowledge statements, example scenarios, and corresponding Accreditation Council for Graduate Medical Education Milestones. Application of these entrustable professional activities in program design, fellow evaluation, and decisions regarding level of supervision is discussed with consideration of benefits and barriers to implementation. These entrustable professional activities may be used by hematopathology fellowship directors and faculty to provide fellows with timely constructive feedback, determine entrustment decisions, provide the Clinical Competency Committee with granular data to support Milestone evaluations, and provide insight into areas of potential improvement in fellowship training. Fellows will benefit from a clear roadmap to independent hematopathology practice with concrete and timely feedback.
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Affiliation(s)
- Kristie White
- Department of Laboratory Medicine, University of California at San Francisco School of Medicine, San Francisco, CA, USA
| | - Julianne Qualtieri
- Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Elizabeth L. Courville
- Department of Pathology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Rose C. Beck
- Department of Pathology, University Hospitals of Cleveland/Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Bachir Alobeid
- Department of Pathology and Cell Biology, Columbia University, New York, NY, USA
| | - David R. Czuchlewski
- Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Julie Teruya-Feldstein
- Department of Pathology, Molecular, and Cell-Based Medicine, Icahn School of Medicine, Mount Sinai Health System, New York, NY, USA
| | - Lorinda A. Soma
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA, USA
| | - Sonam Prakash
- Department of Laboratory Medicine, University of California at San Francisco School of Medicine, San Francisco, CA, USA
| | - Dita Gratzinger
- Stanford University School of Medicine, Stanford, CA, USA
- Dita Gratzinger, Department of Pathology, Stanford University School of Medicine, 300 Pasteur Drive, L235, Stanford, CA 94305, USA.
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Pagano MB, Treml A, Stephens LD, Joshi S, Li Y, Lopez-Plaza I, Poyyapakkam S, Schwartz J, Tanhehco Y, Zantek ND. Entrustable professional activities for apheresis medicine education. Transfusion 2020; 60:2432-2440. [PMID: 32757215 DOI: 10.1111/trf.15983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/24/2020] [Accepted: 06/24/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Entrustable professional activities (EPAs) are well-defined, executable, observable, and measurable activities that are performed by a trainee and can be performed independently as training progresses. The purpose of this study is to develop EPAs specific for the practice of apheresis medicine (AM). METHODS Members of the American Society for Apheresis Graduate Medical Education subcommittee developed a list of 28 apheresis medical activities linked to Accreditation Council for Graduate Medical Education milestones and competencies in five areas: (a) consultation, (b) clinical care for therapeutic apheresis, (c) clinical care for donor collections, (d) test optimization, and (e) vascular access. Ten AM experts using a validated tool to measure the quality of the EPAs (QUEPA) evaluated these activities with use of a Likert scale. Per group consensus, an activity was considered acceptable for each domain if it had received an average score greater than 3.7, and it was rated 4 or 5 (agree or strongly agree) by at least 70% of experts. RESULTS Of the 28 activities, 11 did not have acceptable QUEPA scores: 7 activities were rated as unobservable, 4 were rated unfocused, 2 were rated unrealistic and not generalizable, and 2 were rated as not addressing multiple competencies. Four activities had unacceptable scores in more than one domain. Subcommittee members edited these 11 activities over two review cycles to produce a final list of 26 activities. CONCLUSION A set of practical, focused, and observable EPAs in AM were systematically developed. These EPAs can be used to assess and support trainee performance in AM.
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Affiliation(s)
- Monica B Pagano
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA
| | - Angela Treml
- Department of Pathology, Versiti WI, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Laura D Stephens
- Department of Pathology, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Sarita Joshi
- Department of Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - Yanhua Li
- Department of Pathology and Laboratory Medicine, New York University School of Medicine, New York, New York, USA
| | - Ileana Lopez-Plaza
- Department of Pathology and Laboratory Medicine, Henry Ford Health System, Detroit, Michigan, USA
| | | | - Joseph Schwartz
- Transfusion Medicine and Cellular Therapy, Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
| | - Yvette Tanhehco
- Transfusion Medicine and Cellular Therapy, Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
| | - Nicole D Zantek
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
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Competency-based resident education: The United States perspective. Surgery 2020; 167:777-781. [DOI: 10.1016/j.surg.2019.05.059] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 05/15/2019] [Accepted: 05/21/2019] [Indexed: 11/20/2022]
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Ju JY, Wehrli G. The effect of entrustable professional activities on pathology resident confidence in blood banking/transfusion medicine. Transfusion 2020; 60:912-917. [PMID: 31970781 DOI: 10.1111/trf.15679] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/08/2020] [Accepted: 01/08/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Accreditation Council for Graduate Medical Education requires milestone reporting of the Six General Core Competencies. Additionally, Graduate Medical Education (GME) is transitioning to adopt competency-based education methodologies including entrustable professional activities (EPAs) for objective, observable, and measurable milestone progression. The College of American Pathologists published 19 EPAs, including one for transfusion-related adverse events. This survey study includes developing EPAs for transfusion reaction evaluation and assessing residents before and after implementing these EPAs. STUDY DESIGN AND METHODS Three transfusion reaction EPAs were developed and implemented in July 2018 for the Postgraduate Year (PGY) 2 pathology residents. An online, anonymous survey was sent to all 21 pathology trainees before and one year after EPA implementation. In July 2018 and August 2019, each survey included the same six multiple-choice, single-response, confidence questions, with a rating scale of extremely, very, slightly, or not at all confident. This study was approved by the hospital's Institutional Review Board for Health Sciences Research and GME Committee. RESULTS Analysis was performed on PGY2-4 residents. In 2018, 13 of 20 participants were analyzed. In 2019, 15 of 19 participants were analyzed. Number and percentage of responses were reported. The results showed an increase in trainee confidence, with the greatest improvement among the first class to use the EPAs. CONCLUSION EPAs provide an effective framework for objective and measurable progression of trainees. One year after the implementation of transfusion reaction EPAs at our site, the trainees showed enhanced confidence levels in handling Blood Bank and Transfusion Medicine Services coverage.
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Affiliation(s)
- Jennifer Y Ju
- Department of Pathology, University of Virginia Health, Charlottesville, Virginia
| | - Gay Wehrli
- Department of Pathology, University of Virginia Health, Charlottesville, Virginia
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Schumacher DJ, West DC, Schwartz A, Li ST, Millstein L, Griego EC, Turner T, Herman BE, Englander R, Hemond J, Hudson V, Newhall L, McNeal Trice K, Baughn J, Giudice E, Famiglietti H, Tolentino J, Gifford K, Carraccio C. Longitudinal Assessment of Resident Performance Using Entrustable Professional Activities. JAMA Netw Open 2020; 3:e1919316. [PMID: 31940042 PMCID: PMC6991321 DOI: 10.1001/jamanetworkopen.2019.19316] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
IMPORTANCE Entrustable professional activities (EPAs) are an emerging workplace-based, patient-oriented assessment approach with limited empirical evidence. OBJECTIVE To measure the development of pediatric trainees' clinical skills over time using EPA-based assessment data. DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study of categorical pediatric residents over 3 academic years (2015-2016, 2016-2017, and 2017-2018) assessed on 17 American Board of Pediatrics EPAs. Residents in training at 23 pediatric residency programs in the Association of Pediatric Program Directors Longitudinal Educational Assessment Research Network were included. Assessment was conducted by clinical competency committee members, who made summative assessment decisions regarding levels of supervision required for each resident and each EPA. Data were collected from May 2016 to November 2018 and analyzed from November to December 2018. INTERVENTIONS Longitudinal, prospective assessment using EPAs. MAIN OUTCOMES AND MEASURES Trajectories of supervision levels by EPA during residency training and how often graduating residents were deemed ready for unsupervised practice in each EPA. RESULTS Across the 5 data collection cycles, 1987 residents from all 3 postgraduate years in 23 residency programs were assigned 25 503 supervision level reports for the 17 general pediatrics EPAs. The 4 EPAs that required the most supervision across training were EPA 14 (quality improvement) on the 5-level scale (estimated mean level at graduation, 3.7; 95% CI, 3.6-3.7) and EPAs 8 (transition to adult care; mean, 7.0; 95% CI, 7.0-7.1), 9 (behavioral and mental health; mean, 6.6; 95% CI, 6.5-6.6), and 10 (resuscitate and stabilize; mean, 6.9; 95% CI, 6.8-7.0) on the expanded 5-level scale. At the time of graduation (36 months), the percentage of trainees who were rated at a supervision level corresponding to "unsupervised practice" varied by EPA from 53% to 98%. If performance standards were set to align with 90% of trainees achieving the level of unsupervised practice, this standard would be met for only 8 of the 17 EPAs (although 89% met this standard for EPA 17, performing the common procedures of the general pediatrician). CONCLUSIONS AND RELEVANCE This study presents initial evidence for empirically derived practice readiness and sets the stage for identifying curricular gaps that contribute to discrepancy between observed practice readiness and standards needed to produce physicians able to meet the health needs of the patient populations they serve. Future work should compare these findings with postgraduation outcomes data as a means of seeking validity evidence.
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Affiliation(s)
- Daniel J. Schumacher
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Daniel C. West
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, University of Pennsylvania, Philadelphia
| | - Alan Schwartz
- Department of Medical Education, University of Illinois at Chicago
- Association of Pediatric Program Directors Longitudinal Educational Assessment Research Network, McLean, Virginia
- Department of Pediatrics, University of Illinois at Chicago
| | - Su-Ting Li
- Department of Pediatrics at the University of California Davis Health, Sacramento
| | - Leah Millstein
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore
| | - Elena C. Griego
- Department of Pediatrics, Seattle Children’s Hospital, Seattle, Washington
| | - Teri Turner
- Department of Pediatrics, Texas Children’s Hospital/Baylor College of Medicine, Houston
| | - Bruce E. Herman
- Department of Pediatrics, University of Utah, Salt Lake City
| | - Robert Englander
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis
| | - Joni Hemond
- Department of Pediatrics, University of Utah, Salt Lake City
| | - Valera Hudson
- Department of Pediatrics, Children’s Hospital of Georgia/Augusta University, Augusta
| | - Lauren Newhall
- Department of Pediatrics, Children’s Hospital of Georgia/Augusta University, Augusta
| | | | - Julie Baughn
- Department of Pediatrics, Mayo Medical School, Rochester, Minnesota
| | - Erin Giudice
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore
| | | | - Jonathan Tolentino
- Department of Pediatrics, Stony Brook University, Stony Brook, New York
- Department of Internal Medicine, Stony Brook University, Stony Brook, New York
| | - Kimberly Gifford
- Department of Pediatrics, Dartmouth University, Lebanon, New Hampshire
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Shorey S, Lau TC, Lau ST, Ang E. Entrustable professional activities in health care education: a scoping review. MEDICAL EDUCATION 2019; 53:766-777. [PMID: 30945329 DOI: 10.1111/medu.13879] [Citation(s) in RCA: 114] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 11/30/2018] [Accepted: 02/22/2019] [Indexed: 05/13/2023]
Abstract
CONTEXT The shift in medical education from time-based learning to outcome-based learning has drawn much attention to entrustable professional activities (EPAs) as an ideal assessment framework to translate competencies into clinical practice. Given the relative novelty of EPAs, this review aims to highlight research gaps and explore and consolidate available evidence pertaining to the development and implementation of EPAs in health care. METHOD Arksey and O'Malley's scoping review framework was used to present the findings. The authors performed a systematic search of PubMed, Embase, CINAHL, Scopus, MedNar, OpenGrey and ProQuest Dissertation and Theses for English articles published from the inception of each database to May 2018. A manual search of the reference lists of the included studies was conducted and an expert panel was consulted. Two reviewers screened the articles for eligibility using the inclusion criteria. All authors extracted key data and analysed the data descriptively. Thematic analysis was used to categorise the results into themes. RESULTS Eighty articles were included in the review. All articles were published between 2010 and 2018. Three major themes and eight sub-themes were generated: (i) development of EPAs (frameworks for EPA development and implementation, identifying core or specialty-specific EPAs, and EPAs for faculty development), (ii) evaluation of EPAs and EPA entrustment factors (revised curriculum, entrustment decisions for professional activities, and feedback on implemented EPAs and the development process), and (iii) future directions and recommendations for EPAs (implementation of EPAs in undergraduate medical education and specific disciplines, and other criticisms and recommendations for EPAs). CONCLUSIONS Entrustable professional activities are an essential means to translate competencies into observable and measurable clinical practice. However, high-level evidence-based research on the efficacy, development and implementation of EPAs for specific target groups (i.e. undergraduates and staff) and geographical regions (i.e. Asia and Africa) is still lacking, which suggests a direction for future research.
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Affiliation(s)
- Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, Singapore, Singapore
| | | | - Siew Tiang Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Emily Ang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, Singapore, Singapore
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Development of Breast Imaging Specific Entrustable Professional Activities Using a Double Delphi Technique. Acad Radiol 2019; 26:591-596. [PMID: 31047102 DOI: 10.1016/j.acra.2018.10.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 10/06/2018] [Accepted: 10/08/2018] [Indexed: 11/24/2022]
Abstract
RATIONAL AND OBJECTIVES To develop subspecialty-specific entrustable professional activities for breast imaging radiology (EPA-BRs) through the use of a double consensus-driven, validity-enhancing methodology that may be relevant to other subspecialties in radiology and medicine in general. MATERIALS AND METHODS A six-step methodology was used to develop EPA-BRs via a double Delphi process followed by educational theorist's refinement. Two groups of experts completed each Delphi process: the core group of breast imaging educators and an expert panel of national experts in breast imaging standards and appropriateness. RESULTS Five EPA-BRs were developed, with eight nested EPA-BRs, one of which is elective. This comprehensive list of EPA-BRs covers the role of a breast imaging radiologist in the care of a patient from detection of breast cancer to post-treatment follow-up. CONCLUSION A combined modified and classic double Delphi approach can be utilized by other graduate medical education (GME) specialties and subspecialties as a method by which GME education can be transformed into a clinical framework that more closely bridges individual competencies and real-world clinical practice.
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O'Dowd E, Lydon S, O'Connor P, Madden C, Byrne D. A systematic review of 7 years of research on entrustable professional activities in graduate medical education, 2011-2018. MEDICAL EDUCATION 2019; 53:234-249. [PMID: 30609093 DOI: 10.1111/medu.13792] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 11/05/2018] [Accepted: 11/20/2018] [Indexed: 05/13/2023]
Abstract
PURPOSE This review aimed to synthesise some of the extant work on the use of entrustable professional activities (EPAs) for postgraduate physicians, to assess the quality of the work and provide direction for future research and practice. METHOD Systematic searches were conducted within five electronic databases (Medline, Scopus, Web of Science, PsycINFO and CINAHL) in September 2018. Reference lists, Google Scholar and Google were also searched. Methodological quality was assessed using the Quality Assessment Tool for Studies with Diverse Designs (QATSDD). RESULTS In total, 49 studies were included, classified as Development of EPAs (n = 37; 76% of total included), Implementation and/or assessment of EPAs (n = 10; 20%), or both (n = 2; 4%). EPAs were described for numerous specialties, including internal medicine (n = 14; 36%), paediatrics (n = 8; 21%) and psychiatry (n = 4; 10%). Of the development studies, 92% utilised more than one method to generate EPAs. The two most commonly used methods were developing initial EPAs in a working group, (n = 27; 69%) and revising through deliberation (n = 21; 54%). Development papers were of variable quality (mean QATSDD score = 20, range 6-41). Implementation and assessment studies utilised methods that included observing trainee performance (n = 6; 50%) and enrolling trainees in competency-based curricula, which included EPAs (n = 4; 33%). The methodological quality of these implementation studies varied (mean QATSDD score = 19.5, range = 6-32). CONCLUSIONS This review highlighted a need for: (i) consideration of best practice guidelines for EPA development; (ii) focus on the methodological quality of research on EPA development and of EPAs, and (iii) further work investigating the implementation of EPAs in the curriculum.
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Affiliation(s)
- Emily O'Dowd
- Irish Centre for Applied Patient Safety and Simulation, National University of Ireland, Galway, Ireland
- Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Ireland
| | - Sinéad Lydon
- Irish Centre for Applied Patient Safety and Simulation, National University of Ireland, Galway, Ireland
- School of Medicine, National University of Ireland, Galway, Ireland
| | - Paul O'Connor
- Irish Centre for Applied Patient Safety and Simulation, National University of Ireland, Galway, Ireland
- Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Ireland
| | - Caoimhe Madden
- Irish Centre for Applied Patient Safety and Simulation, National University of Ireland, Galway, Ireland
- Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Ireland
| | - Dara Byrne
- Irish Centre for Applied Patient Safety and Simulation, National University of Ireland, Galway, Ireland
- School of Medicine, National University of Ireland, Galway, Ireland
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Kragel PJ, Hoffman RD, Kaul KL. Position Paper From the Association of Pathology Chairs: Surgical Pathology Residency Training. Acad Pathol 2019; 6:2374289518824054. [PMID: 30783619 PMCID: PMC6365987 DOI: 10.1177/2374289518824054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 12/10/2018] [Indexed: 11/16/2022] Open
Abstract
Training in surgical pathology specimen dissection and microscopic diagnosis is an integral part of pathology residency training, as surgical pathology is one of the defining activities of most pathologists. The Accreditation Council for Graduate Medical Education and the American Board of Pathology policies delineate guidelines and requirements for residency training. Both the ACGME and ABP require that residents are ready for “independent practice” upon completion of training (ACGME) and for board eligibility (ABP). This position paper, developed through a consensus process involving the Association of Pathology Chairs, including the Program Directors and Graduate Medical Education committee, expands on these guidelines and the importance of gross dissection as a part of training.
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Affiliation(s)
- Peter J Kragel
- Department of Pathology and Laboratory Medicine, East Carolina University Brody School of Medicine, Greenville, NC, USA
| | - Robert D Hoffman
- Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Karen L Kaul
- Department of Pathology and Laboratory Medicine, Northshore University Health System, Evanston, IL, USA
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Hoffman RD, Kragel PJ, Kaul KL. Position Paper From the Association of Pathology Chairs: Assessing Autopsy Competency in Pathology Residency Training. Acad Pathol 2019; 6:2374289518824057. [PMID: 30783620 PMCID: PMC6365994 DOI: 10.1177/2374289518824057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 12/10/2018] [Indexed: 11/25/2022] Open
Abstract
Declining numbers of hospital autopsies performed in US pathology residency training programs and perceived declining practice of autopsy by many pathologists has caused stakeholder organizations to reassess the role of autopsy training in pathology residency. A working group convened by the stakeholder organizations has delivered the results of a detailed study of current practice of autopsy education in US pathology programs, along with recommendations for the future of autopsy education. Accepting the report of the Working Group, the Association of Pathology Chairs here publishes its position paper on the proposed recommendations.
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Affiliation(s)
- Robert D. Hoffman
- Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Peter J. Kragel
- Department of Pathology and Laboratory Medicine, East Carolina University Brody School of Medicine, Greenville, NC, USA
| | - Karen L. Kaul
- Department of Pathology and Laboratory Medicine, Northshore University Health System, Evanston, IL, USA
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Aslan D. Which Skills are Needed and How They Should be Gained by Laboratory Medicine Professionals for Successful ISO 15189 Accreditation. EJIFCC 2018; 29:264-273. [PMID: 30574036 PMCID: PMC6295584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Clinical laboratories worldwide are accredited according to the "ISO standard, 15189:2012: Medical Laboratories-Requirements for Quality and Competence." Seeking accreditation has many challenges. Success requires the right competencies and knowledge and the right technical expert and trainer to lead the laboratory through the process. The right competencies and knowledge typcially are beyond the core knowledge, skills and attitudes gained during education of laboratory professionals. The main objective of this paper is to discuss what competencies, knowledge and expertise are essential for laboratories to meet accreditation challenges and gain ISO 15189:2012 accreditation.
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Affiliation(s)
- Diler Aslan
- Department of Medical Biochemistry, Medical Faculty, Pamukkale University, Denizli, Turkey
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Davis GG, Winters GL, Fyfe BS, Hooper JE, Iezzoni JC, Johnson RL, Markwood PS, Naritoku WY, Nashelsky M, Sampson BA, Steinberg JJ, Stubbs JR, Timmons C, Hoffman RD. Report and Recommendations of the Association of Pathology Chairs' Autopsy Working Group. Acad Pathol 2018; 5:2374289518793988. [PMID: 30186954 PMCID: PMC6117865 DOI: 10.1177/2374289518793988] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 07/11/2018] [Accepted: 07/16/2018] [Indexed: 11/17/2022] Open
Abstract
Autopsy has been a foundation of pathology training for many years, but hospital autopsy rates are notoriously low. At the 2014 meeting of the Association of Pathology Chairs, some pathologists suggested removing autopsy from the training curriculum of pathology residents to provide additional months for training in newer disciplines, such as molecular genetics and informatics. At the same time, the American Board of Pathology received complaints that newly hired pathologists recently certified in anatomic pathology are unable to perform an autopsy when called upon to do so. In response to a call to abolish autopsy from pathology training on the one hand and for more rigorous autopsy training on the other, the Association of Pathology Chairs formed the Autopsy Working Group to examine the role of autopsy in pathology residency training. After 2 years of research and deliberation, the Autopsy Working Group recommends the following:Autopsy should remain a component of anatomic pathology training.A training program must have an autopsy service director with defined responsibilities, including accountability to the program director to record every autopsy performed by every resident.Specific entrustable activities should be defined that a resident must master in order to be deemed competent in autopsy practice, as well as criteria for gaining the trust to perform the tasks without direct supervision.Technical standardization of autopsy performance and reporting must be improved.The current minimum number of 50 autopsies should not be reduced until the changes recommended above have been implemented.
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Affiliation(s)
- Gregory G Davis
- Forensic Division, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gayle L Winters
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Billie S Fyfe
- UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Jody E Hooper
- Department of Pathology, The Johns Hopkins University, Baltimore, MD, USA
| | - Julia C Iezzoni
- Department of Pathology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | | | | | - Wesley Y Naritoku
- Department of Pathology and Laboratory Medicine, USC/LAC+USC Medical Center, Los Angeles, CA, USA
| | - Marcus Nashelsky
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, USA
| | - Barbara A Sampson
- City of New York Office of Chief Medical Examiner, New York, NY, USA
| | - Jacob J Steinberg
- Department of Pathology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - James R Stubbs
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Charles Timmons
- Department of Pathology and Laboratory Medicine, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA
| | - Robert D Hoffman
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, TN, USA
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Borges Costa L, Esteche FF, Fernandes Augusto Filho R, Benevides Bomfim AL, Aguiar Mourão Ribeiro MT. Competências e Atividades Profissionais Confiáveis: novos paradigmas na elaboração de uma Matriz Curricular para Residência em Medicina de Família e Comunidade. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2018. [DOI: 10.5712/rbmfc13(40)1632] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objetivo: Realizar uma revisão na literatura sobre Currículo Baseado em Competências que possa subsidiar a elaboração de uma Matriz para Programa de Residência em Medicina de Família e Comunidade de Fortaleza, Ceará. Métodos: Foi realizada revisão de literatura sobre o referencial teórico do ensino baseado em competências, selecionando artigos, diretrizes, documentos e modelos de currículos de escolas médicas e entidades nacionais e internacionais envolvidas com o ensino médico. Resultados: A revisão de literatura evidenciou dois principais modelos de currículo repetidamente citados nas referências consultadas: ACGME (Accreditation Council for Graduate Medical Education) Milestones e CanMEDS (Canadian Medical Education Directions for Specialists) Framework. O Currículo Baseado em Competências enfatiza o ensino centrado no aluno e utiliza abordagem baseada em resultados para a criação, implementação e avaliação de programas de educação médica, usando uma estrutura organizacional de competências mapeadas com atividades profissionais confiáveis, na forma de uma matriz. A avaliação é feita por meio de desempenho e resultados graduados em marcos de desenvolvimento. Para fins de elaboração de Matriz curricular própria, optou-se como modelo e referência a proposta do CanMEDS 2015 por este ser aprovado por 12 organizações médicas canadenses e atualmente usado como base curricular em dezenas de países, sendo o modelo mais amplamente aplicado no mundo. Conclusão: Espera-se que esta revisão sirva de ferramenta para que também outras Instituições de Ensino e seus respectivos Programas de Residência possam desenvolver seus próprios Currículos Baseados em Competências.
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Basehore PM, Mortensen LH, Katsaros E, Linsenmeyer M, McClain EK, Sexton PS, Wadsworth N. Entrustable Professional Activities for Entering Residency: Establishing Common Osteopathic Performance Standards in the Transition From Medical School to Residency. J Osteopath Med 2017; 117:712-718. [DOI: 10.7556/jaoa.2017.137] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Abstract
Entrustable professional activities (EPAs) are measurable units of observable professional practice that can be entrusted to an unsupervised trainee. They were first introduced as a method of operationalizing competency-based medical education in graduate medical education. The American Association of Medical Colleges subsequently used EPAs to establish the core skills that medical students must be able to perform before they enter residency training. A recently published guide provides descriptions, guidelines, and rationale for implementing and assessing the core EPAs from an osteopathic approach. These osteopathically informed EPAs can allow schools to more appropriately assess a learner's whole-person approach to a patient, in alignment with the philosophy of the profession. As the single accreditation system for graduate medical education moves forward, it will be critical to integrate EPAs into osteopathic medical education to demonstrate entrustment of medical school graduates. The authors describe the collaborative process used to establish the osteopathic considerations added to EPAs and explores the challenges and opportunities for undergraduate osteopathic medical education.
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