Development of Entrustable Professional Activities for Hospice and Palliative Medicine Fellowship Training in the United States

Purpose This review aimed to synthesise some of the extant work on the use of entrustable professional activities (EPAs) for postgraduate physicians, to assess the quality of the work and provide direction for future research and practice. Method Systematic searches were conducted within five electronic databases (Medline, Scopus, Web of Science, PsycINFO and CINAHL) in September 2018. Reference lists, Google Scholar and Google were also searched. Methodological quality was assessed using the Quality Assessment Tool for Studies with Diverse Designs (QATSDD). Results In total, 49 studies were included, classified as Development of EPAs (n = 37; 76% of total included), Implementation and/or assessment of EPAs (n = 10; 20%), or both (n = 2; 4%). EPAs were described for numerous specialties, including internal medicine (n = 14; 36%), paediatrics (n = 8; 21%) and psychiatry (n = 4; 10%). Of the development studies, 92% utilised more than one method to generate EPAs. The two most commonly used methods were developing initial EPAs in a working group, (n = 27; 69%) and revising through deliberation (n = 21; 54%). Development papers were of variable quality (mean QATSDD score = 20, range 6–41). Implementation and assessment studies utilised methods that included observing trainee performance (n = 6; 50%) and enrolling trainees in competency‐based curricula, which included EPAs (n = 4; 33%). The methodological quality of these implementation studies varied (mean QATSDD score = 19.5, range = 6–32). Conclusions This review highlighted a need for: (i) consideration of best practice guidelines for EPA development; (ii) focus on the methodological quality of research on EPA development and of EPAs, and (iii) further work investigating the implementation of EPAs in the curriculum.

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“…A total of 2894 records were screened, with 49 articles deemed eligible for inclusion (for PRISMA diagram, see Fig. ).…”

Section: Resultsmentioning

confidence: 99%

A systematic review of 7 years of research on entrustable professional activities in graduate medical education, 2011–2018

et al. 2019

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“…Most adopted the Delphi approach or a modified version of it, and some sought expert discussions . A few studies shortlisted important EPAs through online surveys or focus groups . EPAs were mostly mapped to their respective competencies or curricula's milestones.…”

Section: Resultsmentioning

confidence: 99%

“…Programmes that considered applying EPAs usually had existing milestones or training frameworks that could be enhanced by EPAs . The first step to incorporating EPAs into existing curricula is to establish a process to identify, elaborate and validate these EPAs .…”

Section: Discussionmentioning

confidence: 99%

Entrustable professional activities in health care education: a scoping review

et al. 2019

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CONTEXT The shift in medical education from time-based learning to outcome-based learning has drawn much attention to entrustable professional activities (EPAs) as an ideal assessment framework to translate competencies into clinical practice. Given the relative novelty of EPAs, this review aims to highlight research gaps and explore and consolidate available evidence pertaining to the development and implementation of EPAs in health care.RESULTS Eighty articles were included in the review. All articles were published between 2010 and 2018. Three major themes and eight subthemes were generated: (i) development of EPAs (frameworks for EPA development and implementation, identifying core or specialtyspecific EPAs, and EPAs for faculty development), (ii) evaluation of EPAs and EPA entrustment factors (revised curriculum, entrustment decisions for professional activities, and feedback on implemented EPAs and the development process), and (iii) future directions and recommendations for EPAs (implementation of EPAs in undergraduate medical education and specific disciplines, and other criticisms and recommendations for EPAs).CONCLUSIONS Entrustable professional activities are an essential means to translate competencies into observable and measurable clinical practice. However, high-level evidencebased research on the efficacy, development and implementation of EPAs for specific target groups (i.e. undergraduates and staff) and geographical regions (i.e. Asia and Africa) is still lacking, which suggests a direction for future research.

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“…Consensus methods included (a) Delphi method (Cappiello et al 2016;Sousa and Alves 2015), (b) group priority sort (Ling et al 2017) and, (c) nominal group technique (Kirk et al 2014;Landzaat et al 2017 Ling et al (2017) was the only study to utilise group priority sort method. While consensus is a worthwhile strategy that aligns with previous guidance, the rationale for a given approach over another, the sequence, or application was often unclear, and this poses a challenge when we attempt to examine alignment.…”

Section: Consensus Methodsmentioning

confidence: 99%

The development of competency frameworks in healthcare professions: a scoping review

Batt

Tavares

Williams³

2019

Preprint

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BackgroundCompetency frameworks serve various roles including outlining characteristics of a competent workforce, facilitating mobility, and analysing or assessing expertise. Given these roles and their relevance in the health professions, we sought to understand the methods and strategies used in the development of existing competency frameworks. MethodsWe applied the Arksey and O'Malley framework to undertake this scoping review. We searched six electronic databases (MEDLINE, CINAHL, PsycINFO, EMBASE, Scopus, and ERIC) and three grey literature sources (greylit.org, Trove and Google Scholar) using keywords related to competency frameworks. We screened studies for inclusion by title and abstract, and we included studies of any type that described the development of a competency framework in a healthcare profession. Two reviewers independently extracted data including study characteristics. Data synthesis was both quantitative and qualitative. ResultsAmong 5,710 citations, we selected 190 for analysis. The majority of studies were conducted in medicine and nursing professions. Literature reviews and group techniques were conducted in 116 studies each (61%), and 85 (45%) outlined some form of stakeholder deliberation. We observed a significant degree of diversity in methodological strategies, inconsistent adherence to existing guidance on the selection of methods, who was involved, and based on the variation we observed in timeframes, combination, function, application and reporting of methods and strategies, there is no apparent gold standard or standardised approach to competency framework development. ConclusionsWe observed significant variation within the conduct and reporting of the competency framework development process. While some variation can be expected given the differences across and within professions, our results suggest there is some difficulty in determining whether methods were fit-for-purpose, and therefore in making determinations regarding the appropriateness of the development process. This uncertainty may unwillingly create and legitimise uncertain or artificial outcomes. There is a need for improved guidance in the process for developing and reporting competency frameworks.All rights reserved. No reuse allowed without permission. not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

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Development of Entrustable Professional Activities for Hospice and Palliative Medicine Fellowship Training in the United States

Abstract: A set of 17 EPAs was developed using national input of practicing physicians and program directors and an iterative expert workgroup consensus process. The workgroup anticipates that EPAs can assist fellowship directors with strengthening competency-based training curricula.

Cited by 26 publications

References 14 publications

A systematic review of 7 years of research on entrustable professional activities in graduate medical education, 2011–2018

A systematic review of 7 years of research on entrustable professional activities in graduate medical education, 2011–2018

Entrustable professional activities in health care education: a scoping review

The development of competency frameworks in healthcare professions: a scoping review

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