A Critical Foucauldian Perspective on Competency-Based Medical Education and Entrustable Professional Activities

Entrustable Professional Activities: Reflecting on Where We Are to Define a Path for the Next Decade.

<p>勝任能力導向醫學教育(Competency-Based Medical Education, CBME)是近年來國際醫學教育趨勢，而可信賴專業活動(Entrustable Professional Activities, EPAs)是將CBME精神具體實行的方法之一。中華民國醫事放射師公會全國聯合會為落實醫事放射職類以勝任能力為導向的訓練，提供教師與時俱進的師資培育活動，遂擬定「醫事放射職類CBME訓練計畫三部曲」，透過三階段的方式推廣並落實能力導向醫學教育：「醫事放射學員的能力進展架構」-臺灣醫事放射職類可信賴專業活動的建置、「為勝任能力量身打造的教學與學習經驗」-CBME師資培訓推廣、「計畫性、系統性的評估設計與能力進展的行程」-醫事放射職類CBME訓練計畫全國執行。本會期望輔導各級教學醫院全面推廣台灣醫事放射職類CBME訓練與落實EPAs職場直接觀察教學，並建置執業模式下的能力進展架構與系統化評估，確保醫事放射師專業能力發展和教育品質提升。</p> <p> </p><p>Competency-based medical education (CBME) has become a trend in global medical education. Entrustable professional activities (EPAs) are one of the means to implement CBME. To provide up-to-date teacher training for implementing radiographers’ CBME, the Taiwan Association of Medical Radiation Technologists has organized a Three-Stage Radiographer CBME program. The three stages are as follows: (1) Competency development: establishing EPAs for radiographers. (2) Competency-oriented teaching and learning experience: promoting CBME teacher training. (3) Planned and systematic competency development and assessment: promoting and implementing the CBME teacher training program nationwide. Through the promotion of CBME, teaching based on direct EPA observations, as well as the establishment of a competency development framework and a systematic assessment model for in-service radiographers, the Association expects to improve the competency development of and education quality for radiographers in Taiwan.</p> <p> </p>

<p>能力導向醫學教育已經成為全球醫學教育的主流，可信賴專業活動是專業活動的單位，指學員在具備足夠能力後，被信賴能獨立執行醫療專業任務。EPAs和信賴決定主要涉及情境層面的能力，在臨床情境中，學員經由教師的信賴決定，逐步獲得專業自主權。目前急診EPAs是結訓階段代表性的任務，每個EPA都可以成為課程設計的依據，發展為臨床課程與核心課程，讓概念性的核心能力架構，透過課程的設計，將CBME落實在平時的課程安排、臨床訓練指導與評量中。而EPA的信賴督導等級的總結性評定，則需要臨床能力委員會共識出學員的信賴督導等級。EPAs是一種實施能力導向教育的操作模式或架構，而不是單純的評量表單，利用EPA改善為能力量身打造的教與學，才是落實CBME的重點。</p> <p> </p><p>Competency-based medical education (CBME) is the global standard in medical education. Within CBME, entrustable professional activities (EPAs) are defined as units of professional tasks that learners are entrusted to perform independently after they have demonstrated sufficient competence. EPAs and entrustment decisions primarily focus on contextual competencies, enabling learners to gradually gain professional autonomy through the trust conferred by instructors in clinical settings. Currently, EPAs in emergency medicine are representative tasks in the concluding stages of training. Each EPA serves as a foundation for curriculum design for both clinical and core curricula. This approach integrates the conceptual framework of core competencies into practice, embedding CBME into routine curriculum planning, clinical training guidance, and assessment. The summative assessment of entrustment-supervision levels for EPAs requires the consensus of a clinical competency committee to determine learners’ levels of entrustment. Hence, EPAs represent an operational model or framework for implementing CBME, rather than merely an assessment form. The key to implementing CBME lies in utilizing EPAs to enhance teaching and learning tailored to competencies.</p> <p> </p>

The Importance of Competency-Based Programmatic Assessment in Graduate Medical Education.

ICRE Top Research Abstracts

ICRE Top Research Abstracts

Introduction: Graduate medical education is being reformed in many countries, with a focus on the principles of competency-based medical education (CBME). A main novel aspect in this context is the implementation of entrustable professional activities (EPAs). The introduction of EPAs aims to better align training curricula with clinical practice, provide individualized supervision, and enhance the quality of feedback.Project description: This project report presents the development of a national strategy and the initial results of implementing entrustable professional activities in the Swiss context.Results: Affiliated with the Swiss Institute of Medical Education (SIME), an EPA-Commission was established with the mandate to develop a strategy and provide guidance to medical specialty societies. To date, 28 out of 45 specialty societies have sought advice from the EPA-Commission and have begun developing EPAs. Concurrently, the Commission has expanded the national faculty development courses, adapted the content, started offering multilingual courses, and has published a series of articles on CBME and EPAs. Selected pilot hospitals are now planning to implement EPA-based graduate medical education curricula. Additionally, the introduction of a nationwide electronic solution (app) for assessing EPAs is planned.Conclusion: The introduction of EPAs in graduate medical education is a multilayered project. In addition to medical education aspects, various social, organizational, and professional-political factors are crucial for the transformation processes. In the Swiss context, such a reform has been successfully initiated. Continuous evaluations of the ongoing projects will provide further insights for competency-based graduate medical education reforms.

Setting standards of performance expected in neurosurgery residency: A study on entrustable professional activities in competency-based medical education

Competency-based medical education (CBME) is currently the most common type of curriculum used worldwide. However, its limitations include fragmented learning and difficulties to use properly the knowledge, skills, and attitudes acquired using this educational model. Having this in mind, Entrustable Professional Activities (EPA) emerge as a tool to mediate the transfer of the competency-based curriculum into physicians’ professional practice in graduate medical education. Therefore, based on a narrative review of the existing literature on EPA and the authors’ experience in teaching community-based health care integration services, the aim of this paper is to reflect on the possible use of these activities in undergraduate medical education for the development of a CBME model integrated with primary health care and community medicine. The reflections presented here allow suggesting that, although it is a challenging process, incorporating EPA into undergraduate medical education is appropriate to improve the provision of primary health care to individuals, families, and communities in general.

<p>當代勝任能力導向醫學教育(competency-based medical education, CBME)以可信賴專業活動(entrustable professional activities, EPAs)及里程碑(milestones)為兩項主要推動項目。描述專業工作的EPAs不僅能與描述個人能力的里程碑相輔相成，近年來因其可操作性高，成為國際CBME推動上的關鍵項目。Elaine Van Melle等人提出的CBME核心組成架構，包括成效能力、序列性進展、量身打造的學習經驗、聚焦於能力的指導、計畫性評估5項，可作為落實CBME的參考。在EPAs運用上，需有完整的八大描述項目，選定合適的信賴等級量尺，善用以信賴授權為導向的討論(entrustment-based discussion, EBD)等方式來評估，並參考A-RICH框架(Agency, Reliability, Integrity, Capability, Humility)來進行信賴授權決策。CBME可縱向延伸，自專科住院醫師訓練往醫學生及PGY階段發展，也能整合科技應用進行評估。在不久的將來，時間可變訓練計畫(time-variable training programs)極有可能成真，並會是CBME全面落實的指標。</p> <p> </p><p>The contemporary competency-based medical education (CBME) focuses on individuals’ entrustable professional activities (EPAs) and milestones. The EPAs that describe professional work complement the milestones that describe individual competencies. In recent years, EPAs have become a key component in international CBME due to their high operability. Elaine Van Melle et al. proposed five core components of CBME: outcome competencies, sequenced progression, tailored learning experiences, competency-focused instruction, and programmatic assessment. This core components framework could facilitate the implementation of CBME. EPAs should be written using eight descriptive items, an appropriate entrustment scale, and assessment methods such as entrustment-based discussion; the A-RICH (Agency, Reliability, Integrity, Capability, Humility) framework should be employed to aid entrustment decision making. CBME may be extended vertically from resident doctor training to medical student training and postgraduate year training. Technologies may also be incorporated for assessment in CBME. In the near future, time-variable training programs are likely to be realized and will be an indicator for the full-scale implementation of CBME.</p> <p> </p>

Evaluating the effect of assessment form design on the quality of feedback in one Canadian ophthalmology residency program as an early adopter of CBME

Competency-Based Medical Training in Anesthesiology: Has It Delivered on the Promise of Better Education?

Aim: In recent years Entrustable Professional Activities (EPAs) have developed as an essential framework for competency-based medical education (CBME) implementation, which has become an important component of contemporary medical education. The need to close the gap between healthcare professional education, healthcare delivery, and societal demands motivates the transition to CBME. While the competencies describe the attributes that medical professionals should possess, the EPAs describe the practical activities that learners are expected to perform in their medical education and future careers. The difficulty of translating abstract abilities into clinical practice in the real world encouraged the development of EPAs, which are specific activities or responsibilities that may be delegated to learners upon demonstrating competency. With the introduction of EPAs, medical education programs have discovered a more effective means of assessing competencies that aligns them with the professional tasks that students are expected to perform. This alignment promotes a meaningful connection between intended competencies and real-world practice, which ultimately improves the readiness of future medical professionals. Methods: The article was prepared by the traditional review method. Results: This article highlights the particular features of EPAs and the significance of competency-based assessments being grounded in actual clinical situations. EPAs enable learners to advance progressively, fostering preparedness as well as responsibility over time. It is discussed how the incorporation of technology into EPAs has the potential to improve both teaching and learning. The use of technological support and mobile applications can make EPAs more applicable and comprehensible to both faculty and students. Conclusions: The integration of CBME and EPAs is a promising strategy for addressing concerns about medical education’s effectiveness. By actively engaging in real-world tasks, EPAs facilitate the internalization of competencies by learners. By providing a structured, adaptable, and context-specific approach to competency assessment, EPAs enable learners to assume responsibilities progressively, thereby facilitating their path to becoming competent and confident healthcare professionals. By recognizing the complementary nature of EPAs and competences, medical education programs can develop thorough and efficient training techniques that bridge the gaps between theoretical knowledge and practical clinical abilities.

Entrustable Professional Activities for Pathology: Recommendations From the College of American Pathologists Graduate Medical Education Committee

Background Previous research demonstrates mixed reactions from residents toward competency-based medical education (CBME), and entrustable professional activities (EPAs) specifically. However, understanding what motivates residents to obtain EPAs may be vital to the longevity of CBME, given the emphasis on assessment for learning under this paradigm. Objective This study explored resident perspectives across 3 domains: motivation for obtaining EPAs, perceived importance of EPAs, and overall thoughts on CBME curriculum. Methods This was a sequential exploratory mixed-methods study involving 2 phases of data collection. Phase 1 was semi-structured interviews with residents enrolled in CBME at one Canadian institution from November 2019 to July 2020. Analyses included thematic and manifest content analysis. Phase 2 was an electronic close-ended survey to capture residents' primary motivation for requesting EPAs and importance of EPAs for learning. Survey data were analyzed descriptively. Results Of 120 eligible residents, 25 (21%) and 107 (89%) participated in the interview and survey, respectively. Program requirement was the dominant motivation for obtaining EPAs. There was variability in perceived importance of EPAs on learning. Increased resident workload, gaming the system to maximize EPA scores, and lack of shared ownership from preceptors were cited as critiques of the curriculum. Survey responses corroborated interview findings. Conclusions Although many residents recognize the value of EPAs, the majority are not intrinsically motivated to seek out assessment under the current CBME framework.