Development of entrustable professional activities for paediatric intensive care fellows: A national modified Delphi study.

Marije P Hennus,Anneliese Nusmeier,Olle Ten Cate,Enno D Wildschut,Nikki J Schoenmaker,Tim Fawns,Gwen G M Van Heesch,Maaike A Riedijk,Marijn Soeteman,Richard Bruce Mink

doi:10.1371/journal.pone.0248565

Abstract

Entrustable professional activities (EPAs), as a focus of learner assessment, are supported by validity evidence. An EPA is a unit of professional practice requiring proficiency in multiple competencies simultaneously, that can be entrusted to a sufficiently competent learner. Taken collectively, a set of EPAs define and inform the curriculum of a specialty training. The goal of this study was to develop a set of EPAs for Dutch PICU fellows. A multistage methodology was employed incorporating sequential input from task force members, a medical education expert, PICU fellowship program directors, and PICU physicians and fellows via a modified three-round Delphi study. In the first modified Delphi round, experts rated indispensability and clarity of preliminary EPAs. In the subsequent rounds, aggregated scores for each EPA and group comments were provided. In round two, respondents rated indispensability and clarity of revised EPAs. Round three was used to gain explicit confirmation of suitability to implement these EPAs. Based on median ratings and content validity index (CVI) analysis for indispensability in the first two rounds, all nine preliminary EPAs covered activities that were deemed essential to the clinical practice of PICU physicians. Based on median ratings and CVI analysis for clarity however, four EPAs needed revision. With an agreement percentage of 93–100% for all individual EPAs as well as the set as a whole, a high degree of consensus among experts was reached in the third round. The resulting nine PICU EPAs provide a succinct overview of the core tasks of Dutch PICU physicians. These EPAs were created as an essential first step towards developing an assessment system for PICU fellows, grounded in core professional activities. The robust methodology used, may have broad applicability for other (sub)specialty training programs aiming to develop specialty specific EPAs.

Highlights

To become a certified Paediatric Intensive Care Unit (PICU) physician, paediatricians or anaesthesiologists in training at any Dutch PICU merely have to provide a ‘satisfactory level of care’ during their 2.5-year fellowship
Nine preliminary Entrustable professional activities (EPAs) were developed by the national PICU task force
EPAs were reviewed by an educational expert and refined and finalised by a focus group consisting of all Dutch PICU fellowship training directors (n = 7)

Summary

Introduction

To become a certified Paediatric Intensive Care Unit (PICU) physician, paediatricians or anaesthesiologists in training at any Dutch PICU merely have to provide a ‘satisfactory level of care’ during their 2.5-year fellowship. No official (and/or uniform) forms of assessment are currently in use. As this ‘satisfactory level of care’ is not predefined and there are no guidelines on how to achieve this, it is unclear how supervising consultants can perform a valid and reliable assessment of a fellow’s performance. Competencies being behavioural descriptors, need a strong link to clinical practice to allow teachers to both observe and use them in assessing a learner’s performance. Entrustable professional activities (EPAs), first introduced in 2005 as a focus of learner assessment, may serve as this much needed link to help bridge the gap between competency frameworks and the challenges of education, assessment and clinical practice [4]

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