Preceptor Feedback Research Articles

Preceptor Feedback on Utilization and Pre-APPE Performance Expectations of Pharmacy Practice Skills

ObjectiveThis study aimed to determine the frequency with which preceptors perform skills in their practice setting and the degree of competency that preceptors expect from students to perform those skills upon starting their advanced pharmacy practice experiences (APPEs). MethodsA survey assessing skill utilization and expected pre-APPE student competency level upon entry to APPEs was developed by pharmacy practice faculty and distributed to preceptors. Preceptors were asked to rank their utilization of skills and expected pre-APPE student competency of each skill. Investigators assigned each skill a categorical ranking of high, moderate, or low priority. ResultsThe survey was completed by 448 pharmacy preceptors. Skills related to communication, patient education, documentation, collecting medication histories, and drug therapy review/reconciliation were the most utilized. Skills related to physical assessment and point-of-care testing were the least utilized, and the expected student competency level was also low. Skills identified as highest-priority included those related to patient counseling/education, problem-solving/critical thinking, and information gathering and management. ConclusionThe results of this survey suggest that the frequency with which preceptors perform specific skills in practice and their corresponding competency expectations for APPE students vary and are skill-dependent, allowing for prioritization. Stratifying individual skills according to how commonly they are encountered in practice and the competency levels expected by APPE preceptors can assist institutions in prioritizing skills-based laboratory content and assessment and in addressing curricular bloat and hoarding.

Focused Preceptor Feedback Assessing Student Pharmacists’ Ability to Administer Pediatric Immunizations

ObjectiveTo evaluate experiential pharmacy preceptor perceptions of student pharmacists’ ability to administer pediatric immunizations. MethodsSemi-structured, qualitative key informant interviews using the Outcomes Evaluation Framework were conducted with 10 pharmacist preceptors in outpatient community pharmacies where pediatric immunizations were provided. Interviews were audio-recorded, transcribed, and deidentified prior to analysis by the research team. Qualitative analysis and thematic coding procedures were used to identify relevant themes. ResultsSaturation was met after 10 pharmacists participated. All stated that it was beneficial for student pharmacists to administer pediatric vaccines if trained in proper technique. Participants acknowledged that the training students currently receive in immunization administration within the PharmD curriculum is valuable but did identify general confidence and child-comforting techniques during and after vaccination as areas of improvement for students. Just-in-time training, preceptor coaching, and hands-on practice outside of the didactic curriculum were utilized to help build confidence. Barriers to the implementation or expansion of pediatric immunization delivered by students in community pharmacies were identified as competing priorities, time, and reimbursement. ConclusionStudent pharmacists can be helpful in easing the challenges of incorporating pediatric immunization services into the community pharmacy setting. Results demonstrate that the integration of student pharmacists into these services is beneficial. Pediatric immunizations are still relatively new to many pharmacists and specific training for pediatric immunization administration may not be integrated into all Doctor of Pharmacy curricula but the experiential education of pediatric immunization training can be beneficial to help prepare student pharmacists for hands-on practice.

Inquiry for the win: Fostering curiosity through a BINGO exercise in a longitudinally integrated clerkship

Educational Challenge As technological advancements challenge the current roles healthcare workers fill, curiosity and lifelong learning are becoming increasingly important. However, descriptions of specific curricular interventions that successfully develop these attitudes and skills remain limited. Proposed Solution We aimed to promote curiosity and advance practical application of evidenced-based medicine through a longitudinal, gamified learning activity within a longitudinal integrated clerkship (LIC). Thirty-seven students across two inquiry-themed LICs based at a university hospital and a community-based integrated healthcare delivery system used BINGO cards containing various assignments designed to develop the skill of asking and answering clinical questions. Assignments included: engaging experts, using evidence-based medical resources, attending education events, utilizing medical library resources, and Phone-a-Scientist. Students shared their experiences in a group setting and wrote a reflection for each assignment that was qualitatively analyzed to determine the perceived educational outcomes according to the Kirkpatrick Evaluation Model. Lessons Learned Results suggest that Inquiry BINGO fosters curiosity and builds skill in applied evidenced-based medicine early in clinical training. Most assignments prompted students to engage in opportunities they might not have otherwise explored. All but three students reported a change in behavior as a result of the assignment and 57% reported positive clinical or research results. Next Steps Future iterations of this activity should be evaluated by obtaining patient and/or preceptor feedback as well as longitudinal evaluations of student behavior to ensure higher level educational outcomes are being met.

The influence of educational reform on the self-perceived readiness to practice of newly registered pharmacists in Ireland

Abstract Introduction Newly registered pharmacists serve important roles in our healthcare system. Investigation of their readiness to practice confirms whether their education has furnished them with the knowledge, skills and competencies to be practice-ready. In 2015, a five-year integrated master’s programme in Pharmacy replaced a 4 + 1 model and included integrated learning with dispersed experiential learning placements. Factors known to influence self-perceived readiness to practice are prior experiential learning, education, placement environment and preceptor relationship. Aim This study examined the self-perceived readiness to practice of newly registered pharmacists in their first year of qualification and the influence of educational reform. Methods The participants were newly registered pharmacists who had completed the undergraduate Pharmacy programme within the State. Participants were identified using the Pharmaceutical Society of Ireland’s database of newly qualified registrants. An email was circulated to registrants inviting them to participate in a cross-sectional online survey consisting of 25 items. Variables were self-perceived abilities to perform practice-related competencies (on a five-point Likert scale), relationship with preceptor, placement experience, and demographic information. Three cohorts were surveyed. The first cohort (2020) were graduates from the last year of the 4 + 1 programme. The second (2021) and third (2022) cohorts were graduates from the new five-year integrated programme. All analyses were performed using SPSS 24.0 (SPSS Inc, Chicago, IL, USA) and Microsoft Excel. Results Of 458 registrants, 71 completed the survey (response rate=15%). A greater proportion of females (65%, n=46) than males (31%, n=22) responded to this survey, with 4% (n=3) not disclosing a gender. Most respondents (83%, n=59) had undertaken a community pharmacy placement, while others had either a hospital placement (11%, n=8) or a mixed setting placement (5%, n=4). Participants perceived that they were adept at performing practice-related competencies. Participants agreed that they developed fruitful relationships with preceptors and had positive experiences on placement; when asked about preceptor feedback, there was a positive response: 55% for (n=17), 83% for 2021 (n=15), and 95% for 2022 (n=21). A curriculum effect was observed, as graduates from the post-reform cohort declared readiness to practice in more areas than pre-reform graduates, e.g. in leadership: (58% for 2020 [n=18], 61% for 2021 [n=11], and 73% for 2022 [n=16]), communication (58% for 2020 [n=27], 61% for 2021 [n=16], and 73% for 2022 [n=21]), and recommending drug therapies (77% for 2020 [n=24], 72% for 2021 [n=13], and 95% for 2022 [n=21]). Conclusion This study found that most respondents self-perceived themselves as ready for autonomous practice. Whilst this study found that the pharmacists surveyed were ready to practice, they may still lack practical skills. This study suggests adopting an integrated curriculum that incorporates experiential learning is supportive of readiness to practice and has a positive impact on self-perceived readiness to practice, placement setting, and preceptor relationships. The repeated cross-sectional nature of the study is a strength, but a limitation is the low response rate and there may be response bias by participants. This research seeks to contribute to curriculum development to support students in their transition to professional practice.

Preceptors' perceptions of an entrustable professional activities-based community introductory pharmacy practice experience curriculum

IntroductionIn 2021, the Southeastern Pharmacy Experiential Education Consortium implemented Entrustable Professional Activities (EPAs) into the community introductory pharmacy practice experience (IPPE) curriculum at five colleges/schools of pharmacy. The objective of this study was to evaluate community IPPE preceptors' perceptions regarding the newly implemented EPA-based community IPPE curriculum and corresponding preceptor training. MethodsCommunity IPPE preceptors who precepted first-year student pharmacists in the EPA-based curriculum during the 2021 and 2022 community IPPE cycles were invited to complete a voluntary electronic survey. The survey collected preceptor feedback regarding the required EPA tasks, assessment tool, and preceptor development module. ResultsEighty-eight preceptors began the survey, and approximately half completed the entire survey. Greater than 92% of preceptors surveyed agreed or strongly agreed EPA domain tasks were developed at an appropriate level for a student to complete by the end of the community IPPE, and ≥ 94% agreed or strongly agreed tasks prepared a community IPPE student for the community advanced pharmacy practice experience (APPE). Overall, most preceptors agreed or strongly agreed that the assessment tool was easy to navigate and effective at evaluating students' performance. All preceptors who viewed the recorded preceptor development module found it helpful to their understanding of the new assessment tool. ConclusionsPreceptors' feedback supports the use of an EPA-based community IPPE curriculum to assess student performance and prepare students for community APPEs. Preceptor involvement is valuable in the evaluation of a revised experiential curricula to assure IPPE expectations are appropriate and align with contemporary pharmacy practice.

Programmatic Efforts to Provide Progressively Autonomous Clinical Education Experiences

Context In previous research, athletic trainers (ATs) have identified the formal coursework and clinical experiences of their professional program as contributing to preparedness for autonomous practice. However, new graduates have reported a perceived lack of skills necessary for practicing autonomously. Objective The purpose of this study was to evaluate how programs provide progressively autonomous clinical education experiences and the role of these experiences in preparing future ATs. Design Qualitative study. Setting Virtual interviews. Patients or Other Participants A sample of 17 program administrators (program directors = 12, coordinators of clinical education = 5) representing 16 master of science in athletic training programs participated in this study. Main Outcome Measure(s) Each program completed a virtual interview guided by a semistructured interview protocol. A 3-person data analysis team identified emerging domains and categories through a multiphase approach. Member checking, multiple researcher triangulation, and auditing were used to establish trustworthiness. Results Four domains emerged from participant responses: (1) curricular design, (2) preparatory experience and outcomes, (3) preceptor role, and (4) assessments. We found that intentionality in curricular design to promote progressive autonomy was beneficial in facilitating transition to practice through improved knowledge, skills, and confidence. Due to the importance of clinical education in AT preparation, preceptors played a critical role in creating opportunities for learning in the clinical environment. However, the degree to which experiences were autonomous and the effectiveness of the student in those encounters were rarely measured. Limitations outlined by participants included accreditation and program length. Conclusions The development of knowledge, skills, and confidence through intentionally selected clinical experiences and guided by preceptor feedback are critical to establishing an autonomous practitioner. However, the program’s evaluations were predominantly traditional practice assessments and informal feedback, instead of an assessment of readiness for practice.

Student-led medication histories in hospitals during the COVID-19 pandemic: Analysis of student and preceptor feedback

Student-led medication histories in hospitals during the COVID-19 pandemic: Analysis of student and preceptor feedback

Student-led medication histories in hospital: Analysis of student and preceptor feedback

Student-led medication histories in hospital: Analysis of student and preceptor feedback

An Educational Needs Assessment of Telehealth in Primary Care Among US Internal Medicine Residents.

As a result of the coronavirus disease 2019 pandemic, many Internal Medicine (IM) residency programs converted to telehealth for primary care. Our objectives in this study were to better understand resident past and present telehealth education, their perceived barriers to telehealth practice, and their perceived solutions to improving telehealth use and education. We performed a cross-sectional needs assessment survey between November 2020 and February 2021 among residents at 10 IM residency programs across the United States. Our primary measures were telehealth use in resident continuity clinics before and during the coronavirus disease 2019 pandemic, telehealth training, and confidence and barriers in using telehealth. Of 857 residents contacted, 314 (36.6%) responded. Residents reported low rates of education in telehealth prepandemic with significant improvements after the start of the pandemic across all visit domains (range of 10.7%-19.6% prepandemic compared with 25.6%-55.7% postpandemic, all P < 0.001). Resident confidence levels were significantly lower (P < 0.001) for video visits and telephone visits compared with in-person visiting across domains of communication, history taking, using an interpreter, making a diagnosis, counseling patients, providing psychosocial support, performing medical management, and coordinating after-visit care. Reported barriers included patient resources, clinic resources, lack of preceptor feedback, and lack of observation. Reported resources for improvement included tutorials on physical examination techniques, clinical space for telehealth, and patient resources for telehealth. To effectively address the educational needs for telehealth practice by IM residents, educators must consider not only curricular needs but also clinical, preceptor, and patient barriers to the high-quality use of telehealth for primary care.

Preceptor Training: Evaluation of an On-line Educational Module to Improve Preceptor Feedback

Purpose: Effective feedback delivery is critical to behavior modification and skill improvement in novice learners and athletic training programs often use annual training to teach preceptors to develop feedback skills. The purpose of this research project was to evaluate the effectiveness of an on-line asynchronous educational module for improving feedback delivery. Method: We used a single cohort, repeated measures design (pre, post, post-post) and an eAuthoring tool (Softchalk©) and online assessments (Qualtrics® Provo, UT) to evaluate the educational module. Preceptors (n=351) from 17 post-baccalaureate programs began the study; 48 completed all 3 assessments. We delivered a content validated lesson and assessments using various learning theories including video demonstrations with paired reflections. The desired outcome was to enhance the knowledge of effective feedback characteristics to be used in practice. The pre-test assessed self-reported feedback behaviors on a Likert Scale and knowledge (score=25). The immediate post-test reassessed feedback knowledge. At least 8 weeks following completion of the module, participants were asked to reassess feedback delivery behaviors. Throughout the process, participants provided a definition of “effective feedback” scored on 7 key criteria for effective feedback delivery. Descriptive statistics and paired t-tests were used to analyze the data and significance was set at Pa-priori. Results: Significant improvements (P-3.298 P=.001, Cohen’s d=.889). There were no other significant differences between pre-test and follow-up behaviors (P&gt;.05), as participants generally agreed they performed effective feedback behaviors (mode=4) at both time points. Conclusions: Behaviors regarding effective feedback were not changed over the long-term, which may have been a result of the method of performance feedback. Preceptor training is both a requirement and a need in effective athletic training clinical education. Future research should aim to identify mechanisms to improve preceptor feedback and confirm preceptor perceptions through student evaluations.

Applying the RIME Framework to Level Nurse Practitioner Curriculum Competencies.

Nurse practitioner (NP) faculty assess student acquisition of knowledge through examinations, simulation, and clinical performance. Developing appropriately leveled curriculum, assessments, and clinical expectations that accurately capture student maturation presents a challenge. The Reporter, Interpreter, Manager, Educator (RIME) provided the framework for doctor of nursing practice NP curriculum redesign to enhance student performance and content mastery. Faculty used a gap analysis approach, iteratively leveling specialty content, course competencies, examination questions, simulation cases, and clinical expectations using the building blocks of RIME. Objective scores on student evaluations for clinical courses exceeded the threshold established, including 83% of simulation encounters. Faculty implemented targeted methods to remediate areas of underperformance. Structuring the course competencies and preceptor feedback around RIME made it easier to pinpoint specific deficiencies and target remediation. It also helped guide discussions about the minimum acceptable standard for student performance.

Athletic Training Residency Program Development and Assessment of Advanced Clinical Reasoning

Context Clinical reasoning is an inferential process of collecting and evaluating data in patient cases, necessary in all care. Athletic training residency programs are emerging rapidly as the industry standard for developing clinical specialists who possess advanced clinical reasoning needed for complex cases. Objective The purpose of this study was to explore current practices of advanced clinical reasoning development and assessment in athletic training residency programs. Design Inductive qualitative research. Setting Web-based teleconferencing platform (Zoom Video Communications). Patients or Other Participants Seven of 10 Commission on Accreditation of Athletic Training Education–accredited residency program directors (RPDs) (age = 46 ± 9 years, years as RPD = 5 ± 6). Data Collection and Analysis We used qualitative, semistructured interviews. Audio files were transcribed verbatim, checked for accuracy, deidentified, and member checked before analysis. We used a 2-person data analysis team and an inductive coding approach. The researchers reviewed the transcripts independently, met to develop a codebook, applied the codes, and conducted internal auditing. Trustworthiness was established through member checking, multiple-analyst coding, and auditing. Results Three themes emerged from the RPDs about developing advanced clinical reasoning: (1) defining clinical reasoning, (2) instructional tactics, and (3) assessment tactics. RPDs defined clinical reasoning as the process of the resident justifying their decision-making and the accuracy of their decisions. RPDs described both clinical and didactic instructional tactics, including mentoring, lectures and discussions, case presentations, and journal club. RPDs described assessing advanced clinical reasoning through patient and preceptor feedback in structured and unstructured formats, self-reflection, and knowledge testing to measure clinical reasoning. RPDs highly relied on preceptors and clinical mentoring, but also described a singular reliance on residents to appraise the clinical reasoning capacity of their own preceptors. Conclusions RPDs define clinical reasoning as rationalization and accuracy of decisions. Although the programs are engaged in effective clinical and didactic approaches to teach advanced clinical reasoning, they rely heavily on the subjectivity of preceptors and residents to assess these outcomes.

Exploring simulation design for mental health practice preparation: a pilot study with learners and preceptors

The purpose of this exploratory pilot study was to determine the feasibility of delivering mental health practice simulations for occupational therapy learners, and whether different debriefing approaches yielded performance differences over successive simulations. Five clinical preceptors and nine first year MScOT students participated in this mixed-method study. In week one simulations, one student group received preceptor facilitated debriefing while the other group used self-debriefing. Both groups used the same scripted questions informed by an advocacy-inquiry approach. In the second week, both groups received the preceptor-led debriefing. Preceptors rated student performances while students self-rated their confidence, competence screen, and satisfaction using standardized tools. Ratings of simulation performance revealed gaps in practice knowledge and the process of practice. Preceptor-led debriefing for both groups resulted in greater depth of reflection and insight into learning gaps and opportunities for continued improvement. The self-debriefing group reported feeling less confident in the simulations. Preceptors reported the scripted advocacy inquiry debriefing approach helped draw out clinical reasoning that could not be observed from performance alone. Simulation may be an effective teaching tool for developing core practice competencies. Design and debriefing styles appear to impact preceptor feedback and the depth of learner critical reflection. Further study is required for generalization.

An Exploration of Preceptor-Provided Written Feedback on Entrustable Professional Activities During Early Practice Experiences

Objective. To explore and evaluate open-ended feedback on entrustable professional activities (EPAs) provided by preceptors to Doctor of Pharmacy (PharmD) students completing their first practice experience.Methods. A retrospective review was conducted of qualitative data collected from preceptor evaluations of student pharmacists who had completed a two-month practice experience in either community or health-system pharmacy at the end of their first professional year. Preceptors had used a validated EPA framework to assess students. A codebook was developed around the EPA framework and sub-coding was used to indicate positive, negative, or neutral assessment within each EPA. After several rounds of coding, consensus was reached for all codes by two investigators. A dependability audit was implemented to ensure the trustworthiness of the findings.Results. Preceptor evaluations of 153 student pharmacists were included in the study. Eighty students (52.3%) had completed a community experience and 73 (47.7%) had completed a health-system experience between May and August 2018. The preceptors at both practice settings provided overwhelmingly positive feedback on all EPAs. Opportunities to optimize preceptor-provided feedback were identified. The feedback provided by the preceptors in health-system and community practice settings focused on knowledge and behavior, respectively, with both emphasizing students' skill-based performance.Conclusion. This study provides valuable insight into optimizing preceptor-provided written feedback on EPAs. Conducting deeper analysis of preceptor feedback using focus groups or structured interviews is suggested to further explore preceptors' provision of EPA assessment to student pharmacists practicing in real-world settings.

A Multilevel Model for Evaluating Interprofessional Learning

Medical schools should engage in best practices for evaluating preclinical interprofessional collaborative programs. This innovation models a multilevel program evaluation of Interprofessional Clinical Experience (ICE), a required course for all first-year medical students. Data from student course evaluations and preceptor surveys determined that the course was effective at teaching interprofessional practices. Competency assessments showed nearly all students achieved the expected level. On the Readiness for Interprofessional Learning Scale, students increased their self-reported attitudes around interprofessional practices. Improvements to the ICE course will continue based on student and preceptor feedback from this multilevel program evaluation.

Feedback on feedback: A two-way street between residents and preceptors

BackgroundWorkplace-based assessment (WBA), foundational to competency-based medical education, relies on preceptors providing feedback to residents. Preceptors however get little timely, formative, specific, actionable feedback on the effectiveness of that feedback. Our study aimed to identify useful qualities of feedback for family medicine residents and to inform improving feedback-giving skills for preceptors in PGME training program.MethodsThis study employed a two-phase exploratory design. Phase 1 collected qualitative data from preceptor feedback given to residents through Field Notes (FNs) and quantitative data from residents who provided feedback to preceptor about the quality of the feedback given. Phase 2 employed focus groups to explore ways in which residents are willing to provide preceptors with constructive feedback about the quality of the feedback they receive. Descriptive statistics and a thematic approach were used for data analysis.FindingsWe collected 22 FNs identified by residents as being impactful to their learning; analysis of these FNs resulted in five themes. Functionality was then added to the electronic FNs allowing residents to indicate impactful feedback with a “Thumbs Up” icon. Over one year, 895 out of 8,496 FNs (11%) had a “Thumbs up” added, divided into reasons of: confirmation of learning (28.6%), practice improvement (21.2%), new learning (18.8%), motivation (17.7%), and evoking reflection (13.7%). Two focus groups (12 residents, convenience sampling) explored residents’ perception of constructive feedback and willingness to also provide constructive feedback to preceptors.ConclusionAdding constructive feedback to existing positive feedback choices will provide preceptors with holistic information about the impact of their feedback on learners, which, in turn, should allow them to provide more effective feedback to learners. However, power differential, relationship impact, and institutional support were concerns for residents that would need to be addressed for this to be optimally operationalized.

Redesigning College Professional Development Resources to Meet the Needs of Emerging Public Health Professionals.

The University of South Florida, College of Public Health, is dedicated to providing career planning and professional development services for students in varying formats. However, changing public health training needs and an emerging need for focused attention on professional development necessitated the development of an evaluative program to better understand our students' needs in these areas. Specifically, anecdotal student feedback about feeling unprepared professionally and survey feedback from students, preceptor feedback regarding the need for students to be better trained in core professional concepts, and low rates of attendance in standard professional development events resulted in a quality improvement study to identify students' perceived career planning and professional development needs. Findings were used to redesign current services and provided the basis for developing more targeted trainings to ensure that public health graduates are better prepared to meet employer expectations and to excel in the workforce. This article provides an overview of this transformative process, including the results of the qualitative survey on student, faculty, alumni, and community preceptor perspectives, and resulting prototypes developed for the professional development pilot along with preliminary insights.

Program development of a preceptor bootcamp for operational pharmacy preceptors.

To describe the development, design, and implementation of a pilot preceptor development bootcamp and feedback related to its feasibility and impact on operational pharmacy preceptors. The University of Texas MD Anderson Cancer Center designed and implemented a pilot preceptor development bootcamp for operational staff pharmacists serving as residency preceptors for longitudinal weekend staffing experiences. A systematic, multipronged approach was taken to identify preceptor development gaps and design a full-day bootcamp curriculum. The resultant curriculum was comprised of content in major functional areas including using the 4 preceptor roles, documenting performance, giving and receiving feedback, and dealing with difficult situations or learners. The impact of the pilot preceptor development bootcamp was assessed using survey methodology and qualitative feedback from debrief discussions. Implementation of a pilot preceptor bootcamp program addressing major areas of precepting skill was well received, resulted in positive feedback from operational pharmacy preceptors, and was feasible to implement at a large academic medical center.

Impact of 5-Minute Preceptor Training on the Senior Nursing Student Perception of Clinical Preceptor Feedback Effectiveness

Feedback is a tool that is often not utilized effectively. Clinical preceptors, when utilized, are the primary oversight for nursing students and should be able to provide feedback that is constructive and timely. Clinical preceptor feedback directly impacts the nurse generalists’ transition to practice which can increase competency levels by providing timely and quality feedback (Phillips, Mathew, Aktan, & Catano, 2017; Duteau, 2012). The purpose of this study was to determine if training clinical preceptors in the 5-Minute Preceptor method providing feedback to senior nursing students had an impact on the clinical teaching effectiveness. The research design was a comparative, two-group study with quantitative analysis, which utilized retrospective data from an undergraduate diploma program in the Southern United States. Senior nursing students in the final clinical immersion program from September 2018 to February 2020 were used as a convenience sample with a total of N=164 included in this study (n=100 before group, n=64 after group). Mann-Whitney U was used to analyze the data with a p< .05. Direct statements relating to feedback did not show significant correlations; however, the overall teaching statements showed significant findings on the Clinical Teaching Effectiveness Inventory (CTEI). Training clinical preceptors in how and when to provide feedback has an impact on the overall teaching effectiveness, which could have a direct impact on the graduate nurse’s transition to practice by offering feedback in relation to decision making and critical thinking abilities.

Competency-based education in transitioning nurse practitioner students from education into practice.

Competency-based education (CBE) provides a framework for nursing programs including those educating nurse practitioners (NPs). The basic assumption of CBE is that the student will demonstrate acquisition of the identified essential knowledge, skills, and attitudes expected for the designated educational process before leaving the learning environment. The work done to date in developing competencies and progression indicators provides the critical basis to move toward a common language and clear expectations for the continuum of linear progression of proficiency. Entrustable professional activities (EPAs) are built on competencies and stated as measurable activities that providers can be expected to do, at varying levels of competence or trust or supervision, and allow the faculty member, preceptor, or supervisor to make decisions as to what teaching methods and level of supervision are needed. Numerous methods are used to measure competency in clinical skill knowledge, performance, and practice readiness including clinical preceptor feedback, objective structured clinical examination, and simulation, just to name a few. NP programs continue to struggle with the education practice gap between theory and the actual provision of care. The discussion about novel and reliable methods for measurement of competencies must address the strategic importance of a consensus about when, where, and how students can obtain the appropriate amount and type of experience and supervision required in the transition to independent practice. There is also a significant need for processes and standardized guidelines that can contribute to EPA development.