Entrustable Professional Activities for Entering Residency: Establishing Common Osteopathic Performance Standards in the Transition From Medical School to Residency

Abstract

Entrustable professional activities (EPAs) are measurable units of observable professional practice that can be entrusted to an unsupervised trainee. They were first introduced as a method of operationalizing competency-based medical education in graduate medical education. The American Association of Medical Colleges subsequently used EPAs to establish the core skills that medical students must be able to perform before they enter residency training. A recently published guide provides descriptions, guidelines, and rationale for implementing and assessing the core EPAs from an osteopathic approach. These osteopathically informed EPAs can allow schools to more appropriately assess a learner's whole-person approach to a patient, in alignment with the philosophy of the profession. As the single accreditation system for graduate medical education moves forward, it will be critical to integrate EPAs into osteopathic medical education to demonstrate entrustment of medical school graduates. The authors describe the collaborative process used to establish the osteopathic considerations added to EPAs and explores the challenges and opportunities for undergraduate osteopathic medical education.

Implementation and Use of Workplace-Based Assessment in Clinical Learning Environments: A Scoping Review

“…Several perspectives, commentaries, and framework proposals discussed concepts for developing an overall strategy for implementation of WBA as part of programmatic assessment. 4,5,7,65,88–115 In alignment with programmatic assessments’ ideals, a key element of these frameworks was the use of multiple assessment points to inform summative decisions. 100–102,116–119 Recommendations included combining and using assessment data from multiple contexts and different assessors, paying close attention that assessments have utility in their particular learning environment.…”

Case-based EBM instruction for Osteopathic Medical Students: A Case Report

“…This COM program did not have a liaison librarian for two years prior to the author's appointment, and EBM was not addressed in any part of the COM curriculum. The librarian initially approached the associate dean with the proposal of library instruction by referencing the dean's prior scholarship which supported the inclusion of EBM instruction within COMs to meet AACOM competencies 1,4,20 . The associate dean agreed to allow the librarian one 60-minute session in the late fall to introduce EBM.…”

“…The CBL session goals and course objectives included the AACOM competencies expected by residency 1 . The overall learning goal(s) are to introduce first-year osteopathic medical students to the EBM process and demonstrate the applicability of this process to clinical practice using relevant clinical scenarios in an interactive, engaging environment.…”

“…. using information technology" [1][2] . The ability to search for evidence is foundational to the clinical practice of evidence-based medicine and research.…”

Relationship of Preceptor Ad-hoc Entrustment Decisions to Students’ Clinical Skills Performance

“…Defined as tasks essential to professional practice, EPAs overcame the limitations of evaluating expected physician competencies in favor of a more direct approach of assessing what physicians actually do in daily practice ( ten Cate, Snell and Carraccio, 2010 ; ten Cate, 2013, Crossley and Jolly, 2012 ). As EPAs were expanded across specialties and subsequently adapted for undergraduate medical education (UME) to assess a student’s readiness for residency ( American Association of Colleges of Osteopathic Medicine or AACOM, 2016 ; Association of American Medical Colleges or AAMC, 2014 ; Basehore et al ., 2017 ; Lomis et al ., 2016 ), they became a unifying strategy for linking competencies to clinical practice at every level of medical training ( ten Cate, Snell and Carraccio, 2010 ; ten Cate 2013a ). As such, the need for workplace-based assessments appropriate for capturing ad-hoc entrustment decisions for different levels of learners became paramount.…”