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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] [What about the content of this article? (0)] [Affiliation(s)] [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] [What about the content of this article? (0)] [Affiliation(s)] [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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Caretta‐Weyer HA, Sebok‐Syer SS, Morris AM, Schnapp BH, Fant AL, Scott KR, Pirotte M, Gisondi MA, Yarris LM. Better together: A multistakeholder approach to developing specialty-wide entrustable professional activities in emergency medicine. AEM Educ Train 2024; 8:e10974. [PMID: 38532740 PMCID: PMC10962124 DOI: 10.1002/aet2.10974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/28/2024] [Accepted: 03/04/2024] [Indexed: 03/28/2024]
Abstract
Purpose Entrustable professional activities (EPAs) are a widely used framework for curriculum and assessment, yet the variability in emergency medicine (EM) training programs mandates the development of EPAs that meet the needs of the specialty as a whole. This requires eliciting and incorporating the perspectives of multiple stakeholders (i.e., faculty, residents, and patients) in the development of EPAs. Without a shared understanding of what a resident must be able to do upon graduation, we run the risk of advancing ill-prepared residents that may provide inconsistent care. Methods In an effort to address these challenges, beginning in February 2020, the authors assembled an advisory board of 25 EM faculty to draft and reach consensus on a final list of EPAs that can be used across all training programs within the specialty of EM. Using modified Delphi methodology, the authors came to consensus on an initial list of 22 EPAs. The authors presented these EPAs to faculty supervisors, residents, and patients for refinement. The authors collated and analyzed feedback from focus groups of residents and patients using thematic analysis. The EPAs were subsequently refined based on this feedback. Results Stakeholders in EM residency training endorsed a final revised list of 22 EPAs. Stakeholder focus groups highlighted two main thematic considerations that helped shape the finalized list of EM EPAs: attention to the meaningful nuances of EPA language and contextualizing the EPAs and viewing them developmentally. Conclusions To foreground all key stakeholders within the EPA process for EM, the authors chose within the development process to draft; come to consensus; and refine EPAs for EM in collaboration with relevant faculty, patient, and resident stakeholders. Each stakeholder group contributed meaningfully to the content and intended implementation of the EPAs. This process may serve as a model for others in developing stakeholder-responsive EPAs.
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Affiliation(s)
- Holly A. Caretta‐Weyer
- Department of Emergency MedicineStanford University School of MedicinePalo AltoCaliforniaUSA
| | - Stefanie S. Sebok‐Syer
- Department of Emergency MedicineStanford University School of MedicinePalo AltoCaliforniaUSA
| | - Amanda M. Morris
- Department of Emergency MedicineStanford University School of MedicinePalo AltoCaliforniaUSA
| | - Benjamin H. Schnapp
- Berbee Walsh Department of Emergency MedicineUniversity of WisconsinMadisonWisconsinUSA
| | - Abra L. Fant
- Department of Emergency Medicine, Northwestern University Feinberg School of MedicineMcGaw Medical Center at Northwestern UniversityChicagoIllinoisUSA
| | - Kevin R. Scott
- Department of Emergency MedicineUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Matthew Pirotte
- Department of Emergency MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Michael A. Gisondi
- Department of Emergency MedicineStanford University School of MedicinePalo AltoCaliforniaUSA
| | - Lalena M. Yarris
- Department of Emergency MedicineOregon Health & Science UniversityPortlandOregonUSA
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Treml A, Joshi SA, Stephens LD, Zantek ND, Tanhehco YC, Mason HM, Li Y, Srivaths P, Mattiazzi AD, Schwartz J, Wehrli G. Apheresis medicine education during the early phase of the COVID-19 pandemic. Transfusion 2023; 63:1580-1589. [PMID: 37421258 DOI: 10.1111/trf.17481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND The COVID-19 pandemic introduced challenges and disruption across healthcare, including apheresis medicine (AM). In this study, we report findings from a survey conducted among American Society for Apheresis Physician Committee (ASFA-PC) members to describe the impact of the COVID-19 pandemic on AM education practices. STUDY DESIGN AND METHODS A voluntary, anonymous, 24-question, institutional review board-approved survey regarding AM teaching during the pandemic was distributed to ASFA-PC members in the United States between December 1, 2020, and December 15, 2020. Descriptive analyses were reported as number and frequency of respondents for each question. Free text responses were summarized. RESULTS Responses were received from 14/31 (45%) of ASFA-PC members, of whom 12 practiced at academic institutions. Among these, 11/12 (92%) transitioned to virtual platform for AM trainee conferences during the pandemic. A variety of resources were employed to support independent AM learning. While 7/12 (58%) respondents did not change the informed consent process for AM procedures, others delegated this process or introduced remote alternatives. The most common method respondents used to conduct AM patient rounding was a hybrid in-person/virtual model. CONCLUSION This survey describes the adaptations and changes AM practitioners made to trainee education in response to the early phase of the COVID-19 pandemic. The transition to virtual and/or hybrid trainee learning and AM rounds underscores the importance of digital AM resources. Further study of the effects of the pandemic and its impact on AM trainee education, as well as patient care is warranted.
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Affiliation(s)
- Angela Treml
- Versiti WI, Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - Laura Dilly Stephens
- Department of Pathology, University of California San Diego, La Jolla, California, USA
| | - Nicole D Zantek
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Yvette C Tanhehco
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
| | - Holli M Mason
- Department of Pathology, Harbor-UCLA and Olive View-UCLA Medical Centers, Los Angeles, California, USA
| | - Yanhua Li
- Department of Medicine and Department of Pathology, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - Poyyapakkam Srivaths
- Division of Pediatric Nephrology, Baylor College of Medicine, Houston, Texas, USA
| | - Adela D Mattiazzi
- Division of Nephrology and Hypertension and Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Joseph Schwartz
- Department of Pathology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Gay Wehrli
- University Hospitals Samaritan Medical Center, Ashland OH and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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Elmes AT, Tekian A, Jarrett JB. The Need for Quality Assessment of Entrustable Professional Activities in Pharmacy Education. Am J Pharm Educ 2023; 87:ajpe9039. [PMID: 35351798 PMCID: PMC10159503 DOI: 10.5688/ajpe9039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/28/2022] [Indexed: 05/06/2023]
Abstract
Entrustable professional activities (EPAs) are specific tasks that a professional is entrusted to perform autonomously and, together, they define the scope of a profession. There are specific attributes that a task must possess both structurally and conceptually to be classified as an EPA. A high-quality EPA must be an observable, measurable, and professional task that requires training to execute, is fit for entrustment, and can be performed independently. In 2017, the American Association of Colleges of Pharmacy (AACP) defined 15 core EPAs expected of a pharmacy learner upon graduation (Core EPAs). Despite acceptance and implementation by pharmacy schools across the country, the Core EPAs have not been evaluated using an objective assessment tool to ensure that they meet specific EPA quality standards outlined in the literature. This article describes existing objective assessment tools for EPA quality and highlights the importance of ensuring high-quality EPAs in pharmacy education, which would be an important step for the AACP Academic Affairs Committee to take to further develop EPAs for implementation.
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Affiliation(s)
- Abigail T Elmes
- University of Illinois Chicago, College of Pharmacy, Chicago, Illinois
| | - Ara Tekian
- University of Illinois Chicago, College of Medicine, Chicago, Illinois
| | - Jennie B Jarrett
- University of Illinois Chicago, College of Pharmacy, Chicago, Illinois
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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