Entrustable Professional Activities for Community Medicine: Integrating Medical Undergraduate Courses and Primary Health Care

Ieda Francischetti,Harm Peters,Ylva Holzhausen,José Bitu Moreno

doi:10.4236/ce.2020.112007

Abstract

Community medicine represents a far-reaching field for the advance of health care, with impact on people’s quality of life and health needs. Health promotion, disease prevention, recovery and rehabilitation have to be incorporated satisfactorily into medical education. The search for a pedagogical tool to fulfill the medical curriculum through actions of community medicine care led us to outline 11 Entrustable Professional Activities (EPAs) for community medicine. The study was carried out at a public Medical School in Brazil that has a Competency-Based Curriculum (CBC). Fifteen teachers with expertise in community medicine analyzed the resulting EPAs. The EPAs were distributed in three domain areas: care needs of the individual, family and community in Primary Health Care. The teachers answered a total of 13 open questions in a two-round Delphi study. The discourses were submitted to thematic content analysis. Three discourse categories were found about the outlined EPAs: curriculum management and social needs, curriculum management and service integration, and curriculum management and actors. The understanding of the EPAs as a curriculum management tool was relevant, as well as their interface with health care and learning development. The consulted teachers agreed with the designed EPAs and that they are adequate for the first two years of the studied medical course in their Brazilian context. Therefore, it was concluded that the community medicine EPAs are appropriate for the new medical profile, especially in countries with social exclusion, and are a very good tool to promote integrality of care and humanism. This study can facilitate the implementation of a CBC in community medicine and assist in overcoming its challenges through the adoption of the designed EPAs.

Highlights

Competency-Based Medical Education (CBME) has become largely accepted in medical undergraduate courses, mainly due to its practical approach, which can foster a more responsive type of care.For economic and social reasons, the most expected medical profile around the globe is that of an interactive, generalist professional who is able to meet the population’s health demands with effective, integral and humanistic care, and who has an epidemiological and social perception
The domains were oriented towards integrality of health care to meet people’s health needs in three dimensions aligned with community medicine assumptions: 1) Integrality of care for the health needs of the individual in all phases of the life cycle, 2) Integrality of care for the health needs of the family, and 3) Integrality of care for the health needs of the community
2) Curriculum management and service integration This category approached the curriculum’s commitment to academia-service-community integration to foster health care integrality. It was seen as a challenge: The Individual Therapeutic Project (ITP) involves the systematization of the work process and, in this context, it is necessary to synchronize the service with the actions, so that the student experiences the care process in practice. (N1) The discussion about the visited families could include members of the service team and the supervising teacher, as the team often knows the family better. (M9) The panelists expressed their comprehension of the potentiality of the proposed Entrustable Professional Activities (EPAs) to mediate integrated health care

Summary

Introduction

Competency-Based Medical Education (CBME) has become largely accepted in medical undergraduate courses, mainly due to its practical approach, which can foster a more responsive type of care. For economic and social reasons, the most expected medical profile around the globe is that of an interactive, generalist professional who is able to meet the population’s health demands with effective, integral and humanistic care, and who has an epidemiological and social perception. Community medicine represents the key approach to meet people’s real needs and act in health surveillance. The search for a better way to implement the medical curriculum in community medicine was mobilized by the demand for offering a qualified and praxis-focused undergraduate medical course based on medical competence. The implementation and assessment of what is called “competence” are complex processes and, to preserve the potentiality of this construct, extended integration with the real context is required (Frank et al, 2010; Lima, 2005)

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