Entrustable Professional Activities Research Articles

Implementation and Evaluation of Entrustable Professional Activities for a Pharmacy Intern Training Program in Australia

The purpose of this study was to describe the implementation and evaluation of Entrustable Professional Activities (EPAs) for a pharmacy Intern Training Program in Australia. Surveys and focus groups were used to evaluate the perceptions and experiences of provisionally registered pharmacists and pharmacists using the EPAs as an assessment tool in the workplace. Thematic analysis was used to analyse the focus group data. Surveys compared the frequency and median responses to the Likert scale items. Entrustment levels at six, 13, 26 and 44 weeks were reported for each EPA. Pharmacist (n=6) and provisionally registered pharmacist (n=8) focus groups identified the following themes: use of EPAs in the workplace, benefits and challenges of using EPAs and future direction and recommendations for using EPAs in the workplace. Feasibility measures in the pharmacist survey suggested that pharmacists were satisfied with using EPAs in the workplace. The provisionally registered pharmacist survey showed that they valued feedback given by pharmacists and that they engaged with the EPAs in the workplace. Provisionally registered pharmacists enrolled in the study (n=40) showed progression in entrustment levels at each reporting period. Pharmacists and provisionally registered pharmacists reported that EPAs were feasible and could be utilised in the workplace as an educative tool, however highlighted the importance of education as an important factor for successful implementation. At each milestone, provisionally registered pharmacists showed progression of entrustment level.

Assessing ChatGPT’s impact on curriculum outcomes and Entrustable Professional Activities (EPAs) during Advanced Pharmacy Practice Experiences (APPEs)

Background: Chat Generative Pre-trained Transformer (ChatGPT) use in higher education has been controversial. The purpose of this study was to evaluate the impact of ChatGPT on pharmacy student achievement of educational outcomes and entrustable professional activities, as outlined by the American Association of Colleges of Pharmacy (AACP), during Advanced Pharmacy Practice Experiences (APPEs). Methods: A 20-question electronic survey was distributed to pharmacy students in the Class of 2023 and 2024. The survey evaluated the impact of ChatGPT on educational outcomes and student perceptions of the technology. Results were analysed using descriptive statistics. Results: A total of 69 students participated in the survey. Among them, 44% (17/39) used ChatGPT during their APPE rotations. Of those, 82% (14/17) of students agreed or strongly agreed that ChatGPT helped them find, analyse, and integrate foundational knowledge of medications. Similarly, 82% (14/17) agreed or strongly agreed that ChatGPT positively impacted their approach to work and research habits. Additionally, 89% (15/17) agreed or strongly agreed that they will use ChatGPT on future APPEs and in professional practice. Conclusion: The use of ChatGPT by pharmacy students during their APPE rotations demonstrates a potential benefit in student achievement of educational outcomes across all three domains during APPEs.

Can routine EPA-based assessments predict OSCE performances of undergraduate medical students?

Background Objective structured clinical examination (OSCE) is used worldwide. This study aims to explore potential alternatives to the OSCE by using entrustable professional activities (EPA)-based assessments in the workplace. Methods This study enrolled 265 six-year undergraduate medical students (UGY) from 2021 to 2023. During their rotations, students were assessed using 13 EPAs, with the grading methods modified to facilitate application. Before graduation, they participated in two mock OSCEs and a National OSCE. We used generalized estimating equations to analyze the associations between the EPA assessments and the OSCE scores, adjusting for age and sex, and developed a prediction model. EPA8 and EPA9, which represent advanced abilities that were not significant in the regression models, were removed from the prediction model. Results Most EPAs were significantly correlated with OSCE scores across the three cohorts. The prediction model for forecasting passing in the three OSCEs demonstrated fair predictive capacity (area under curve = 0.82, 0.66, and 0.71 for students graduated in 2021, 2022, and 2023, respectively all p < 0.05). Conclusions The workplace-based assessments (EPA) showed a high correlation with competency-based assessments in simulated settings (OSCE). EPAs may serve as alternative tools to formal OSCE for medical students.

Bridging the procedures skill gap from medical school to residency: a simulation-based mastery learning curriculum.

The transition from medical student to intern is a recognized educational gap. To help address this, the Association of American Medical Colleges developed the Core Entrustable Professional Activities for entering residency. As these metrics outline expectations for all graduating students regardless of specialty, the described procedural expectations are appropriately basic. However, in procedure-heavy specialties such as emergency medicine, the ability to perform advanced procedures continues to contribute to the disconnect between undergraduate and graduate medical education. To prepare our graduating students for their internship in emergency medicine, we developed a simulation-based mastery learning curriculum housed within a specialty-specific program. Our overall goal was to develop the students' procedural competency for central venous catheter placement and endotracheal intubation before graduation from medical school. Twenty-five students participated in a simulation-based mastery learning procedures curriculum for ultrasound-guided internal jugular central venous catheter placement and endotracheal intubation. Students underwent baseline assessment, deliberate practice, and post-test assessments. Both the baseline and post-test assessments used the same internally developed checklists with pre-established minimum passing scores. Despite completing an emergency medicine rotation and a critical care rotation, none of the students met the competency standard during their baseline assessments. All twenty-five students demonstrated competency on both procedures by the end of the curriculum. A second post-test was required to demonstrate achievement of the central venous catheter and endotracheal intubation minimum passing scores by 16% and 28% of students, respectively. Students demonstrated procedural competency for central venous catheter placement and endotracheal intubation by engaging in simulation-based mastery learning procedures curriculum as they completed their medical school training. With three instructional hours, students were able to achieve basic procedural competence for two common, high-risk procedures they will need to perform during emergency medicine residency training.

Entrustable Professional Activities in Medical Education: SELECT Leadership, Values-Based Patient-Centered Care, Health Systems, and Scholarly Excellence

Entrustable Professional Activities (EPAs) represent a concept in medical education that has gained significant traction over the last few years, particularly in the context of competency-based medical education. An EPA refers to a specific task or responsibility that can be entrusted to a trainee once they have demonstrated the necessary competence. EPAs provide concrete tasks that a trainee should be able to complete at various stages of training in order to clarify expectations and responsibilities they should master. The University of South Florida Morsani College of Medicine (USFMCOM), Scholarly Excellence, Leadership Experiences, Collaborative Training (SELECT) MD program pairs a unique four-year longitudinal leadership program including the domains of leadership, values-based patient-centered care, health systems, and scholarly excellence with an innovative medical degree program. Students in the SELECT program spend the first two years on the campus in Tampa, Florida, and the clinical years on the regional campus in Allentown, Pennsylvania. These additional threads of curriculum call for a unique set of EPAs. A working group of faculty, students, and administrators within the college from both the main and regional campus developed EPAs for each of the above listed areas of focus within the curriculum. In this paper, the authors describe how Entrustable Professional Activities were developed at MCOM to assess the SELECT curriculum in the areas of leadership, values-based patient-centered care, health systems, and scholarly excellence.

For which entrustable professional activities must medical students be prepared if unsupervised patient care without further training is an expectation? An international Global South study

IntroductionTraining medical students requires objectives that are often translated into frameworks of competencies. Since the introduction of entrustable professional activities (EPAs), these tasks or ‘units of professional practice’, originally conceived...

Entrustable Professional Activities for Cytopathology Fellowship

Entrustable professional activities (EPAs) are an educational tool in the framework of competency based medical education. EPAs are a relatively new concept in pathology. No studies to date exist on the utilization of EPAs during cytopathology fellowship training. This article reviews the recent literature on this topic and shares our institutional experience with the implementation of an EPA for fine needle aspirations (FNAs) and rapid on-site evaluations (ROSEs). While EPAs allow for tracking the competence of the cytopathology fellow toward independent practice for FNAs and ROSEs, the required amount of documentation may represent a potential barrier for the widespread adoption of this new tool.

Structured Debriefing to Assess Performance of Entrustable Professional Activities.

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.

Exploring the Utility of a Novel Approach of Evaluating Application of a Validated Violence Risk Assessment Instrument.

Mental health nurses are often responsible for assessment/management of inpatient aggression. Validated instruments such as the Dynamic Appraisal of Situational Aggression (DASA), can aid risk assessment. However, limited attention has been paid to evaluating nurses' ability to administer risk assessment instruments. An entrustable professional activity may offer way of evaluating risk assessment clinical activities. DASA trainers' perceptions of the value and utility of an EPA were explored via collection of data through focus groups, with 17 participants from six countries. Thematic analysis was conducted to analyze the data. Three themes were interpreted: (1) DASA trainers-a way of knowing and being (2) An EPA-something you did not know you need until you see it; (3) The DASA-EPA supports the need for training and importance of integrity in assessment. Trainers engaged in innovative ways to ensure training is suitable and responsive to needs of nurses and their setting. Participants understood how an EPA could be used to evaluate DASA administration, monitor DASA use, provide feedback, and highlight the importance of training to ensure best practice.

Postgraduate Training: eLogbook, Entrustable Professional Activities & Co.

The transformation of time-bound and procedure-oriented specialist medical postgraduate training towards a competency-based approach (competency-based medical education, CBME) has been demanded for several years. Many frameworks, like the CANMEDs (Canadian Medical Education Directives for Specialists) describe competencies that should be acquired by each physician. In Germany, the medical council has recently obligated a competency-based postgraduate training. Although the idea of CBME emphasizes the learning process at the working place, CBME has also been criticized to be too theoretical and detached from the clinical working practice. To close this gap, the concept of Entrustable Professional Activities (EPA) has been introduced. An EPA describes concrete clinical tasks that are successively entrusted to the trainee. The decision to entrust a task is supported by the sum of workplace-based assessments.Sustainable implementation of competency-based training requires close collaboration among all involved individuals and institutions. Furthermore, continuous feedback and open dialogue are crucial for identifying challenges and areas for improvement. The success of CBME hinges on the collective effort of all stakeholders to create a framework to enhance specialty training and an overall advancement in the field. This cooperative approach is essential to successfully translate the theoretical foundations of competency-based teaching into clinical practice and ensure high-quality specialty training.

426 - Entrustable Professional Activities for Radiation Therapy Students: A Literature Review

426 - Entrustable Professional Activities for Radiation Therapy Students: A Literature Review

Development of Entrustable Professional Activities in Adult Nephrology Fellowship Training

Development of Entrustable Professional Activities in Adult Nephrology Fellowship Training

Redesigned Entrustable Professional Activity (EPA) Assessments Reduce Grade Inflation in the Experiential Setting

ObjectiveThis study aims to evaluate the impact of redesigning an entrustable professional activities (EPAs) assessment tool on the accuracy of student performance assessment within pharmacy education. MethodsThe study used retrospective programmatic data for students on clinical rotations over a 3-year period and compared entrustment levels assigned by preceptors with suggested entrustment levels. This tool was redesigned to separate formative EPA feedback from final grade determination. Data were analyzed using chi-squared tests to identify trends in students ABOVE, AT, or BELOW the suggested entrustment levels. Additionally, to account for intercohort variability, the relationship between students ABOVE the suggested level of entrustment and postgraduate metrics was examined. ResultsAfter the implementation of the revised tool, there was a significant decrease (−3%) in the percentage of students scoring ABOVE the suggested entrustment levels and an increase in the percentage of students scoring AT (+1%) or BELOW (+2%) the suggested entrustment levels. Changes were also observed in individual patient care settings, with a decrease in grade inflation and an increase in accurate assessments. North American Pharmacist Licensure Examination (NAPLEX) pass rates, residency match rates, and grade point average did not correlate with entrustment levels. ConclusionThe redesigned EPA assessment tool demonstrated a decrease in grade inflation resulting in more accurate assessments. The tool’s focus on holistic grading and narrative descriptors contributed to better alignment between preceptor assessment and school-suggested achievement levels. This study suggests that EPA assessments in pharmacy education could benefit from a stronger emphasis on formative feedback and the use of holistic assessment methods for final grade determinations. The findings underscore the potential advantages of considering a separation between EPA scoring and final grades, prompting the Academy to explore their assessment practices to better reflect student performance in clinical experiences.

Enhancing medical training in conflict zones and remote areas through innovation: introducing the Canadian Virtual Medical University Initiative

The WHO projects a global shortage of 4.3 million physicians by 2030, with the largest deficits in developing and conflict-affected regions. Our aim is to train competent physicians rapidly and affordably through remote education programs. We developed an online medical training curriculum with four levels, focusing on different aspects of human body systems using a competency-based, student-centered approach. This study evaluates the first three levels; level four (internship) is outside this scope. The 105 medical students from eight Afghan universities were randomly assigned to nine groups. The curriculum includes Entrustable Professional Activities (EPA) for the cardiovascular system: level 1 covers basic medical sciences, level 2 pathology and basic clinical skills, and level 3 full clinical competencies. EPAs were delivered asynchronously online via Lecturio, CyberPatient, and Zoom. The 30-day intervention included 4h of weekly online classes for formative assessment, collaborative learning, and evaluation, supervised by medical faculty members. Virtual pre- and post-intervention evaluations used multiple-choice questions and objective structured clinical examination (OSCE). We also conducted a satisfaction survey and open interview forum. Data triangulation from observations, surveys, and interviews validated curriculum effectiveness. The benchmarking method assessed cost-effectiveness. Pre- and post-intervention analysis showed a significant increase in clinical competencies and knowledge acquisition (P<0.0001). The CyberPatient intervention improved clinical competency quality (P<0.0001) and shortened decision-making time (P<0.001). Cost analysis revealed that a virtual medical university would be 95% more cost-effective than traditional medical education. Integrating virtual technology with modern curriculum concepts in pre-internship years can effectively address healthcare training gaps and enhance education quality for healthcare workers at a low cost. Provided by CanHealth International. A UBC spin-off not-for-profit organization.

Entrustable professional activities in medical education and their importance

The Article Abstract is not available.

Assessment Tools for Patient Notes in Medical Education: A Scoping Review.

Physician proficiency in clinical encounter documentation is a universal expectation of medical education. However, deficiencies in note writing are frequently identified, which have implications for patient safety, health care quality, and cost. This study aimed to create a compendium of tools for educators' practical implementation or future research. A scoping review was conducted using the Arksey and O'Malley framework. PubMed, Embase, Ovid All EBM Reviews, Web of Science, and MedEdPortal were searched for articles published from database inception to November 16, 2023, using the following search terms: documentation, note-writing, patient note, electronic health record note, entrustable professional activity 5, and other terms. For each note-writing assessment tool, information on setting, section(s) of note that was assessed, tool properties, numbers and roles of note writers and graders, weight given, if used in grading, learner performance, and stakeholder satisfaction and feasibility was extracted and summarized. A total of 5,257 articles were identified; 32 studies were included. Eleven studies (34.4%) were published since 2018. Twenty-two studies (68.8%) outlined creating an original assessment tool, whereas 10 (31.2%) assessed a curriculum intervention using a tool. Tools varied in length and complexity. None provided data on equity or fairness to student or resident note writers or about readability for patients. Note writers often had missing or incomplete documentation (mean [SD] total tool score of 60.3% [19.4%] averaged over 25 studies), often improving after intervention. Selected patient note assessment tool studies have been cited a mean (SD) of 6.3 (9.2) times. Approximately half of the tools (53.1%) or their accompanying articles were open access. Diverse tools have been published to assess patient notes, often identifying deficiencies. This compendium may assist educators and researchers in improving patient care documentation.

When the first try fails: re-implementation of SIMPL in a general surgery residency

BackgroundWorkplace-based assessment (WBA) can facilitate evaluation of operative performance; however, implementation of WBA is sometimes unsuccessful. The American Board of Surgery Entrustable Professional Activities WBA project was launched in July 2023. Some programs will face the challenge of re-implementation of a WBA following previous failures. It is unknown what interventions are most effective for WBA re-implementation. Our goal is to identify barriers and facilitators to re-implementing SIMPL, an operative performance WBA.MethodsThe System for Improving and Measuring Procedural Learning (SIMPL) was implemented at our residency in 2018, but usage rates were low. We interviewed residents and faculty to identify barriers to usage and opportunities for improvement. Residents reported that SIMPL usage declined because of several factors, including a low faculty response rate, while some faculty reported not responding because they were unable to login to the app and because usage was not mandated. We then re-implemented SIMPL using a plan based on Kotter’s Model of Change. To evaluate impact, we analyzed rates of SIMPL usage when it was first implemented, as well as before and after the date of re-implementation.ResultsIn September 2022, we re-implemented SIMPL at our program with measures addressing the identified barriers. We found that, in the six months after re-implementation, an average of 145.8 evaluations were submitted by residents per month, compared with 47 evaluations per month at the start of the original implementation and 5.8 evaluations per month just prior to re-implementation. Faculty completed 60.6% of evaluations and dictated feedback for 59.1% of these evaluations, compared with 69.1% at implementation (44% dictated) and 43% prior to re-implementation (53% dictated).ConclusionsAfter identifying barriers to implementation of a WBA, we re-implemented it with significantly higher usage by faculty and residents. Future opportunities exist to implement or re-implement assessment tools within general surgery programs. These opportunities may have a significant impact in the setting of national standardization of workplace-based assessment among general surgery residencies.

Equity, diversity, and inclusion in entrustable professional activities based assessment.

Recognizing the value of Entrustable Professional Activities, Hennus and Chen argue that deliberate and conscious efforts at implementation are pivotal to addressing and mitigating the risks of racism and bias.

Facilitating Integration of Interprofessional Education-related Entrustable Professional Activities into the Medical Curriculum

Abstract In competency-based education, entrustable professional activities (EPAs) play a defining role in developing the competence of students by providing contextual relevance. EPAs aid in the assessment of both cognitive and noncognitive (namely teamwork, leadership, communication skills, professionalism, etc.) attributes of the student. In fact, the inclusion of EPAs targeting interprofessional education (IPE) in the curriculum strengthens collaborative learning. The process of integration of EPAs related to IPE in the medical curriculum requires systematic planning and implementation to encourage collaborative learning and prepare students for medical practice. Assessment of IPE-related competencies using EPAs can be carried out with the help of different methods. In conclusion, EPAs can significantly strengthen the delivery of IPE by promoting collaboration and teamwork. There is an immense need to integrate IPE-related EPAs into the medical curriculum to improve the quality of care and patient-related outcomes.

Effective Implementation of Entrustable Professional Activities in Medical Colleges: Faculty Perspective

Abstract Entrustable professional activities (EPAs) refer to the key activities that medical students should be in a position to perform on their own by the time of completion of their training. The process of implementation of EPAs in medical training is a complex and challenging one. In medical colleges, faculty members have been identified as the change agents who will eventually determine the success and effectiveness of planning and implementation. From the faculty perspective, multiple challenges have been identified, including the reluctance to adopt EPAs and preference for traditional assessment methods. In conclusion, the success of EPAs integration into the medical curriculum, as evidenced by improvement in the learning outcomes essentially requires active support from faculty members. Thus, there is an immense need to strengthen faculty development activities to enhance their competency and confidence to implement EPAs.