Revisiting the Core Entrustable Professional Activities for Entering Residency

Abstract

As the AAMC initiates a pilot for the Core Entrustable Professional Activities (EPAs) for Entering Residency, we are seeking baseline data from residency program directors about the readiness of graduates of LCME-accredited US medical schools to perform the 13 Core EPAs without direct supervision upon entry to residency. These EPAs are based on the work of a thirteen-member expert panel informed by the literature and by feedback from the academic medicine community. Your response will be helpful in establishing a baseline against which we can assess impact as some schools implement the Core EPAs for Entering Residency.Your participation in this project is voluntary. All responses are confidential. The data will be reported in aggregate by specialty type for research purposes. No individual respondent or individual program will be identified in any report of these data. This data collection activity has been reviewed according to AAMC policies and procedures and its Institutional Review Board and is considered to be minimal risk. The AAMC has taken extensive measures to ensure the security of the data and the confidentiality of the responses. Nevertheless, if individually identified data were made public, it could prove embarrassing. If you have any questions about your rights as a participant, contact the AAMC Office of Human Subjects Research Protection by email

Enter and Discuss Orders and Prescriptions (EPA 4): A Curriculum for Fourth-Year Medical Students

“…Preparation of students to perform EPA 4 skills is a core expectation of undergraduate medical education institutions yet has proven challenging, as evidenced by residency program director observations. 4 , 5 In the context of a health care system that increasingly relies upon EHRs for its CPOE and CDS functionalities, our curriculum provides undergraduate medical educators with the tools and framework to start preparing their students to effectively use these tools in order entry. In this formative workshop, students familiar with institutional EHR use and entering sporadic orders were tasked with entering a complete admission order set in a collaborative setting before their subinternship rotations.…”

“… 24 Additionally, 87% of graduates from two of the participating Core EPA Pilot Project institutions were deemed to be prepared to perform EPA 4 skills by their residency program directors. 4 These studies suggest that intentional instruction and feedback can result in entrustment.…”

“…The 2014 AAMC program director EPA survey revealed relatively low residency program director confidence in the ability of PGY 1 graduates of Liaison Committee for Medical Education–accredited U.S. medical schools to perform with only indirect supervision many of these activities, among them being EPA 4. 4 A multispecialty survey of program directors several years later similarly revealed program director perceptions that only 69% of interns were adequately prepared to perform the skills required for EPA 4. 5 …”

Entrustable Professional Activities: Reflecting on Where We Are to Define a Path for the Next Decade

“…Articles from Lindeman and colleagues as well as Amiel and colleagues highlight that EPAs for a given field should not be viewed as static. 21,47 In the case of Lindeman and colleagues, they took a pragmatic approach to developing EPAs for general surgery, electing to start with 5 that had consensus as core to the specialty while they negotiated additional EPAs that broadly define the specialty. 21 The experience of Amiel and colleagues follows extensive work implementing the Association of American Medical Colleges' (AAMC) Core EPAs for Entering Residency (CEPAERs) at multiple schools.…”

“…21 The experience of Amiel and colleagues follows extensive work implementing the Association of American Medical Colleges' (AAMC) Core EPAs for Entering Residency (CEPAERs) at multiple schools. 47 These experiences led them to reflect on EPAs that should perhaps be added, including educating patients about their illness, motivational interviewing, and providing telemedicine services. For us, these examples highlight both EPAs not included in the first iteration that are worthy of consideration as well as clear changes in the practice of medicine (telemedicine) since the AAMC CEPAERs were published.…”