Experiences in DOCS Clinic: Direct Observation of Clinical Skills

Abstract

PURPOSE: To investigate the efficacy of an assessment tool for core entrustable professional activities (EPAs) in obstetrics and gynecology. BACKGROUND: Medical education is moving toward competency-based assessment. EPAs standardize proficiency levels for learners and provide assessment frameworks, but require direct observation. Students report little direct observation of history taking or physical exam skills in clerkships. We implemented a standardized clinical experience and assessment tool to assess student progress on EPAs. METHODS: We developed an assessment tool for history, physical exam, and counseling, with behavioral anchors to describe achievement levels. Participants included OBGYN clerkship students in 2016-2017. Students conducted patient encounters with direct observation and feedback by faculty. Students then conducted a separate patient encounter with an experienced educator, who rated performance using the assessment tool. RESULTS: Forty-two of 63 students participated. 98% rated emerging or entrustable level in history-taking (EPA 1A) and physical exam (EPA 1B). Students who were assessed on differential diagnosis (EPA2), and ordering/interpreting tests (EPA 4) were rated pre-entrustable or emerging. All students demonstrated entrustability in collaboration and teamwork (EPA 9). DISCUSSION: Most students were rated emerging or entrustable in EPA 1; all demonstrated entrustability in EPA 9. Our assessment tool provided a framework to ensure consistency in assessment of EPAs. Our study was limited by availability of clinical educators. We plan to refine the assessment tool to develop standards for each EPA. Faculty development is required as clinical educators are not familiar with this framework. Change in the educational culture is needed for EPAs to be successful.