From principles to practice: Implementation of entrustable professional activities (EPAs) for surgical pathology residency education in a large academic hospital
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PROVIDER: S-EPMC10679497 | biostudies-literature | 2023 Jan
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Project description:Entrustable professional activities (EPAs) have been implemented in various medical specialties, and the Pathology National EPA Working Group has piloted the implementation of four pathology EPAs. We recently published the development of EPAs within our surgical pathology rotation. Following a six-month pilot, a survey demonstrated that faculty and residents found the forms helpful and easy to use and easy to understand, and EPAs have been fully incorporated into our surgical pathology rotation. Here, we discuss our experience, challenges, and results of resident EPA performance for intraoperative consultations (IOC) and sign-out (SO) after 21 months of implementation. Between June 2022 and March 2024, 24 residents were evaluated by 13 faculty members, resulting in 136 IOC and 298 SO EPA forms. Paper forms were predominantly used, with only five electronic forms submitted. EPA performance scores for SO increased from 2.4 ± 0.8 in Block 1 to 4.6 ± 0.2 in Block 14 (p < 0.0001), whereas performance scores for IOC increased from 2.7 ± 1.0 in Block 1 to 4.8 ± 0.2 in Block 14 (p < 0.0001). The progressive decrease in the standard deviation throughout residency denotes higher competence homogeneity as residency graduation approaches. Overall, our EPA evaluation method showed ease of use, provided valuable tracking tools, and long-term feasibility. EPAs are robust tools for tracking resident progression toward independent practice in surgical pathology, offering valuable insights for program and rotation directors to assess and track individual EPA skills, identify intervention points, and provide an opportunity for immediate, actionable feedback based on current performance.
| S-EPMC11541477 | biostudies-literature
Project description:PurposeAs global health education and training shift toward competency-based approaches, academic institutions and organizations must define appropriate assessment strategies for use across health professions. The authors aim to develop entrustable professional activities (EPAs) for global health to apply across academic and workplace settings.MethodIn 2019, the authors invited 55 global health experts from medicine, nursing, pharmacy, and public health to participate in a multiround, online Delphi process; 30 (55%) agreed. Experts averaged 17 years of global health experience, and 12 (40%) were from low- to middle-income countries. In round one, participants listed essential global health activities. The authors used in vivo coding for round one responses to develop initial EPA statements. In subsequent rounds, participants used 5-point Likert-type scales to evaluate EPA statements for importance and relevance to global health across health professions. The authors elevated statements that were rated 4 (important/relevant to most) or 5 (very important/relevant to all) by a minimum of 70% of participants (decided a priori) to the final round, during which participants evaluated whether each statement represented an observable unit of work that could be assigned to a trainee. Descriptive statistics were used for quantitative data analysis. The authors used participant comments to categorize EPA statements into role domains.ResultsTwenty-two EPA statements reached at least 70% consensus. The authors categorized these into 5 role domains: partnership developer, capacity builder, data analyzer, equity advocate, and health promoter. Statements in the equity advocate and partnership developer domains had the highest agreement for importance and relevance. Several statements achieved 100% agreement as a unit of work but achieved lower levels of agreement regarding their observability.ConclusionsEPAs for global health may be useful to academic institutions and other organizations to guide the assessment of trainees within education and training programs across health professions.
| S-EPMC7899746 | biostudies-literature
Project description:Entrustable professional activities (EPAs) are observable clinical skills and/or procedures that have been introduced into medical education at the student and resident levels in most specialties to determine readiness to advance into residency or independent practice, respectively. This publication describes the process and outcomes of a pilot study looking at the feasibility of using two anatomic pathology and two clinical pathology EPAs in pathology residency in 6 pathology residency programs that volunteered for the study. Faculty development on EPAs and their assessment was provided to pilot program faculty, and EPA assessment tools were developed and used by the pilot programs. Pre- and post-study surveys were given to participating residents, faculty, and program directors to gauge baseline practices and to gather feedback on the EPA implementation experience. Results demonstrated overall good feasibility in implementing EPAs. Faculty acceptance of EPAs varied and was less than that of program directors. Residents reported a significant increase in the frequency with which faculty provided formative assessments that included specific examples of performance and specific ways to improve, as well as increased frequency with which faculty provided summative assessments that included specific ways to improve. EPAs offered the most benefit in setting clear expectations for performance of each task, for providing more specific feedback to residents, and in increasing Program director's understanding of resident strengths abilities and weaknesses.
| S-EPMC10978478 | biostudies-literature
Project description:ObjectiveConcerns over resident ability to practice effectively after graduation have led to the competency-based medical education movement. Entrustable professional activities (EPAs) may facilitate competency-based medical education in surgery, but implementation is challenging. This manuscript describes 1 strategy used to implement EPAs into an academic general surgery residency.Design, setting, participantsA mobile application was developed incorporating 5 EPAs developed by the American Board of Surgery; residents and faculty from the Departments of Surgery, Emergency Medicine, and Hospital Medicine at a single tertiary care center were trained in its use. Entrustment levels and free text feedback were collected. Self-assessment was paired with supervisor assessment, and faculty assessments were used to inform clinical competency committee entrustment decisions. Feedback was regularly solicited from app users and results distributed on a monthly basis.ResultsOne thousand seven hundred and twenty microassessments were collected over the first 16 months of implementation; 898 (47.8%) were performed by faculty with 569 (66.0%) matched pairs. Engagement was skewed with small numbers of high performers in both resident and faculty groups. Continued development of resident and faculty was required to sustain engagement with the program. Nonsurgical specialties contributed significantly to resident assessments (496, 28.8%).ConclusionsEPAs are being successfully integrated into the assessment framework at our institution. EPA implementation in surgery residency is a long-term process that requires investment, but may address limitations in the current assessment framework.
| S-EPMC7305986 | biostudies-literature
Project description:IntroductionThe Association of American Medical Colleges (AAMC) proposed thirteen core Entrustable Professional Activities (EPAs) that all graduates should be able to perform under indirect supervision upon entering residency. As an underlying premise is that graduates ready to do so will be better prepared to transition to the responsibilities of residency, we explored the relationship between postgraduate year (PGY)-1 residents' self-assessed preparedness to perform core EPAs under indirect supervision at the start of residency with their ease of transition to residency.MethodsUsing response data to a questionnaire administered in September 2019 to PGY-1 residents who graduated from AAMC core EPA pilot schools, we examined between-group differences and independent associations for each of PGY-1 position type, specialty, and "EPA-preparedness" score (proportion of EPAs the resident reported as prepared to perform under indirect supervision at the start of residency) and ease of transition to residency (from 1 = much harder to 5 = much easier than expected).ResultsOf 274 questionnaire respondents (19% of 1438 graduates), 241 (88% of 274) had entered PGY-1 training and completed all questionnaire items of interest. EPA-preparedness score (mean 0.71 [standard deviation 0.26]) correlated with ease of transition (3.1 [0.9]; correlation = .291, p < .001). In linear regression controlling for specialty (among other variables), EPA-preparedness score (β-coefficient 1.08; 95% confidence interval .64-1.52; p < .001) predicted ease of transition to residency.ConclusionGraduates who felt prepared to perform many of the core EPAs under indirect supervision at the start of PGY-1 training reported an easier-than-expected transition to residency.Supplementary informationThe online version contains supplementary material available at 10.1007/s40670-021-01370-3.
| S-EPMC8651854 | biostudies-literature
Project description:BackgroundSports Medicine is an upcoming postgraduate speciality in India. A MD Sports Medicine specialist is expected to contribute in the prevention of sports injuries, sportsmen training and enhancement of performance apart from being involved in planning of conduct of sports events amongst many other roles and responsibilities. This requires hands-on training and acquisition of skill sets required to perform these roles. The National Medical Council of India highlights the need for a competency based curriculum and has laid down guidelines for the course. There was a felt need to develop Entrustable Professional Activities (EPAs) and milestones based on the prescribed curricula and develop a portfolio for continuous monitoring of the achievement of these EPAs.MethodsA five step model was done by experts in the field to prepare the EPAs, milestones and portfolio. This consisted of faculty development, identification of the EPAs and milestones and portfolio preparation.Results114 EPAs and 961 milestones were identified by the subject experts. The portfolio was developed with the help of specialists and faculty of the field of sports medicine, and medical educationists.ConclusionPost graduate medical education is mandated to be competency based. A portfolio has been developed in the current exercise for use in a competency based post-graduate curriculum in sports medicine. This will help in the better implementation of CBME in the country.
| S-EPMC7873686 | biostudies-literature
Project description:IntroductionThis study seeks to explore validity and reliability evidence for core residency entrustable professional activities (CR-EPAs) that were developed by Peking University First Hospital (PKUFH) in 2020.MethodsA prospective cohort study was conducted in PKUFH. Trainers (raters) assessed pediatric residents on CR-EPAs over 1 academic year, bi-annually. Critical components within a validity evidence framework were examined: response process (rater perceptions), the internal structure (reliability and contributions of different variance sources), and consequences (potential use of a cutoff score).ResultsIn total, 37 residents were enrolled, and 111 and 99 trainers' ratings were collected in Fall 2020 and Spring 2021, respectively. For rater perceptions, all the raters considered CR-EPAs highly operational and convenient. In all ratings, individual EPAs correlate with total EPA moderately, with Spearman correlation coefficients spanning from 0.805 to 0.919. EPA 2 (select and interpret the auxiliary examinations), EPA 5 (prepare and complete medical documents), EPA 6 (provide an oral presentation of a case or a clinical encounter), and EPA 7 (identify and manage the general clinical conditions) were EPAs correlated with other EPAs significantly. The results of the generalizability theory indicated that the variability due to residents is the highest (nearly 78.5%), leading to a large size of the reliability estimates. The matching results indicate that the lowest error locates at 5.933.ConclusionThe rating showed good validity and reliability. The ratings were reliable based on G-theory. CR-EPAs have a magnificent internal structure and have promising consequences. Our results indicate that CR-EPAs are a robust assessment tool in workplace-based training in a carefully designed setting.
| S-EPMC10801054 | biostudies-literature
Project description:Competency-based medical education has evolved over the past decades to include the Accreditation Council for Graduate Medical Education Accreditation System of resident evaluation based on the Milestones project. Entrustable professional activities represent another means to determine learner proficiency and evaluate educational outcomes in the workplace and training environment. The objective of this project was to develop entrustable professional activities for pathology graduate medical education encompassing primary anatomic and clinical pathology residency training. The Graduate Medical Education Committee of the College of American Pathologists met over the course of 2 years to identify and define entrustable professional activities for pathology graduate medical education. Nineteen entrustable professional activities were developed, including 7 for anatomic pathology, 4 for clinical pathology, and 8 that apply to both disciplines with 5 of these concerning laboratory management. The content defined for each entrustable professional activity includes the entrustable professional activity title, a description of the knowledge and skills required for competent performance, mapping to relevant Accreditation Council for Graduate Medical Education Milestone subcompetencies, and general assessment methods. Many critical activities that define the practice of pathology fit well within the entrustable professional activity model. The entrustable professional activities outlined by the Graduate Medical Education Committee are meant to provide an initial framework for the development of entrustable professional activity-related assessment and curricular tools for pathology residency training.
| S-EPMC5496684 | biostudies-literature
Project description:ObjectiveDefine and develop a set of entrustable professional activities (EPAs) to link clinical training and assessment of the hospital components of neonatal care in neonatology medical residency programs.MethodsAn exploratory study was conducted in two phases using a modified Delphi approach. In the first phase, a committee of five neonatology residency program coordinators drafted an initial set of EPAs based on the national matrix of competencies and on EPAs defined by international organizations. In the second phase, a group of neonatal care physicians and medical residents rated the indispensability and clarity of the EPAs and provided comments and suggestions.ResultsSeven EPAs were drafted by the coordinators´ committee (n = 5) and used in the content validation process with a group (n = 37) of neonatal care physicians and medical residents. In the first Delphi round, all EPAs reached a content validity index (CVI) above 0.8. The coordinators´ committee analyzed comments and suggestions and revised the EPAs. A second Delphi round with the revised EPAs was conducted to validate and all items maintained a CVI above 0.8 for indispensability and clarity.ConclusionSeven entrustable professional activities were developed to assess residents in the hospital components of neonatal care medicine. These EPAs might contribute to implementing competency-based neonatology medical residency programs grounded in core professional activities.
| S-EPMC11662742 | biostudies-literature
Project description:IntroductionThe last 3 decades have seen significant changes in medical education and corresponding assessment of medical trainees. Competency-based medical education provided a more comprehensive model than the previous time-based process but remained insufficient. Introduced in 2005, entrustable professional activities (EPAs) offer a more robust curriculum development and assessment process, especially in regard to clinician-oriented workplace-based assessments. Despite their intuitive match with decisions made in the clinical environment daily by clinicians, the development of specialty-specific EPAs and corresponding culturally situated assessment tools has lagged.MethodsTo address this gap, a 90-minute faculty development workshop was created to introduce faculty to EPAs and their assessment and to provide hands-on practice developing and using EPAs.ResultsPrevious facilitations of this workshop received favorable responses from participants regarding level of detail, understanding of the content, and intent to employ EPAs at their own institutions.DiscussionImplementation of EPAs into the assessment portfolio of medical trainees following this workshop will maximize confidence in determining when a trainee is ready for independent practice.
| S-EPMC6342153 | biostudies-literature