Entrustment and Mapping of Observable Practice Activities for Resident Assessment

Abstract

Entrustable Professional Activities (EPAs) and the Next Accreditation System reporting milestones reduce general competencies into smaller evaluable parts. However, some EPAs and reporting milestones may be too broad to use as direct assessment tools. We describe our internal medicine residency curriculum and assessment system, which uses entrustment and mapping of observable practice activities (OPAs) for resident assessment. We created discrete OPAs for each resident rotation and learning experience. In combination, these serve as curricular foundation and tools for assessment. OPA performance is measured via a 5-point entrustment scale, and mapped to milestones and EPAs. Entrustment ratings of OPAs provide an opportunity for immediate structured feedback of specific clinical skills, and mapping OPAs to milestones and EPAs can be used for longitudinal assessment, promotion decisions, and reporting. Direct assessment and demonstration of progressive entrustment of trainee skill over time are important goals for all training programs. Systems that use OPAs mapped to milestones and EPAs provide the opportunity for achieving both, but require validation.

Using a Curricular Vision to Define Entrustable Professional Activities for Medical Student Assessment

“…22 Another approach is to define smaller units of activities that nest together within larger EPAs, as has been proposed with Observable Professional Activities. 23 Our approach to EPA development and mapping to milestones has limitations. This work occurred at a single institution.…”

For the General Internist: A Summary of Key Innovations in Medical Education

“…[13][14][15][16][17][18][19][20][21][22][23][24][25] Compared to our review of the 2013 literature relevant to general medicine educators, 26 we found more multi-institutional studies of high quality. Similar to last year, resident continuity clinic and handoffs were areas of focus.…”

“…14,16,19,25 We also found descriptive studies on use of the milestone-based learner assessments. 18 Our selection process prioritized those most relevant, important, and generalizable, and with greatest methodological quality, for our audience of general internist educators.…”

Rating the Quality of Entrustable Professional Activities: Content Validation and Associations with the Clinical Context

“…OPAs differ from EPAs in that they are more context or content specific than EPAs, but are used in a similar manner to EPAs for learner assessment. 10 Observable practice activities were originally described as a way to assess learners' observed performance, which in turn serves to inform entrustment within EPAs. 10 However, EPAs expand beyond OPAs, by addressing activities that society trusts all physicians to do, 5 and by allowing assessment of these activities over the course of a resident's training.…”