Set Of Entrustable Professional Activities Research Articles

Exploring the Utility of Entrustable Professional Activities as a Framework to Enhance Nurse Practitioner Education

Entrustable professional activities (EPAs) are used in medical education in the assessment of clinical competence, but consideration of EPAs in nurse practitioner (NP) education is emerging. There are critical points in the NP educational trajectory when a student should demonstrate requisite knowledge and abilities. It can be challenging to assess and measure clinical proficiency in a way that can be clearly interpreted by students, faculty, and preceptors. NP faculty reviewed a set of medical EPAs that were linked with physician competencies to determine if they related to national NP competency areas and learning activities in their curriculum. Several NP competency areas (8 of 9) related to these EPAs, and the learning activities also related to multiple EPAs. Although further work would be needed to tailor EPAs to the NP role and link them specifically with NP competencies, EPAs may offer another valuable method for clinical evaluation of NP students.

Development of Entrustable Professional Activities for entry into residency at the Charité Berlin.

Background: Entrustable Professional Activities (EPAs) have emerged as a new approach to operationalise the workplace performance expectations for the transition from under- to postgraduate medical training. However, the transferability of such EPAs from one context to another appears limited. In this article, we report on the results of our approach to define a full set of core EPAs for entry into residency with the expectation to be performed under distant supervision. Methods: The EPA development involved a modified, three round Delphi study, conducted at the Charité – Universitätsmedizin Berlin. The supervision level was operationalised as supervisor being distantly available and findings being reviewed. The threshold for consent was reaching a content validity index of a least 80%. The Delphi study involved experienced physicians (n=45) and resulted in a set of core EPAs with the descriptions of the categories: title, specification/limitations, conditions and implications of entrustment decision, knowledge, skills, and attitude, link to competencies and assessment sources. Results: The response rates were 76-80% in the Delphi rounds. Key to the content validation process for the performance expectation was deciding on “to act under distant supervision”. The results are full descriptions of 12 core EPAs, organised into 5 overarching EPA domains. Conclusions: Our systematic approach yielded the definition of 12 core EPAs for entry into residency at the level of “act with distant supervision” according to the practice in our context. This report may support other medical schools who plan to implement EPAs into their curricula.

How to define core entrustable professional activities for entry into residency?

Institutions considering to employ core Entrustable Professional Activities (EPAs) for entry into postgraduate training as outcomes for their undergraduate medical programs can partly build on published examples, but also have to undergo their own content validation process to take their specific context into consideration. This process involves several challenges and is not well-described in the literature. Here, we report in detail on a systematic, literature-based approach we recently utilised at our institution to define core EPAs for entry into residency. Central to the process was a modified Delphi consent procedure. It involved a multistep interaction between a writing team and a multidisciplinary panel of experienced physicians. Panel members provided both quantitative ratings and qualitative feedback on the EPA categories title, specification/limitations, conditions and implications of entrustment decision, knowledge, skills, and attitude. Consent was achieved when a Content Validity Index (CVI) of ≥80% was reached. The writing team adjusted the EPA category descriptions on the basis of panel members´ ratings and comments, and specified the EPA categories’ link to competencies and assessment sources. This process produced a description and definition of a full set of core EPAs for entry into residency adapted to our context. This process description for locally adapted core EPAs for entry into residency may support and guide other medical schools in the development and implementation of EPAs into their programs.

Effect of PGY Training Year on Perceived Readiness to Perform Entrustable Professional Activities.

This article was migrated. The article was marked as recommended. Background The Family Medicine for America's Health (FMAH) collaborative approved a set of Entrustable Professional Activities (EPAs) for the specialty, designed to serve as a set of activities that all practitioners in the specialty can be expected to perform. The extent to which family medicine residents feel equipped to perform EPAs is not known. Objective To assess the extent to which family medicine residents in all three PGY years feel ready to perform Entrustable Professional Activities. Methods This spring, eighteen residents were asked to complete the "ProMedica Monroe Family Medicine Entrustable Professional Activities Survey," which asks residents, for all 20 EPAs, to 1) identify their readiness to perform the EPA on a 9-point Likert scale, and 2) endorse their level of PGY training. Results Fifteen of out eighteen eligible participants completed the survey. Mean readiness levels across EPAs were 5.23/9 for PGY1s, 7.27 for PGY2s, and 8.17 for PGY3s. Residents reported higher readiness levels with inpatient care (7.67) and relationship building (7.80), but lower levels with mental health care (5.87) and obstetrical care (5.07). Conclusions Residents perceive increases in readiness to perform family medicine EPAs with each PGY year. Resident readiness levels are broadly similar across EPAs, with few outliers.

Entrustable Professional Activities For Residency Training in Physical Medicine and Rehabilitation.

Entrustable professional activities are observable units of professional practice that can potentially provide a link between competency-based medical education and clinical practice. The authors, part of a subcommittee of the Association of Academic Physiatrists Education Committee, identified a set of entrustable professional activities that would serve residency training programs in the specialty of physical medicine and rehabilitation. Using a modified Delphi process, residency program directors in the field reviewed and validated a set of entrustable professional activities. The final set of 19 entrustable professional activities is presented in this article.

The development of national entrustable professional activities to inform the training and assessment of public health and preventative medicine residents

Entrustable Professional Activities (EPAs) have emerged to bridge the gap between the learning of individual competencies and competence in real world practice. EPAs capture the critical core work of a discipline integrating competencies from multiple domains. This report describes the development of a set of EPAs for specialty training in Public Health and Preventive Medicine (PHPM) in Canada. The PHPM EPAs were developed using multiple existing sources. A combination of workshops and a national online survey was used to consult with PHPM program directors, the national specialty committee, and competency-based education experts. A national survey of PHPM program directors had a 71% response rate with 80% or more of respondents agreeing with all of the 20 EPA titles and all but one of their descriptions. Competency developmental stage-specific milestones were identified for each EPA. The identification of the EPAs and their milestones will increase emphasis on the demonstrated performance of the specialty's core work. Simulations applicable to several EPAs have been developed. The EPAs have also been incorporated into a PHPM National Review Course and will be used to develop a national PHPM curriculum, as well as a national written practice examination.

Describing Entrustable Professional Activities Is Merely the First Step

The profession of pharmacy needs a core set of entrustable professional activities (EPAs)--not only to describe what pharmacists do but also to set expectations and guide future action. Entrustable professional activities are units of work. (1) They can be observed and assigned by preceptors and supervisors. Unlike competency statements, which can seem abstract and academic to noneducators, (2) EPAs are intuitively understood by patients, practitioners, and policymakers. The EPAs for New Pharmacy Graduates reported in this issue of the Journal are an important first step, but far more needs to be done. (3) Entrustable professional activities were first described and subsequently used by medical residency training programs as a means to translate competency statements (ie, general qualities that every health professional should possess) into concrete tasks that supervisors can observe and delegate to trainees in the clinical environment. (1) Discipline-specific EPAs have been formulated for postgraduate training in family medicine, internal medicine, and pediatrics. (4-6) In 2014, the Association of American Medical Colleges (AAMC) published a list of 13 core EPAs for entering residency that medical school graduates are expected to perform without direct supervision on day 1 of residency, regardless of specialty. (7) The enthusiasm and speed with which EPAs have been embraced by medical schools and residency training programs suggests there has been a need for greater clarity regarding a core set of skills that all physicians should possess. Currently, 10 medical schools are pilot testing the AAMC core EPAs. (8) These institutions will formally report outcomes as well as lessons learned from implementing the EPA framework in their curricula. The development of the Core EPAs for New Pharmacy Graduates was rigorous. (9) Although input from a wide range of stakeholders was sought and received, undoubtedly some will view them with skepticism. To some, the EPAs represent yet another mandate that colleges and schools must somehow assimilate into their curricula and use to assess student progress. For others, the EPAs do not reflect their specialized areas of practice. And still others will have difficulty seeing the connection between the EPAs and the content they teach. These are legitimate concerns but miss the point. We argue that a lack of clarity regarding the role and responsibilities of pharmacists has hampered the advancement of pharmacy practice. Today the profession has a shared vision and model of practice. (10) The accreditation of doctor of pharmacy programs is contingent on producing practice-ready and team-ready graduates. (11) The Core EPAs for New Pharmacy Graduates reflect these realities. While the EPAs often are presented as a list of discrete tasks and activities, they are interrelated and over-lapping (Figure 1). Moreover, EPAs do not negate the need for a set of underlying competencies. (12) These competencies, which were derived from the cognitive, affective, and psychomotor domains, are articulated in the CAPE 2013 Educational Outcomes statements. (13) The EPA statements flow from and are extensions of these competencies (Figure 2). Moreover, the Core EPAs for New Pharmacy Graduates describe the foundation for the development of EPAs for postgraduate pharmacy training programs. New pharmacy graduates should be able to perform all Core EPAs without direct supervision. (9) This does not imply that new pharmacy graduates are fully formed and no longer will need feedback, guidance, or coaching from exemplary role models after graduation (Table 1). Postgraduate training, both formal and informal, in the workplace after licensure should be structured in a way that will enable new graduates to refine their skills, build their confidence, and increase their proficiency. (14) Over time, pharmacy graduates should be entrusted to assume greater autonomy and the responsibility of supervising others. …

American Association of Colleges of Pharmacy 2016 Council of Faculties Business Meeting, Anaheim, July 25, 2016

Call to Order Chair Todd Sorensen (University of Minnesota) called the meeting to order at 1:38 pm in the Marquis Ballroom, Marriott-Anaheim, Anaheim, CA, on Monday, July 25,2016. The Chair introduced the other members of the COF board. Preliminary Quorum Committee Report Quorum committee member Matthew Dintzner (Western New England University) reported that 51 member institutions were represented, constituting a quorum. Report of the Chair Chair Sorensen shared his reflections on the work of the COF over the past year. Chair Sorensen recognized the work of the special COD/COF Taskforce on Accelerating Change. The committee worked fast to develop the report and heavily influenced AACP's strategic plan, particularly strategic priority 3. A new group will be formed called Accelerating Change and Transformation Team (ACT2) that will work closely with the AACP Board of Directors and AACP Staff on identifying and leading Accelerating Change Campaigns. Old Business Chair Sorensen discussed that the work that began in 2014 to recognize Distinguished Teaching Scholars has finally come to fruition and at the 2016 Annual Meeting first 4 scholars were recognized at the Opening General Session. The Chair recognized and thanked Robin Zavod (Midwestern-Chicago) and the 2014 Faculty Affairs Committee for their work on this initiative. Report of the Secretary Margarita DiVall (Northeastern University) reported that the minutes of the 2015 COF Annual Business Meeting held in National Harbor, MD are available via download from the COF webpage under governance on the AACP website as well as through the Pathable app. Other reports available in the same places include the Chair report with embedded committee reports and The Accelerating Change Taskforce Report. After the quorum committee confirmed that a quorum had been met, the minutes were received and approved. Report on Board of Directors' Activities from COF Immediate Past Chair Past Chair Scott (Purdue) reported on the Board of Directors Activities: * The Board approved membership requests from 3 schools that received pre-candidate status at the June meeting of the ACPE board of directors--the House affirmed Associate Institutional Membership status for Highpoint, Larkin, and Ketchum. * Council leaders discussed the first opportunity to engage AACP members in a transformational change project affecting both education and practice. * The Council of Sections has released a toolkit and other resources to facilitate discussions and policy-setting related to the management of issues associated with the use of medical marijuana; these will be disseminated in August via the AACP elert. * The Board had a lengthy conversation about the proposed Cooperative Admissions Guidelines, including the three provisions that seem the most controversial ** March 1st deadline for students to release all but one admission offer ** The initial $200 hold deposit ** The lack of enforcement of the guidelines The Board recognized that there is a need to listen to all sides of this issue and will take final action on the guidelines during the November meeting. Steven Scott encouraged faculty to voice their perspectives on the Cooperative Admission Guidelines during the open forum on Tuesday. * The Board reviewed the strategic recommendations from the 2015-16 standing committees which are posted on the House of Delegates Annual Meeting resource page and will be published later this year in AJPE; among the work initiated this year are the draft set of Entrustable Professional Activities and the pilot of a new membership affinity group model the community of practice for those engaged in interprofessional education and practice development. More information about joining this IPE community will be sent to all members after the annual meeting. …

Development and Validation of a Set of Palliative Medicine Entrustable Professional Activities: Findings from a Mixed Methods Study.

Entrustable professional activities (EPAs) are routine tasks considered essential to a professional practice. An EPA can serve as a performance-based outcome that a clinical supervisor would progressively entrust a learner to perform. Our aim was to identify, develop, and validate a set of EPAs for the palliative medicine discipline. The design was a sequential qualitative and quantitative mixed methods study. A working group was convened to develop a set of EPAs. Focus groups and surveys were used for validation purposes. Palliative medicine educators and content experts from across Canada participated in both the working group as well as the focus groups. Attendees of the 2014 Canadian Society of Palliative Care Physicians (CSPCP) annual conference completed surveys. A questionnaire was used to collect survey participant sociodemographic, clinical, and academic information along with ratings of the importance of the EPAs individually and collectively. Cronbach's alpha examined internal consistency of the set of EPAs. Focus group participants strongly endorsed the 12 EPAs. Virtually all survey participants rated the individual EPAs as being "fairly/very important" (range 94% to 100%). Of the participants, 97% agreed that residents able to perform the set of EPAs would be practicing palliative medicine and 87% indicated strong agreement that this collective set of EPAs captures activities that all palliative medicine physicians must be able to perform. A Cronbach's alpha of 0.841 confirmed good internal consistency. Near uniform agreement from a national group of palliative medicine physicians provides strong validation for the set of 12 EPAs.

The development of entrustable professional activities for internal medicine residency training: a report from the Education Redesign Committee of the Alliance for Academic Internal Medicine.

The Alliance for Academic Internal Medicine charged its Education Redesign Committee with the task of assisting internal medicine residency program directors in meeting the challenges of competency-based assessment that were part of the Accreditation Council for Graduate Medical Education's (ACGME's) Next Accreditation System. Recognizing the limitations of the ACGME general competencies as an organizing framework for assessment and the inability of the milestones to provide the needed context for faculty to assess residents' competence, the Education Redesign Committee in 2011 adopted the work-based assessment framework of entrustable professional activities (EPAs). The committee selected the EPA framework after reviewing the literature on competency-based education and EPAs and consulting with experts in evaluation and assessment. The committee used an iterative approach with broad-based feedback from multiple sources, including program directors, training institutions, medical organizations, and specialty societies, to develop a set of EPAs that together define the core of the internal medicine profession. The resulting 16 EPAs are those activities expected of a resident who is ready to enter unsupervised practice, and they provide a starting point from which training programs could develop assessments and curricula. The committee also provided a strategy for the use of these EPAs in competency-based evaluation. These EPAs are intended to serve as a starting point or guide for program directors to begin developing meaningful, work-based assessments that inform the evaluation of residents' competence.

A case for competency-based anaesthesiology training with entrustable professional activities: an agenda for development and research.

Competency frameworks are based on what are considered to be the general essential qualities of a doctor. Competencies, being behavioural descriptors, need a strong link to clinical practice to allow trainers to observe and then use them in assessing trainees' performance. The emerging concept of entrustable professional activities (EPAs) may serve as such a link. An EPA is a description of an essential clinical task that frames competencies in the context of clinical practice. A full set of EPAs defines a specialty and constitutes the curriculum of specialty training. After observation of satisfactory performance on an EPA, the resident should be permitted to perform that activity without direct supervision. The terms of this should allow a trainer to provide justification for this decision. This makes graded assumption of responsibilities possible. We describe the potential benefits of working with EPAs in anaesthesiology training and set an agenda for curriculum development and research in this area.