Development of entrustable professional activities for regional anesthesia and pain medicine fellowship training

Abstract

IntroductionThe Accreditation Council for Graduate Medical Education (ACGME) offers descriptions of competencies and milestones but does not provide standardized assessments to track trainee competency. Entrustable professional activities (EPAs) and special assessments (SAs) are emerging methods to assess the level of competency obtained by regional anesthesiology and acute pain medicine (RAAPM) fellows.MethodsA panel of RAAPM physicians with experience in education and competency assessment and one medical student were recruited to participate in a modified Delphi method with iterative rounds to reach consensus on: a list of EPAs, SAs, and procedural skills; detailed definitions for each EPA and SA; a mapping of the EPAs and SAs to the ACGME milestones; and a target level of entrustment for graduating US RAAPM fellows for each EPA and procedural skill. A gap analysis was performed and a heat map was created to cross-check the EPAs and SAs to the ACGME milestones.ResultsParticipants in EPA and SA development included 19 physicians and 1 medical student from 18 different programs. The Delphi rounds yielded a final list of 23 EPAs, a defined entrustment scale, mapping of the EPAs to ACGME milestones, and graduation targets. A list of 73 procedural skills and 7 SAs were similarly developed.DiscussionA list of 23 RAAPM EPAs, 73 procedural skills, and 7 SAs were created using a rigorous methodology to reach consensus. This framework can be utilized to help assess RAAPM fellows in the USA for competency and allow for meaningful performance feedback.

Teaching regional anesthesia: current perspectives

“…In this case, the anesthesiologist needs other specific skills to improve their performance in this technique. Additionally, nerve stimulation techniques are fundamental for nerve localization, aiding in identifying nerve responses and further enhancing the accuracy of the regional block [1,3,8,12,13,28].…”

“…Experienced mentors guide learners through the process, offering real-time feedback and constructive critiques [45,46]. This close supervision ensures that learners perform procedures safely and effectively, minimizing the risk of complications and errors [28,47]. Supervision may gradually decrease as learners progress, allowing them to develop their autonomy in regional anesthesia practice.…”

“…Gaining confidence and autonomy is a significant outcome of hands-on teaching in regional anesthesia [28]. As learners master different nerve block techniques and gain experience with various patient scenarios, they become more self-assured in their abilities [11,48].…”

“…The emergence of Entrustable Professional Activities (EPAs) has led to a call for change in medical and health profession curricula. EPAs are units of clinical practice, Advances in Regional Anesthesia -Future Directions in the Use of Regional Anesthesia tasks, or responsibilities that students can perform without supervision once they have achieved the desired competency [28,[63][64][65]. Each EPA incorporates domains and subdomains of general competencies, integrated with specific content from the curriculum's educational programs.…”

“…Each EPA incorporates domains and subdomains of general competencies, integrated with specific content from the curriculum's educational programs. Didactic activities are designed from concrete daily experiences in clinical practice at different levels depending on the year of study [28,64,65]. Three strategies, namely, situated learning, deliberate practice, and reflection, are used to help students achieve reliable clinical activities [66].…”