Longitudinal survey of self-reported level of entrustment across the first year of clinical practice.

Paul O'Connor,Sinéad Lydon,Dara Byrne,Orla Mongan

doi:10.12688/hrbopenres.13487.1

Paul O'Connor, Sinéad Lydon + Show 2 more

Open Access

https://doi.org/10.12688/hrbopenres.13487.1

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Abstract

Background. Newly graduated medical students often report that they lack the skills required to care for patients, and feel unprepared for clinical practice. However, little is known about when, and if, they acquire these skills in practice. The aim of this study was to assess self-reported level of entrustment in, and frequency of performance of, the seven Entrustable Professional Activities (EPAs) comprising the EPA framework for interns in Ireland. EPAs describe discrete activities that are essential to a particular profession. Methods. Self-report survey data were collected from doctors in the Republic of Ireland during their first year of clinical practice at four different time points during 2020/21. Results. Response rates to the survey varied from 73.3% (126/172) at Time 1 to 25.6% (44/172) at Time 4. After three months, the respondents reported that they could execute all of the EPAs, inclusive of 12 essential procedural skills, with indirect supervision. As the year progressed there was an increase in the proportion of respondents reporting that they performed the EPAs at least once a week. However, the proportion of respondents performing five of the essential procedural skills (e.g. nasogastric tube insertion) remained low across all time points. Conclusion. Consideration should be given as to how to better prepare medical students to execute these EPAs, how the interns can be better supported during the first quarter of internship. The findings from this research are positive. However, there is an urgent need to carry out formal assessments of entrustability, rather than relying on self-report.

Highlights

It has consistently been found that junior doctors lack the skills required to care for patients, and feel unprepared for clinical practice[1,2]
The issues associated with a time-based approach to training has led to an interest in a Competency Based Medical Education (CBME) for the training of junior doctors
This finding is consistent with other studies that have found that high percentages of newly graduated medical students report feeling under-prepared to begin working in a hospital[11], and variability in their confidence to perform specific clinical skills[1]

Summary

Introduction

It has consistently been found that junior doctors lack the skills required to care for patients, and feel unprepared for clinical practice[1,2]. A particular approach to CBME that has received interest within the context of the training of junior doctors is Entrustable Professional Activities (EPAs)[6]. Graduated medical students often report that they lack the skills required to care for patients, and feel unprepared for clinical practice. Self-report survey data were collected from doctors in the Republic of Ireland during their first year of clinical practice at four different time points during 2020/21. The proportion of respondents performing five of the essential procedural skills (e.g. nasogastric tube insertion) remained low across all time points. There is an urgent need to carry out formal assessments of entrustability, rather than relying on self-report

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