Introducing a clerkship curriculum based on entrustable professional activities: a pilot study

Abstract

BackgroundGeneral clerkship quality criteria have not been studied after introducing a curriculum based on entrustable professional activities (EPAs). Therefore, we conducted a pilot study to explore educational outcomes of an EPA-based clerkship curriculum reform.MethodsWe collected multiple self-assessment and evaluation data on levels 1-3 of the New World Kirkpatrick model (KPM). For level 1 (reaction) we analyzed curriculum evaluations and verbal and written students’ feedback. For level 2 (learning) pre- and post-clerkship self-assessments of perceived need for supervision for each EPA and students’ written learning reflections based on patient mix exposure were analyzed. For level 3 (behavior) we evaluated workplace-based assessments.ResultsThe first student cohort in the new EPA-based clerkship completed 180 self-assessments (18 per student) of need for supervision and 63 documented workplace-based assessments (average of 6.3 per student in four weeks). On KPM level 1 we saw a high overall satisfaction with the clerkship (average of 4.9, range: 4.0-5.0 on a 5-point Likert scale). In written evaluations and feedback rounds students pointed out the importance of structured bedside teaching in the first clerkship week. On KPM level 2 the overall decrease of self-assessed need for supervision before and after the clerkship was two supervision levels (from direct to indirect supervision) and statistically significant (p < 0.05). For three EPAs students reached indirect supervision levels. Learning reflections and patient mix analysis indicated that students were exposed to a wide range of diagnostic categories (ICD-10: F0 – F6) and received actionable feedback for communication skills. On KPM level 3 clinical supervisors predominantly used EPAs 1 (History taking), 2 (Assessing mental status) and 8 (Documentation and presentation) for workplace-based assessments. We saw a decreasing need for supervision from the first to the last week in the clerkship according to the supervisors’ judgements.ConclusionStudents reacted positively to introducing an EPA-based clerkship curriculum. The EPA-oriented formative self-assessments and workplace-based assessments seemed to support achievement of competency-based learning goals. However, more in-depth understanding of the entrustment process in the clerkship context is necessary to fully leverage the potential of an EPA-based clerkship.

Analisis Kualitatif Refleksi Diri Dokter Muda tentang Pembelajaran pada Stase Psikiatri di Fakultas Kedokteran Universitas Jember/RSD Dr. Soebandi Jember

“…Kondusivitas pembelajaran stase juga ditunjukkan dengan adanya variasi antara penilaian berbasis performa (penilaian seminar, refleksi kasus, laporan kasus, book reading, telaah rekam medis dummy, miniPAT) dan self assessment (refleksi diri). Pinilla, et al, (2021) mendukung temuan ini sebagai aspek kondusif karena karakteristik pembelajaran yang menggabungkan penilaian berbasis performa dan self assessment memang terbukti dapat membantu mahasiswa mencapai tujuan belajar yang berbasis kompetensi.…”

Entrustable Professional Activities in der psychiatrischen Weiterbildung: Ein vielversprechendes Konzept

“…Die dort definierten neun Kern-EPAs (Tabelle 2) sollen während der Ausbildung erlernt werden, sodass Medizinstudierende am ersten Tag ihrer Weiterbildung (unabhängig vom Fachgebiet) die Tätigkeiten der neun Kern-EPAs sicher unter indirekter Supervision ausführen können. Erste Pilotprojekte in der klinisch-praktischen Ausbildung von Medizinstudierenden im Fach Psychiatrie an der Universität Bern wurden positiv evaluiert [12].…”