IntroductionMedical schools in the United States are encouraged to prepare and certify the entrustment of medical students to perform 13 core entrustable professional activities (EPAs) prior to graduation. Entrustment is defined as the informed belief that the learner is qualified to autonomously perform specific patient-care activities. Core EPA-10 is the entrustment of a graduate to care for the emergent patient. The purpose of this project was to design a realistic performance assessment method for evaluating fourth-year medical students on EPA-10.MethodsFirst, we wrote five emergent patient case-scenarios that a medical trainee would likely confront in an acute care setting. Furthermore, we developed high-fidelity simulations to realistically portray these patient case scenarios. Finally, we designed a performance assessment instrument to evaluate the medical student’s performance on executing critical actions related to EPA-10 competencies. Critical actions included the following: triage skills, mustering the medical team, identifying causes of patient decompensation, and initiating care. Up to four students were involved with each case scenario; however, only the team leader was evaluated using the assessment instruments developed for each case.ResultsA total of 114 students participated in the EPA-10 assessment during their final year of medical school. Most students demonstrated competence in recognizing unstable vital signs (97%), engaging the team (93%), and making appropriate dispositions (92%). Almost 87% of the students were rated as having reached entrustment to manage the care of an emergent patient (99 of 114). Inter-rater reliability varied by case scenario, ranging from moderate to near-perfect agreement. Three of five case-scenario assessment instruments contained items that were internally consistent at measuring student performance. Additionally, the individual item scores for these case scenarios were highly correlated with the global entrustment decision.ConclusionHigh-fidelity simulation showed good potential for effective assessment of medical student entrustment of caring for the emergent patient. Preliminary evidence from this pilot project suggests content validity of most cases and associated checklist items. The assessments also demonstrated moderately strong faculty inter-rater reliability.

Background Simulation-based education (SBE) with high-fidelity simulation (HFS) offers medical students early exposure to the clinical environment, allowing development of clinical scenarios and management. We hypothesized that supplementation of standard pulmonary physiology curriculum with HFS would improve the performance of first-year medical students on written tests of pulmonary physiology. Methods This observational pilot study included SBE with three HFS scenarios of patient care that highlighted basic pulmonary physiology. First-year medical students’ test scores of their cardio-pulmonary curriculum were compared between students who participated in SBE versus only lecture-based education (LBE). A survey was administered to the SBE group to assess their perception of the HFS. Results From a class of 188 first-year medical students, 89 (47%) participated in the SBE and the remaining 99 were considered as the LBE group. On their cardio-pulmonary curriculum test, the SBE group had a median score of 106 [IQR: 97,110] and LBE group of 99 [IQR: 89,105] (p < 0.001). For the pulmonary physiology subsection, scores were also significantly different between groups (p < 0.001). Conclusions Implementation of supplemental SBE could be an adequate technique to improve learning enhancement and overall satisfaction in preclinical medical students.

The development of core entrustable professional activities (EPA) for entering residency and Accreditation Council for Graduate Medical Education’s milestones have spurred thinking about the fourth year of medical school as a transition to residency. In this monograph, we lay out our specialty focused post-clerkship curriculum and report learner and residency director perceptions over the first three years of implementation. Ongoing curricular monitoring has reinforced core principles but has also informed actionable quality improvement efforts. EPA-focused learning experiences, integration of specialty-specific milestones, addition of the feedforward process, and accessible mentorships have been key curricular elements to guide the transition to residency.

Background: Educational handoffs between medical schools and residency may facilitate the transition into graduate medical education. Attitudes of residency program directors about handoffs are largely unknown. Objective: This study assessed the opinions of residency program directors from four specialties, regarding information sharing between medical schools and residencies, and whether they desire student performance data post-match, including milestones, competency and entrustable professional activity (EPA) achievement, and capstone or boot camp-based performance data. Methods: In 2017 a thirteen question survey was sent to program directors from internal medicine, pediatrics, emergency medicine, and obstetrics/gynecology. Responses were anonymous and data was analyzed using descriptive statistics and thematic analysis. Results: Twenty percent of program directors surveyed submitted a survey (187 out of 950). Fifty-nine percent reported that unexpected remedial issues often arise within the first 6 months of internship. Twenty-four percent stated that information currently received is adequate to structure the learning environment of individual residents. Seventy-seven percent responded that they desire access to EPA-based information; seventy-four percent to milestone or competency-based data; eighty-two percent to performance data from fourth-year capstone courses or boot camps. No significant differences were found between specialties. Concerns were raised by respondents about the validity and reliability of performance metrics that would be shared with program directors.

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