Core EPAs Research Articles

ICRE Top Research Papers.

ICRE Top Research Papers.

Implementation of a Workplace-Based Assessment System to Measure Performance of the Core Entrustable Professional Activities in the Pediatric Clerkship.

The Core Entrustable Professional Activities for Entering Residency (Core EPAs) were developed to address the gap between medical school and residency. There is a lack of instruments to measure performance of the Core EPAs in clerkships. We describe the operationalization and outcomes of a workplace-based assessment (WBA) system to measure performance of the Core EPAs in the pediatrics clerkship. A mobile-friendly WBA was developed at the authors' institution. The WBA incorporated a modified version of the Ottawa Clinic Assessment Tool (OCAT), an instrument that rates performance on a scale of 1 to 4 (1- "I had to do it" to 4- "I had to be there just in case"). During 2018 to 2019, all students were required to request feedback for 6 of the 13 Core EPAs using the WBA in the Pediatrics clerkship. Descriptive and inferential statistics were calculated to assess mean OCAT scores, variance in performance and correlation between scores, clerkship timing, and grades. Total 1655 WBAs were completed for 218 students. The overall mean OCAT score was 3.47 out of 4. Scores across Core EPAs were greater in later rotations (r=0.157, P< .001). One-way analysis of variance revealed significant variance on score by student, assessor, and timing of clerkship block. Final grades were correlated with OCAT scores (Spearman's ρ=0.25, P < .001). The results of this study demonstrate initial outcomes for a WBA system to assess performance for the Core EPAs in pediatrics using the OCAT scale. Future studies will assess the system across clerkships.

University of Utah School of Medicine.

University of Utah School of Medicine.

Oregon Health & Science University School of Medicine.

Oregon Health & Science University School of Medicine.

Texas A&M University College of Medicine.

Texas A&M University College of Medicine.

The development of a framework of entrustable professional activities for the intern year in Ireland

BackgroundEntrustable Professional Activities (EPAs) are units of professional practice that capture essential competencies in which trainees must become proficient before undertaking them independently. EPAs provide supervisors with a solid justification for delegating an activity to trainees. This study aimed to develop and ensure face validity of a set of EPAs for junior doctors in the first year of clinical practice in the Republic of Ireland.MethodsAn iterative eight stage consensus building process was used to develop the set of EPAs. This process was based on international best practice recommendations for EPA development. A series of surveys and workshops with stakeholders was used to develop a framework of EPAs and associated competencies. An external stakeholder consultation survey was then conducted by the Irish Medical Council. The framework of EPAs was then benchmarked against the 13 core EPAs developed by the Association of American Medical Colleges (AAMC).ResultsA framework of seven EPAs, and associated competencies resulted from this study. These EPAs address all core activities that junior doctors should be readily entrusted with at the end of the intern year, which is the first year of clinical practice in the Republic of Ireland. Each EPA contains a series of defined competencies. The final EPAs were found to be comparable to the AAMC core EPAs for entering residency.ConclusionsA framework of EPAs for interns in Ireland that are appropriate for the intern year has been developed by key stakeholders. The implementation of the EPAs in practice is the next step, and is likely to result in an improved intern training process and increased patient safety.

Medical Students' Views on Implementing the Core EPAs: Recommendations From Student Leaders at the Core EPAs Pilot Institutions.

In 2014, the Association of American Medical Colleges recruited 10 institutions across the United States to pilot the 13 Core Entrustable Professional Activities for Entering Residency (Core EPAs). The goal was to establish a competency-based framework to prepare graduating medical students for the transition to residency. Within the Core EPAs pilot, medical students play an influential role in the development and implementation of EPA-related curricula. Student engagement was a priority for the Core EPAs institutions given students' roles as the end users of the curriculum, thus they may offer valuable insight into its design and implementation. Here, the authors provide the perspective of medical students who serve as leaders in the Core EPAs pilot at their respective institutions. They describe student leadership models across the pilot institutions as well as 6 key challenges to implementation of the Core EPAs: (1) How and when should the Core EPAs be introduced? (2) Who is responsible for driving the assessment process? (3) What feedback mechanisms are required? (4) What systems are required for advising, mentoring, or coaching students? (5) Should EPA performance contribute to students' grades? and (6) Should entrustment decisions be tied to graduation requirements? Using a polarity management framework to address each challenge, the authors describe inherent tensions, approaches used by the Core EPAs pilot institutions, and student-centered recommendations for resolving each tension. By sharing the experiences and perspectives of students engaged in the Core EPAs pilot, the authors hope to inform implementation of EPA-oriented assessment practices and feedback across institutions in the United States.

The Impact of Learning Abroad Programs on Graduate Social Work Students’ Competency Development

ABSTRACT This research examines students’ perceptions of how learning abroad programs furthered the development of the nine core EPAS social work competencies. Ninety MSW graduates who participated in a learning abroad course during their graduate program completed an anonymous online survey assessing the association between study abroad participation, cultural engagement, attitudes toward diversity, and social work competency development. Results indicate learning abroad participation had the strongest impact on the development of competencies related to diversity, social justice, and engagement. Ethnic minority students reported participating in learning abroad as particularly important to their competency development. Implications for social work education and research are explored.

Perception and confidence of medical students in informed consent: A core EPA

BackgroundInformed consent discussions have been identified as a core entrustable professional activity for medical students by the Association of American Medical Colleges. Medical students, however, rarely receive formal instruction on how to appropriately conduct informed consent discussions before residency, resulting in inconsistent levels of experience and deficiencies in performance. This study explores medical students’ understanding of the elements of informed consent discussions and their readiness to perform a comprehensive informed consent discussion. MethodsUsing expert consensus, cognitive interviews, and piloting, we iteratively developed a 15-item survey aligned with entrustable professional activity guidelines concerning informed consent discussions consisting of multiple choice, free text, and 5-point Likert-type questions. The instrument covered domains of experience, confidence, medical-legal knowledge, and recall of informed consent discussion elements. The full survey was distributed anonymously to undergraduate medical students at our institution. An abbreviated survey was administered to postgraduate students who were new interns at our institution. Responses were analyzed quantitatively using descriptive statistics. The free text data were coded for inclusion in this analysis. ResultsA total of 75 undergraduate medical students across all years responded (response rate [RR] = 86%), and 34 (RR = 77%) of the postgraduate students who were new interns participated. A total of 45 (75%) undergraduate medical students reported no training on informed consent discussions, and 9 (15%) undergraduate medical students had never witnessed an informed consent discussion. The undergraduate medical students agreed that informed consent discussions could be legally performed by residents and advance practice providers but were unsure whether the same applied to medical students. On a 5-point scale (anchored to “Not at all,” “Somewhat,” and “Extremely”), they were “somewhat confident” in their ability to perform an informed consent discussion. When asked to list the 7 elements of an informed consent discussion, 2 undergraduate medical students (3%) were able to identify all the elements. Although 3 undergraduate medical students (9%) had experience leading an informed consent discussion and 11 (32%) reported formal instruction in informed consent, the ability (3.7 ± 0.9 standard deviation [SD]) of the postgraduate students who were new interns to recall the 7 elements was similar to that of the undergraduate medical students (3.4 ± 1.2 SD); P = .31. ConclusionThese findings suggest that undergraduate medical students and postgraduate students who are new interns are not confident or competent in their ability to perform an appropriate informed consent discussion. Our study findings support the creation of a needs-based, entrustable professional activity–aligned informed consent discussion teaching program and the need for an ongoing evaluation of the success of such a program.

A Self-Evaluation of the AAMC Core EPAs During Residency

PURPOSE: To have residents at all PGY levels self-evaluate their competence with regard to the Core Entrustable Professional Activities for Entering Residency (CEPAER). BACKGROUND: The AAMC has described thirteen areas in which all graduating medical students should be proficient and that these areas should be evaluated for potential deficiencies early in residency. However, these areas of weakness may extend well into residency as these skills may not specifically be taught during residency. METHODS: All residents in an Ob/Gyn program (42 in total) were asked to self-evaluate in each of the thirteen EPAs at the beginning of the academic year using Miller's Pyramid. Each resident marked his or her competency as either, “knows,” “knows how,” “shows how,” or “does.” The responses were dichotomized, grouping the “knows,” and “knows how” as “non-entrustable” and “shows how” and “does” as “entrustable.” RESULTS: Seven of twelve PGY1s and eight of twenty-nine PGY2-4s completed the survey. Four (57.1%) PGY1s self-evaluated as “non-entrustable” for patient handovers, obtaining informed consent, and identifying and correcting systems failures, and five (71.4%) felt “non-entrustable” in writing orders and prescriptions and in general procedures of physicians. All of the PGY2-4s felt “entrustable” in all areas except for two who felt “non-entrustable” in identifying and correcting systems failures. DISCUSSION: The areas noted above may warrant more concerted educational focus at the beginning of an intern's year, but identifying and correcting systems failures appears to be an area that deserves continued education during residency.

Entrustable professional activity 7: opportunities to collaborate on evidence-based medicine teaching and assessment of medical students

BackgroundThis study was conducted to examine gaps and opportunities for involvement of librarians in medical education and patient care as well as improve the teaching and assessment of Entrustable Professional Activity 7 (EPA 7) -- the ability to form clinical questions and retrieve evidence to advance patient care.MethodsThe Association of Academic Health Sciences Libraries (AAHSL) Competency-Based Medical Education Task Force surveyed all AAHSL member libraries in October 2016 on health sciences librarian awareness and involvement in teaching and assessing EPA 7.ResultsThe survey response rate was 54% (88/164 member libraries). While 90% (n = 76) of respondents were regularly engaged in teaching or assessing aspects of EPA 7 only 34 (39%) were involved explicitly in a Core EPA 7 project, 44% (15/34) of these projects were librarian initiated.ConclusionsInvolvement in teaching and assessment of EPA 7 is an untapped opportunity for librarians to collaborate in medical education and patient care. Although librarians are already deeply involved in teaching and assessment of EPA 7 related knowledge, skills, and behaviors, further librarian collaboration can help bolster the planning or updating of existing curricula and assessments of this entrustable professional activity.

Crossing the Gap: Using Competency-Based Assessment to Determine Whether Learners Are Ready for the Undergraduate-to-Graduate Transition.

In 2011, the Education in Pediatrics Across the Continuum (EPAC) Study Group recruited four medical schools (University of California, San Francisco; University of Colorado; University of Minnesota; and University of Utah) and their associated pediatrics clerkship and residency program directors to be part of a consortium to pilot a model designed to advance learners from undergraduate medical education (UME) to graduate medical education (GME) and then to fellowship or practice based on competence rather than time spent in training. The central design features of this pilot included predetermined expectations of performance and transition criteria to ensure readiness to progress from UME to GME, using the Core Entrustable Professional Activities for Entering Residency (Core EPAs) as a common assessment framework. Using this framework, each site team (which included, but was not limited to, the EPAC course, pediatric clerkship, and pediatric residency program directors) monitored learners' progress, with the site's clinical competency committee marking the point of readiness to transition from UME to GME (i.e., the attainment of supervision level 3a). Two of the sites implemented time-variable transition from UME to GME, based on when a learner met the performance expectations and transition criteria. In this Article, the authors describe each of the four sites' implementation of Core EPA assessment and their approach to gathering the data necessary to determine readiness for transition. They conclude by offering recommendations and lessons learned from the pilot's first seven years of development, adaptation, and implementation of assessment strategies across the sites, and discussing next steps.

23 - Preliminary Evaluation of an Intern Clinical Orientation Based on the AAMC Core Epas

Background: New resident physicians demonstrate a wide variation in readiness to perform the skills which are required at the beginning of residency. Most residency programs include an intern orientation, but the content and amount of time focused on clinical skills is variable. In response to concerns regarding the competency of new medical school graduates, the Association of American Medical Colleges (AAMC) has identified 13 core entrustable professional activities (EPAs) for entering residency. A focused needs assessment performed at Inova Children's Hospital prioritized 5 of these EPAs for intern clinical orientation curriculum development: (EPA 2) Prioritize a differential diagnosis following a clinical encounter, (EPA 3) Recommend and interpret common diagnostic and screening tests, (EPA 4) Enter and discuss orders and prescriptions, (EPA 8) Give or receive a patient handover to transition care responsibility, and (EPA 10) Recognize a patient requiring urgent or emergent care and initiate evaluation & management. Based on this needs assessment, the intern clinical orientation was re-designed for 2017.

The integration of a new simulation center within a Competency-Based Curriculum: an opportunity for holistic undergraduate medical education curriculum redesign

This article was migrated. The article was not marked as recommended. Problem: Medical education is shifting to competency based training focusing on 13 Core EPA's for Entering Residency. In response, UME leaders are reforming curricula to focus on Competency Based Education (CBE), and many institutions are choosing to incorporate Simulation Based Educations (SBE) into these efforts. Guidance for institutions planning comprehensive reform and simulation integration is limited. The purpose of this paper is to describe the experience at one medical school attempting to align a new UME curriculum and a new simulation center using CBE principles.Approach: As part of a UME curriculum redesign, the University of Texas Southwestern took two major actions. First, they secured funding to build a campus wide simulation center to host large-scale, high-quality simulation activities. Second, they formed a simulation planning committee to coordinate existing simulation activities and develop new activities to integrate into the new curriculum. This committee chose to use EPAs as an organizing framework.Outcome: The simulation planning committee carefully identified 25 simulation activities that would effectively target core EPAs, while also complementing existing UME courses. The committee identified a director and co-director for each activity and established standard elements that would be common to all simulation activities. Learners' progress through each activity is tracked and verified in a comprehensive portfolio.Next Steps: Throughout the academic year, data will be collected for each simulation activity according to uniform metrics. These data will be used to inform the committee's decisions to continue, modify, or discontinue certain activities for future cohorts of students.

Internal Medicine Residency Program Directors' Views of the Core Entrustable Professional Activities for Entering Residency: An Opportunity to Enhance Communication of Competency Along the Continuum.

To examine internal medicine (IM) residency program directors' (PDs') perspectives on the Core Entrustable Professional Activities for Entering Residency (Core EPAs)-introduced into undergraduate medical education to further competency-based assessment-and on communicating competency-based information during transitions. A spring 2015 Association of Program Directors in Internal Medicine survey asked PDs of U.S. IM residency programs for their perspectives on which Core EPAs new interns must or should possess on day 1, which are most essential, and which have the largest gap between expected and observed performance. Their views and preferences were also requested regarding communicating competency-based information at transitions from medical school to residency and residency to fellowship/employment. The response rate was 57% (204/361 programs). The majority of PDs felt new interns must/should possess 12 of the 13 Core EPAs. PDs' rankings of Core EPAs by relative importance were more varied than their rankings by the largest gaps in performance. Although preferred timing varied, most PDs (82%) considered it important for medical schools to communicate Core EPA-based information to PDs; nearly three-quarters (71%) would prefer a checklist format. Many (60%) would be willing to provide competency-based evaluations to fellowship directors/employers. Most (> 80%) agreed that there should be a bidirectional communication mechanism for programs/employers to provide feedback on competency assessments. The gaps identified in Core EPA performance may help guide medical schools' curricular and assessment tool design. Sharing competency-based information at transitions along the medical education continuum could help ensure production of competent, practice-ready physicians.

Implementing an Entrustable Professional Activities Framework in Undergraduate Medical Education: Early Lessons From the AAMC Core Entrustable Professional Activities for Entering Residency Pilot.

In 2014, the Association of American Medical Colleges (AAMC) published a list of 13 Core Entrustable Professional Activities for Entering Residency (Core EPAs) that medical school graduates might be expected to perform, without direct supervision, on the first day of residency. Soon after, the AAMC commissioned a five-year pilot with 10 medical schools across the United States, seeking to implement the Core EPA framework to improve the transition from undergraduate to graduate medical education.In this article, the pilot team presents the organizational structure and early results of collaborative efforts to provide guidance to other institutions planning to implement the Core EPA framework. They describe the aims, timeline, and organization of the pilot as well as findings to date regarding the concepts of entrustment, assessment, curriculum development, and faculty development. On the basis of their experiences over the first two years of the pilot, the authors offer a set of guiding principles for institutions intending to implement the Core EPA framework. They also discuss the impact of the pilot, its limitations, and next steps, as well as how the pilot team is engaging the broader medical education community. They encourage ongoing communication across institutions to capitalize on the expertise of educators to tackle challenges related to the implementation of this novel approach and to generate common national standards for entrustment. The Core EPA pilot aims to better prepare medical school graduates for their professional duties at the beginning of residency with the ultimate goal of improving patient care.

Constructing a Shared Mental Model for Faculty Development for the Core Entrustable Professional Activities for Entering Residency.

In 2014, the Association of American Medical Colleges identified 13 Core Entrustable Professional Activities for Entering Residency (Core EPAs), which are activities that entering residents might be expected to perform without direct supervision. This work included the creation of an interinstitutional concept group focused on faculty development efforts, as the processes and tools for teaching and assessing entrustability in undergraduate medical education (UME) are still evolving. In this article, the authors describe a conceptual framework for entrustment that they developed to better prepare all educators involved in entrustment decision making in UME. This framework applies to faculty with limited or longitudinal contact with medical students and to those who contribute to entrustment development or render summative entrustment decisions.The authors describe a shared mental model for entrustment that they developed, based on a critical synthesis of the EPA literature, to serve as a guide for UME faculty development efforts. This model includes four dimensions for Core EPA faculty development: (1) observation skills in authentic settings (workplace-based assessments), (2) coaching and feedback skills, (3) self-assessment and reflection skills, and (4) peer guidance skills developed through a community of practice. These dimensions form a conceptual foundation for meaningful faculty participation in entrustment decision making.The authors also differentiate between the UME learning environment and the graduate medical education learning environment to highlight distinct challenges and opportunities for faculty development in UME settings. They conclude with recommendations and research questions for future Core EPA faculty development efforts.

Using the Entrustable Professional Activity Framework to Guide Medical School Training Enhancement

Many undergraduate medical education (UME) programs are interested in implementing Core Entrustable Professional Activities for Entering Residency (Core EPAs). The Core EPAs have been adopted by one northwest medical school for health professional training enhancement, setting expectations for undergraduate medical education environments. The Comprehensive Osteopathic Medical Licensure Examination-USA (COMLEX-USA) is a summative assessment sequence of the National Board of Osteopathic Medical Examiners. COMLEX-USA Level 2PE is a nationally-normed clinical performance evaluation. Results from sub-scores on this assessment can be matched to several entrustable activities, providing a context for discussion on documentation of student achievement within the Core EPA framework.

The Gap Between Current and Ideal Approaches to the Core EPAs: A Mixed Methods Study of Recent Medical School Graduates

In 2014, the Association of American Medical Colleges (AAMC) developed a list of Core Entrustable Professional Activities (Core EPAs) to optimize the transition from medical school to residency training. In the coming years, medical schools will begin implementing curriculum targeted toward the instruction and assessment of the Core EPAs. The purpose of this convergent mixed methods study was to examine the perspective of recent medical school graduates to describe their perceived preparation for each Core EPA-based skill and to identify potential predictors that contribute to those perceptions. Forty-four first-year residents from a single hospital system (representing 29 unique medical schools) completed a questionnaire and 15 residents participated in focus group sessions. Participants were asked to rate their overall preparedness for each of the Core EPAs and describe the instruction and assessment provided during medical school. Responses were further explored through three focus group sessions. Respondents felt most prepared for Core EPAs which emphasized skills related to history and physical examinations (EPAs 1, 5, and 6) and less prepared in skills such as entering orders and prescriptions (EPA 4), performing handovers (EPA 8), and identifying system failures (EPA 13). Perceived preparation was highly correlated with the presence of early and formal training, opportunities for experience, and explicit methods of assessment. Building upon the results of these data and principles of integrated curriculum design, the authors propose a longitudinal method to focus efforts in developing curriculum for the Core EPAs.