Guia Atualizado sobre Atividades Profissionais Confiáveis (APCs)

Abstract

Since the turn of the millennium, competency-based medical education (CBME) has become a new standard for medical training in many countries. CBME has been operationalized in detailed frameworks of competencies that every physician should demonstrate at graduation, and similar frameworks have been created for specialties. However, the competencies, describing qualities that physicians should possess, do not directly translate into everyday activities of physicians. For that reason, the Entrustable Professional Activities (EPAs) were introduced. EPAs are units of professional practice that may be entrusted to undergraduate students, once they show the competencies needed to perform them without supervision. EPAs have become a popular topic within CBME programs in many countries and hundreds of publications within only a few years. This paper was written to introduce the strengths and weaknesses of EPAs. After a brief historical overview, the reason why EPAs are a bridge between a competency framework and daily clinical practice is explained. While competencies are qualities of individuals, EPAs are units of work. The two can be seen as two dimensions of a matrix, showing that almost all activities in health care are based on multiple competencies, such as communication skill, collaboration, professional behavior, content knowledge. Next, entrustment decision-making as a form of assessment is created and a framework of levels of supervision is presented. Entrustment decisions focus on the level of supervision a student requires for a specific activity, divided into five levels (1: allowed to observe; 2; allowed to perform under direct supervision; 3: allowed to perform under indirect supervision; 4: allowed to perform the activity unsupervised; 5: allowed to supervise the activity performed by more junior learners). For readers interested in applying the concept to practice, a stepwise approach to the curriculum development is proposed. The paper concludes with an overview of the state-of-the-art of working with EPAs across disciplines, professions and countries.

Desenvolvimento docente pós-COVID-19: mudanças ou troca de cenário?

“…Precisamos avançar em soluções digitais, simples e factíveis de acompanhamento personalizado, de modo a viabilizar a implantação plena da CBME 19 .…”

“…pacientes e criar experiências para os estudantes nos hospitais ou nos ambulatórios, e persistir buscando formas inovadoras de aprendizagem18,23,24 .Há décadas, várias escolas têm introduzido mudanças pedagógicas profundas, utilizando a tecnologia de modo racional, favorável à integração dos conteúdos, para romper barreiras na comunicação e concretizar a memorização associada com a aplicabilidade25 . Mais forte ainda surgiram a simulação, telemedicina, telepatologia, aprendizagem e ensino em equipe, a realidade aumentada e virtual, tudo com foco no estímulo à aprendizagem ativa, no contexto da CBME e de atividades médicas confiáveis (Entrustable Professional Activities -EPA)19,26 . Este é um momento para contribuir com transformações que possam melhorar a carreira profissional e, para muitas disciplinas médicas, um momento em que as ações integrativas podem avançar para a integração6,21 .…”

Creation of Entrustable Professional Activities (EPAs) in obstetrics and gynecology for medical undergraduate students

“…The need to take responsibility for the health of the population and the protection of citizens against incompetent medical professional practice led to the concept of competence and the identification of the medical curriculum components 1 . By refocusing on professional practice, schools are required to rethink their curricula and evaluation processes, reorienting educational planning based on the desirable competence profile for their graduates 2 .…”

“…Each EPA is a synthesis of several competence domains (for instance, medical knowledge, communication skills and professionalism) and requires the integration of knowledge, skills and attitudes 9 . The EPAs are professional practice units that constitute the daily practice of clinicians 1,5 . They constitute a list of tasks to be performed in a certain period of time during patient care.…”

Avaliação em uma residência de radiologia: elaboração de um novo instrumento e experiência inicial

“…Esses marcos são definidos para cada nível, por meio de várias ferramentas de avaliação, como observação direta, casos simulados, feedback com múltiplas fontes, entre outras [11][12][13] . No Reino Unido, o Royal College of Radiologists (RCR) utiliza um sistema de atividades profissionais confiáveis (APC) 14,15…”