Structured Debriefing to Assess Performance of Entrustable Professional Activities.

Abstract

Background The medical workplace presents challenges for workplace-based learning. Structured debriefing of shared clinical experiences has been proposed as a way to take advantage of workplace-based learning in a setting that facilitates deep learning conversations. Objective To investigate faculty and learner acceptance of private, face-to-face, structured debriefing of performance of entrustable professional activities (EPAs). Methods During the 2020-2021 academic year, faculty at the University of Colorado (CU) and the University of Utah (UU) debriefed fellow performance of jointly selected EPAs in neonatal-perinatal medicine pertinent to shared 1- to 3-week clinical rotations. Private face-to-face debriefing was structured by a comprehensive EPA-specific list of behavioral anchors describing 3 levels of entrustment/accomplishment. Sessions ended with joint decisions as to level of entrustment/accomplishment and goals for improvement. We used thematic analysis of semistructured fellow interviews and faculty focus groups to identify themes illustrated with representative quotations. Results We interviewed 17 fellows and 18 faculty. CU participants debriefed after clinical rotations; UU usually debriefed during rotations. Debriefing sessions for 1 to 2 EPAs lasted 20 to 40 minutes. Themes represented in fellow interviews and faculty focus groups suggested that debriefing facilitated formative feedback along with shared understanding of clinical performance and assessment criteria. The standardized format and private conversations supported assessment of aspects of performance for which review might otherwise have been overlooked or avoided. The conversations also provided valuable opportunities for formative discussion of other matters of importance to fellows. Conclusions Structured debriefing of recently shared clinical experiences fostered formative assessment viewed positively by teachers and learners.