What can we expect from medical graduates? Empirical survey on the performance of Core EPAs in the first days of residency

[The new medical licensing regulations (ÄApprO) : Status and expected challenges]

BackgroundThe amendment to the medical licensing regulations (ÄApprO) was decided at the federal level in the version of the "Master Plan for Medical Studies 2020" passed in 2017. In addition to the organizational effort involved in redesigning the curricular teaching, the expected costs associated with the implementation of the new licensing regulations due to the necessary additional time and, therefore, personnel expenditure are of particular importance. Taking into account the different forms of study and the 20% scope for study-design provided to the individual faculties, the process of transferring the teaching content to the new modules confronts us with an enormous organizational challenge.Significance of O&UDiseases of the musculoskeletal system are of particular medical, social and economic importance. Therefore, the training of future physicians in the field of orthopedics and traumatology must be taken into account. The visibility of the field of orthopedics and traumatology must not be lost with the introduction of the new medical licensing regulations (ÄApprO).ImplementationThe implementation of the new medical licensing regulations at German universities will be costly and necessitates an increased number of staff. However, there is a great opportunity to position orthopedics and traumatology as a "central player" in the modular, interdisciplinary and interprofessional course landscape. It is, therefore, important to take on concrete responsibility for the design of the new teaching programs and to bring in our specialist and interdisciplinary skills wherever sensible and possible.

The Fate of Entrustable Professional Activities After Graduation: A Survey Study Among Graduated Physician Assistants

INTRODUCTION

Entrustable professional activities (EPAs) are used during training but may also have significance after graduation. This domain has not yet been much explored. We investigated the use of EPAs among alumni of Master Physician Assistant programs in the Netherlands, where EPAs have been used since 2010. We aim to describe if and how EPAs have a role after graduation. Are EPAs used for continuous entrustment decisions or when shifting work settings?

METHODS

In September 2020, all registered Dutch physician assistants (PAs) ( n = 1441) were invited to participate in a voluntary, anonymous survey focusing on the use of EPAs after graduation. Survey items included questions regarding the use and usefulness of EPAs, views on continuous entrustment decisions, and how PAs document their competence.

RESULTS

A total of 421 PAs (response rate 29%) yielded information about the significance of EPAs after training. Among the respondents, 60% ( n = 252) reported adding new competencies and skills after graduation. One-third ( n = 120) of the respondents were trained in EPA-based programs. Almost all EPA-trained PAs (96%; n = 103) considered the EPA structure suitable to maintain and renew entrustment. Furthermore, PAs reported continued use of the EPA framework to seek formal qualifications through entrustment decisions.

CONCLUSION

This study shows that EPAs can play an ongoing role for PAs after graduation. EPA-trained PAs overwhelmingly support the continuous use of the EPA framework for entrustment decisions from graduation until retirement.

An update on current EPAs in graduate medical education: A scoping review

The purpose of this scoping review is to update the recent progress of EPAs research in GME, focusing on the topical concern of EPAs effectiveness, and to provide a reference for medical researchers in countries/regions interested in introducing EPAs. Guided by Arksey and O'Malley's framework regarding scoping reviews, the researchers, in January 2021, conducted a search in five databases to ensure the comprehensiveness of the literature. After the predetermined process, 29 articles in total were included in this study. The most common areas for the implementation and evaluation of EPAs were Surgery (n = 7,24.1%), Pediatric (n = 5,17.2%) and Internal medicine (n = 4,13.8%), a result that shows a relatively large change in the research trend of EPAs in the last two years. Prior to 2018, EPAs research focused on internal medicine, psychiatry, family medicine, and primary care. The articles in the category of EPAs implementation and evaluation had four main themes: (1) validation of EPAs (n = 16,55.2%); (2) describing the experience of implementing EPAs (n = 11,37.9%); (3) examining the factors and barriers that influence the implementation and evaluation of EPAs (n = 6,20.6%); and (4) researching the experiences of faculty, interns, and other relevant personnel in using EPAs. Training programs were the most common EPAs implementation setting (n = 26,89.6%); direct observation and evaluation (n = 12,41.4%), and evaluation by scoring reports (n = 5,17.2%) were the two most common means of assessing physicians' EPA levels; 19 papers (65.5%) used faculty evaluation, and nine of these papers also used self-assessment (31.0%); the most frequently used tools in the evaluation of EPAs were mainly researcher-made instruments (n = 37.9%), assessment form (n = 7,24.1%), and mobile application (n = 6,20.7%). Although EPAs occupy an increasingly important place in international medical education, this study concludes that the implementation and diffusion of EPAs on a larger scale is still difficult.