EPA Framework Research Articles

Entrustable professional activities: a model for job activity competency framework with microcredentials

PurposeJob competency frameworks are based on the listing skills required for a job. The assumption is that if a candidate is presumed to have the skills, then the candidate should be able to do the job. Thus, employers hope to identify prospective employees having the required skills. However, this may differ from knowing whether the employee is ready to be trusted to do the job activities with minimal or no supervision. The authors pose the question how employers might know about the capability of prospective employees to perform the job activities for which the employees are being hired.Design/methodology/approachIn health professions education, a job activity-based framework has been developed called “entrustable professional activities” (EPAs, activities to be entrusted). This paper reviews the job activity framework and EPAs used in medical education, considering how this might support preparation for work in other sectors of the labor market.FindingsThe authors describe the EPA framework, some implementation issues and how EPAs lead to a type of microcredential being awarded to individuals as the individuals demonstrate that the individuals can be entrusted with specific job activities.Originality/valueThe focus of this paper is to demonstrate that a medical education model could potentially be adopted by other industries to provide employers with information regarding the ability of a prospective employee in performing the job activities required. Such an approach would address employer's concerns about the job readiness of potential employees.

Using entrustable professional activities to better prepare students for their postgraduate medical training: Amedical student's perspective.

Medical students graduate underprepared for postgraduate medical training despite years of classroom and clinical training. In this article, amedical student shares her personal perspectives on three factors contributing to this problem in undergraduate medical education: students' peripheral roles in the clinical environment impede learning, students receive inadequate feedback, and assessments do not measure desired learning outcomes. The authors describe how using entrustable professional activities (EPAs) could address these issues and promote students' clinical engagement by clarifying their roles, providing them with frequent and actionable feedback, and aligning their assessments with authentic work. These factors combined with grading schemes rewarding improvement could contribute to agrowth mindset that reprioritizes clinical skill acquisition. The authors explore how medical schools have begun implementing the EPA framework, highlight insights from these efforts, and describe barriers that must be addressed. Incorporating EPAs into medical school curricula could better prepare students for postgraduate training while also alleviating issues that contribute to student burnout by defining students' roles, improving feedback, and aligning assessments with desired learning outcomes.

Entrustable professional activities for Junior Brazilian Medical Students in community medicine

BackgroundEntrustable professional activities (EPAs) have been defined to promote the workplace participation of undergraduate medical students, generally in the context of high-income countries with a focus on the secondary and tertiary health care sectors. These EPAs have limited applicability to training and health care contexts in low- to middle-income countries that have a focus on primary health care, for instance, the context of community medicine. The purpose of this article is to report the process and results of defining EPAs for undergraduate medical training in a community health care setting.MethodsA modified Delphi study was performed to develop EPAs for the training of medical students in community medicine during their first and second years of education at the Marília Medical School (FAMEMA), Brazil. The supervision level was operationalized in terms of a student’s ability to perform the EPA autonomously in an effective and safe manner with supervision readily available on request. Panellists (9 physicians and 6 nurses) rated the completeness of the proposed list of EPAs and EPA categories on four-point Likert scales. The threshold for consensus among panellists was a mean content validity index of at least 80%.ResultsConsensus was reached after two Delphi rounds, resulting in 11 EPAs for undergraduate medical education and training in community medicine. These EPAs were organized into three overarching EPA domains: integrality of care for individual health needs in all phases of the life cycle (5 EPAs), integrality of care for family health needs (3 EPAs), and integrality of care for community health needs (3 EPAs). For each EPA, descriptions of the following categories were created: title; specifications and limitations; conditions and implications of the entrustment decision; knowledge, skills, and attitudes; links to competencies; and assessment sources.ConclusionThe resulting 11 EPAs for training medical students in community medicine expand the application of the EPA framework to both early undergraduate medical education and the context of primary health care. This report can support and guide other medical schools in their attempts to train students in primary health care contexts and to incorporate EPAs into their curricula.

The logic behind entrustable professional activity frameworks: A scoping review of the literature.

IntroductionEntrustable professional activities (EPAs), discrete profession‐specific tasks requiring integration of multiple competencies, are increasingly used to help define and inform curricula of specialty training programmes. Although guidelines exist to help guide the developmental process, deciding what logic to use to draft a preliminary EPA framework poses a crucial but often difficult first step. The logic of an EPA framework can be defined as the perspective used by its developers to break down the practice of a profession into units of professional work. This study aimed to map dominant logics and their rationales across postgraduate medical education and fellowship programmes.MethodsA scoping review using systematic searches within five electronic databases (Medline, Embase, Google Scholar, Scopus and Web of Science) was performed. Dominant logics of included papers were identified using inductive coding and iterative analysis.ResultsIn total, 42 studies were included. Most studies were conducted in the United States (n = 22; 52%), Canada (n = 6; 14%) and the Netherlands (n = 4; 10%). Across the reported range of specialties, family medicine (n = 4; 10%), internal medicine (n = 4; 10%), paediatrics (n = 3; 7%) and psychiatry (n = 3; 7%) were the most common. Three dominant logics could be identified, namely, ‘service provision’, ‘procedures’ and/or ‘disease or patient categories’. The majority of papers (n = 37; 88%) used two or more logics when developing EPA frameworks (median = 3, range = 1–4). Disease or patient groups and service provision were the most common logics used (39% and 37%, respectively).ConclusionsMost programmes used a combination of logics when trying to capture the essential tasks of a profession in EPAs. For each of the three dominant logics, the authors arrived at a definition and identified benefits, limitations and examples. These findings may potentially inform best practice guidelines for EPA development.

ICRE Top Research Papers.

ICRE Top Research Papers.

Heavy metals in urban road dusts from Kolkata and Bengaluru, India: implications for human health.

Air pollution and dust pollution are major urban environmental issues, with road dust being a potential source and a pathway for human exposure. The developing megacities of India, where the population may spend a significant portion of their working lives close to the roadside, including consuming street food, have obvious source-pathway-receptor linkages. The aim of this study in Kolkata and Bengaluru, India, was to evaluate the risk to human health from inorganic components of road dust. Samples were collected and analysed from a cross section of urban environments for a wide range of anthropogenic and geogenic elements, some such as antimony showing an increase in response to vehicle activity. Calculated enrichment factors relative to crustal abundance demonstrated significant enrichment in common heavy metals and less commonly reported elements, e.g. molybdenum, antimony, that may be used as contaminant markers. Factor analysis gave multielement signatures associated with geography, vehicle traffic and local industry. The bio-accessibility of road dusts in terms of ingestion was determined using the BARGE method with more than 50% of zinc and lead being available in some cases. A formal human health risk assessment using the US EPA framework showed that lead in Kolkata and chromium in Bengaluru were the elements of most concern amongst chromium, nickel, copper, zinc and lead. However, the only risk combination (hazard index) shown to be significant was lead exposure to children in Kolkata. Ingestion dominated the risk pathways, being significantly greater than dermal and inhalation routes.

Evaluation of an undergraduate nursing entrustable professional activities framework: An exploratory qualitative research

BackgroundEntrustable professional activities (EPA) are mainly used in graduate medical education and professional development and have not been widely implemented in nursing undergraduate settings. Nursing EPAs were therefore developed by the Alice Lee Centre of Nursing to translate theoretical nursing competencies into clinical practice and as forms of standardized clinical assessment tools. Feedback from various stakeholders is required to further refine the framework. ObjectivesTo explore the perceptions and experiences of using the new EPA framework in nursing students and hospital and university clinical instructors. DesignAn exploratory qualitative study using focus group interviews. ParticipantsSeven year-one nursing undergraduates, 12 year-two undergraduates, seven university clinical instructors, and 18 hospital clinical instructors participated in this study. MethodsThe students formed five groups, while the clinical instructors formed seven groups, each consisting of three to four participants. Semi-structured interviews were conducted to explore stakeholders' experiences and perceptions of the EPA assessment framework. Thematic analysis was used to analyze the data. ResultsDespite initial mixed reactions of confusion and relief, many students and clinical instructors commended the comprehensive and structured EPA framework and its emphasis on holistic patient-centered care. EPAs also allow flexible assessment methods, encourage critical thinking among students, and promote team-based care and peer teaching. However, the assessment using a two-dimensional matrix with multiple competencies for the EPAs, subjective assessment criteria, the lack of standardization using checklists, subjective assessment criteria, and the lack of, manpower, and time may potentially affect the accuracy of the clinical assessments. The effectiveness of the EPA framework was also dependent on the quality of feedback, students' intrinsic motivations, and learning environments. The refinement of EPAs and entrustment levels, a physical checklist, and an incorporation of EPAs into school curricula were recommended to improve practitioners' learning experiences. ConclusionsThe use of EPAs in nursing education continues to be a novel and evolving process. There remains a need for a further refinement of the EPA framework to tailor to instructors' expectations and students' capabilities.

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.

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.

Appropriate drinking water treatment processes for organic micropollutants removal based on experimental and model studies — A multi-criteria analysis study

The presence of organic micropollutants (OMPs), pharmaceuticals and personal care products (PPCPs) in potable water is of great environmental and public health concern. OMPs are included in the priority list of contaminants in United States EPA and European framework directives. Advanced treatment processes such as reverse osmosis, nanofiltration, ozonation and adsorption are the usual industry-recommended processes for OMPs removal, however, natural systems, e.g., riverbank filtration and constructed wetlands, are also potentially efficient options for OMPs removal. In this study, a decision support system (DSS) based on multi-criteria analysis (MCA) was created to compare processes for OMPs removal under various criteria. Multi-criteria analysis (MCA), a transparent and reliable procedure, was adopted. Models were built for both experimental and predicted percent-removals for a range of OMPs reflecting different physicochemical properties. The experimental percent-removals for several processes (riverbank filtration (RBF), ozonation, advanced oxidation, adsorption, reverse osmosis, and nanofiltration) were considered. The predicted percent-removals were taken from validated quantitative structure activity relationship (QSAR) models. Analytical methods to detect OMPs in water are very laborious, thus a modeling approach such as QSAR is an attractive option.A survey among two groups of participants including academics (PhD students and post-doctoral research associates) and industry (managers and operators) representatives was conducted to assign weights for the following criteria: treatability, costs, technical considerations, sustainability and time. The process rankings varied depending on the contaminant species and personal preferences (weights). The results indicated that RBF and oxidation were preferable over adsorption and membranes processes. The results also suggest that the use of a hybrid treatment process, e.g., combining a natural system with an advanced treatment (oxidation) process, may provide benefits for OMPs removal.The proposed DSS can be used as a screening tool for experimental planning or a feasibility study preceding the main treatment system selection and design. It can also be considered as an aid in assessing a multi-barrier approach to remove OMPs.

流域生态风险评价研究进展

Watershed ecological risk assessment is an important research subject of watershed eco-environmental protection and management,which also uses distinct watershed characteristics compared with regional ecological risk assessment.In this paper,we firstly present the concept and definition of watershed ecological risk assessment based on existing research.The watershed ecological risk assessment is a complicated dynamic process,taking eco-spatial pattern formed by physical landform differentiation and hydrological process as evaluation region,in order to assess the possibility and its harmful levels of the negative influence caused by natural hazard,artificial interference as well as some other risk sources on each ecosystem and its components in the watershed.The process of ecological risk assessment has great ambiguity,uncertainty and relativity.Thus,the focal point is to investigate the relationship and ecological risk effects among the water,soil,vegetation,biodiversity as well as human activity in different hydrologic compartments of the whole watershed. Secondly,we analyze its spatial-temporal characteristics,heterogeneity,regional correlation and integrity and discuss the research hotspot region at present.Based on the properties,the quantity and the extent of risk sources,ecological receptor and ecological endpoint(defined as the damage to ecological receptor),we divide the ecological risk assessment into several types.Through an overview of the development and related research about the watershed ecological risk assessment,the main research subjects related to watershed ecological risk assessment are classified into three kinds.The first subject is about ecological risk of freshwater system,which concerns mainly about eco-toxicological research of one or more contaminants in different compartments of the hydrologic system.The second subject is about ecological risk of natural disasters in watershed,especially the risks of flood,drought,soil erosion on the ecosystem and its components.The third subject is application of comprehensive evluation model for watershed ecological risks involving multiple receptors and risk sources like land use,soil erosion,pollution emission,etc. Thirdly,based on the EPA framework and watershed characters,we build a conceptual model of watershed ecological risk assessment which considers the environmental characteristics of a watershed and can reflect the spatial and temporal changes of the assessment parameters.According to the successive steps of risk assessment as problem formation,risk analysis and characterization,risk management and its feedback,we construct an index system which includes the hazard indicators of risk sources,the vulnerability indicators of habitats as well as the potential loss of risk receptors based on the three basic elements of ecological risk assessment consist of risk sources,habitat and effect.Finally,problems and perspectives are discussed,expecting to make contribution to the further research in this field.

The Legal and Economic Implications of Economic Partnership Agreements in Kenya's Trade Arena: Assessing Liberalization of Agriculture and Food Security

This paper examines the concept of Reciprocal Trade Liberalization – the common objective of Economic Partnership Agreements, and its legal and economic effect on Kenya’s Agricultural Sector/Industry within the purview of the General Agreement on Trade in Services (GATS). The study is premised on the fact that EPA’S are beneficial and within the ambits of WTO’S rules of reciprocal trade among member states, however, it advocates for legal caution and prudence on the same considering that Kenya is a developing Nation with higher economic obligations and ambitions than that of its trading partner the European Union (EU). The review particularly focuses on the International Convention for the Protection of New Varieties of Plants (UPOV) in relation to EPA negotiations and implementation. It then assesses whether the EPA framework has adequately addressed, food security and biosafety with respect to farmers and plant breeders’ rights, sustainable development, access and benefit sharing (ABS) and protection of traditional knowledge in agriculture. The place of the UPOV is of utmost significance in Kenya’s Agriculture sector because Kenya is a signatory of the 1978 UPOV Act whereas there is in place the 1991 UPOV Act (the basis of EPA negotiations on Agriculture) which has broader objectives and features, with respect to plant varieties and the time frame for protection on the same. Currently, Kenya’s Agricultural policies, legislations and institutions reflect the objectives of UPOV 1978. This essentially means that should Kenya decide to accede to UPOV 1991 which is more EPA compliant, first, it will have to amend its laws governing agriculture and intellectual property rights to adjust with its new commitments under UPOV 1991, and secondly to be in tandem with relevant plant variety protection clauses in the EPA framework. In view of the above, there good chances for policy and legislative conflict with the possibility of distorting Kenya’s trade performance. Therefore, what mechanisms are available to bridge the gap so as to ensure it is compliant with the ESA-EU EPA provisions? If there are available mechanisms, are the same viable to vouch Kenya’s competitiveness in the EPA trade arena?

Scientific Issues in the U.S. EPA Framework for Metals Risk Assessment

This article on the U.S. Environmental Protection Agency document, “Framework for Metals Risk Assessment” (U.S. EPA, 2007a) was presented at the “Health Risk Assessment of Essential Metals” Workshop held at the University of Ottawa in May 2008. This article discusses the basic principles included in the Framework for Metals Risk Assessment and outlines how these principles need to be considered in human health and ecological risk assessment practices. Recognizing that metals present unique risk assessment issues, the article includes discussion of the various scientific issues related to metals assessments, such as environmental chemistry, bioavailability, bioaccumulation, and essentiality.

Importance of Considering the Framework Principles in Risk Assessment for Metals

The recent EPA Framework for Metals Risk Assessment provides the opportunity for contextual risk assessment for sites impacted by metals (such as the depicted Dauntless Mine in Colorado).

Organizing Citizen Engagement for Democratic Environmental Planning

In recent years civic engagement emphasizing community involvement and collective learning has become a centerpiece of environmental management. This article explores civic participation in water resources management and whether a framework developed by the U.S. Environmental Protection Agency (U.S. EPA) fosters democratic environmental planning. We provide an overview of citizen involvement in water resource management, discuss the U.S. EPA framework, and highlight key issues with two case studies. It is widely acknowledged that lack of meaningful stakeholder and other public input in the planning process may lead to barriers to successful environmental management. Our case studies indicate that the U.S. EPA framework, while not new or especially innovative, represents a necessary commitment to civic engagement and provides a structure for organizing it. Findings from our study emphasize the importance of financial resources and strong commitment to the principle of civic engagement in order to increase and sustain the democratic underpinnings of environmental planning.

Exposure to multiple environmental agents and their effect

All children are exposed to multiple physical, chemical and biological challenges that can result in adverse health effects before and after birth. In this context, the danger of multiple exposures cannot be assessed from a single-chemical approach as used in classical toxicology. To open up a 'negotiation space' for the problem of multiple exposure to environmental stressors, defined as any physical, chemical or biological entity that can induce an adverse response. In this context, two further questions obtain: to what extent can synergistic risks be assessed, and how far could potential adverse effects be prevented by enhanced regulation? A discussion of two general approaches is taken: 1) the investigation of mixtures such as smoking or air pollution without specifying the individual agents, and 2) the investigation of individual substances with a focus on possible interactions in the context of dose to receptor. Although mixtures of compounds can have effects, it may not be possible to ascribe causation to a single compound. Furthermore, cumulative low-dose insult can, in some circumstances, be more toxic than a single high-dose exposure, e.g. endocrine disruptive effects of a combination of PCBs and dioxins which disrupt the thyroid hormone status; this tends to contradict elements of classical toxicology, . These cumulative insults may further combine with heavy metals and can disrupt the heme synthesis. It is possible that groups of pollutants could be used to test their cumulative capacity to multiple stress-susceptible receptor targets as is done in smoking and air pollution. This methodology could be used for further groups of potential pollutants, for example those associated with cleaning products, or cosmetics. Testing individual substances with a focus on interactions means that not only chemicals but also concurrent diseases should be taken into account. We suggest that the enhanced regulation of potential multiple stressors falls into two discrete categories. The first comprises a more precautionary approach (as demonstrated by the banning of chemicals such as some brominated flame retardants in Europe). The second comprises a more 'permissive' liberal approach involving the initial study of an individual compound, and subsequent interrogation of that compound in combination with another (as demonstrated by lowering the carcinogenicity of aflatoxin by vaccination against hepatitis B). It is necessary to define and study groups of multiple stressors as in US EPA's Framework for Cumulative Risk Assessment (U.S. EPA 2003). Recent increased knowledge of the greater sensitivity of the unborn baby, the infant and the child, has led to general recognition that a higher degree of precaution is now needed in regulating for multiple stressors on the young. The more liberal permissive approach proceeding from established effects of the individual exposures is becoming less acceptable now that we know that there is much we do not understand about chronic effects of stressors during the early development phases. Conflicts over which approach to take may have to be resolved through engagement and negotiation with a wide community of stakeholders. This "community of interest" may include fundamental research scientists, practicing clinical paediatricians, patient groups, and others concerned with the health and wellbeing of infants and children.

Ecological Risk Assessment in Water Resource Management

The US EPA published guidelines for the application of ecological risk assessment (ERA) in the USA in 1998 (US EPA 1998). The process diagram derived by Murray and Claassen (1999) in an evaluation of the US EPA framework is discussed in the context of the South African National Water Act. The evaluation discusses the various steps involved in an ERA and how it can be applied in the implementation of the National Water Act. It is concluded that the application of ERA can make a significant contribution towards sustainable water resource management. Two requirements for this are the need for more demonstration projects and that capacity be developed in risk assessment and risk-based decision making.

PPG to use EPA Framework to make safer chemicals

PPG to use EPA Framework to make safer chemicals

Biological responses of the sea urchin, Arbacia punctulata, to lead contamination for an estuarine ecological risk assessment

An estuarine ecological risk assessment for thePortsmouth Naval Shipyard (PNS) Kittery, ME, wasconducted utilizing the U.S. EPA's Framework forEcological Risk Assessment (ERA). As part of theanalysis phase of the ERA, laboratory studies wereconducted to develop quantitative exposure-responserelationships for lead (Pb), a key contaminant ofconcern for PNS, in order to evaluate the role of Pbin the ecological stress observed near PNS, and toestimate the probability of ecological risk associatedwith Pb contamination at the site. Biological effectsof exposure to Pb via sediment or diet were evaluatedusing several life stages of the sea urchin, Arbacia punctulata. This strategy was employedbecause echinoderm species, including A.punctulata, are amenable to laboratory testing andhave been used frequently to assess the toxicity ofestuarine waters and sediments. In addition, lifestage-specific biological effects could be comparedand integrated into projections of population-levelresponses to Pb. Results indicated that adult seaurchins accumulated Pb in direct proportion toexposure medium Pb concentration, whether exposureoccurred via sediment or diet. High Pb concentrationsreduced survival and gamete production in females, buthad no effect on the viability of produced gametes. Aqueous Pb exposure concentrations that producedadverse effects on adult sea urchin survival andreproduction were also directly toxic to early lifestages. In addition to their utility for this ERA,these results have applicability for the prediction ofbiological effects or the retrospective analysis ofcausal relationships at other estuarine sites.