79. DEMYSTIFYING COMPLEX CARE: DEVELOPMENT OF ENTRUSTABLE PROFESSIONAL ACTIVITIES IN PEDIATRIC COMPLEX CARE

Abstract

Background Care of medically complex children, commonly managed by general pediatricians in hospital and community settings, involves unique knowledge, skills and attitudes. Currently, there are no established competency frameworks for training physicians in these specific elements of care. Previous work identified curricular priorities in complex care for pediatricians. Applying the framework of Entrustable Professional Activities (EPAs) to provide rich description for concrete clinical activities and practical skills in complex care can help guide educators and trainees. Objective To develop EPAs focused on the care of children with medical complexity. Design/Methods Utilizing an established approach for developing EPAs, we created a template with guidelines for elaborating EPA elements and mapping to the pediatric competencies/milestones framework. We recruited small teams of complex care clinicians with content expertise via an international listserv and complex care special interest groups to further develop these EPAs and map to existing pediatric competency frameworks. Drafts were reviewed and refined by key stakeholders including medical educators, complex care clinicians, trainees, and patient families. Results Content experts developed five complex care EPAs with an additional six in progress (Table 1). Each EPA includes rich description and explicit delineation of activity-specific knowledge, skills, and attitudes required for attaining competency. In addition, we mapped completed EPAs to 15 of the 21 (71%) core pediatric milestones that are reported to the Accreditation Council for Graduate Medical Education. Each completed complex care EPA aligned with 1-2 of the General Pediatric EPAs (Table 2). Conclusion Development of EPAs in the care of children with medical complexity expands upon existing pediatric competency frameworks. This work can guide educators and trainees in curriculum development and training activities essential to attaining competence to care for this growing population.