The Application of Entrustable Professional Activities to Inform Competency Decisions in a Family Medicine Residency Program

Abstract

Assessing entrustable professional activities (EPAs), or carefully chosen units of work that define a profession and are entrusted to a resident to complete unsupervised once she or he has obtained adequate competence, is a novel and innovative approach to competency-based assessment (CBA). What is currently not well described in the literature is the application of EPAs within a CBA system. In this article, the authors describe the development of 35 EPAs for a Canadian family medicine residency program, including the work by an expert panel of family physician and medical education experts from four universities in three Canadian provinces to identify the relevant EPAs for family medicine in nine curriculum domains. The authors outline how they used these EPAs and the corresponding templates that describe competence at different levels of supervision to create electronic EPA field notes, which has allowed educators to use the EPAs as a formative tool to structure day-to-day assessment and feedback and a summative tool to ground competency declarations about residents. They then describe the system to compile, collate, and use the EPA field notes to make competency declarations and how this system aligns with van der Vleuten's utility index for assessment (valid, reliable, of educational value, acceptable, cost-effective). Early outcomes indicate that preceptors are using the EPA field notes more often than they used the generic field notes. EPAs enable educators to evaluate multiple objectives and important but unwieldy competencies by providing practical, manageable, measurable activities that can be used to assess competency development.

Curriculum development for the workplace using Entrustable Professional Activities (EPAs): AMEE Guide No. 99

“…EPAs have now been identified for many graduate medical education programmes including obstetrics/gynaecology (Scheele et al 2013), paediatrics (Gilhooly et al 2014), internal medicine (Caverzagie et al 2015), family medicine (Shaughnessy et al 2013;Schultz et al 2015), psychiatry (Boyce et al 2011), haematology and oncology (Shumway et al 2015) and pulmonary and critical care (Fessler et al 2014a,b). Examples of EPAs from the literature are providing preoperative assessment, managing care of patients with acute common diseases across multiple care settings, providing palliative care, managing common gastro-intestinal infections in non-immunosuppressed and immune-compromised populations, conducting a family education session for schizophrenia, conducting a risk assessment, serving as the primary admitting paediatrician for previously well children suffering from common acute problems, pharmacological management of an anxiety disorder, providing end-of-life care for older adults and office-based counselling in developmental and behavioural paediatrics.…”

“…General internal medicine residency 3 30 Chang et al (2013) Internal medicine (patient-centred med. home programme) Unspecified 25 Shaughnessy et al (2013) Family medicine residency 3 76 O'Keeffe (2014) Developmental-behavioural paediatrics residency Unspecified 14 Englander et al (2014) Undergraduate medical education (AE 2.5 year clinical) 2.5 13 Fessler et al (2014a,b) Pulmonary care residency 1-2 18 Fessler et al (2014a,b) Critical care medicine residency 1-2 13 Rose et al (2014) Gastro-intestinal fellowship 3 13 Caverzagie et al (2015) Internal medicine residency 3 16 Chen et al (in press) Undergraduate medical education pre-clerkship training 2 5 Shumway et al (2015) Haematology/oncology fellowship 2-3 5 Schultz et al (2015) Family medicine 2 35 We recommend that ''conducting a literature review'' not be considered an EPA, as one cannot envision an entrustment decision before which a trainee is not permitted to do this unsupervised. Designing one's personal development plan is actually not part of the necessary tasks that must be carried out by the profession.…”

The Role of Generic Competencies in the Entrustment of Professional Activities: A Nationwide Competency-Based Curriculum Assessed

“…Having an EPA-based curriculum is expected to contribute to assessment and documentation of a resident's performance in generic competencies, 25,26 and we expected entrustments based on generic competencies. In contrast, our findings suggest that an EPA-based curriculum does not guarantee the desired attention to generic competencies during entrustment decisions.…”

Entrustable Professional Activities for Pathology

“…Much of the literature to date on EPAs has served to delineate the concept and establish EPAs for various specialties, including internal medicine, 10,11 family medicine, 12,13 pediatrics, 14 developmental-behavioral pediatrics, 15 geriatrics, 16 pulmonary and critical care, 17 hematology/oncology, 18 gastroenterology, 19 and radiology, 20 in the United States and abroad, and for undergraduate medical education. 21,22 In their recent publication in Human Pathology , Powell and Wallschlaeger provide examples of possible EPAs for pathology, give a detailed description of performance of an autopsy as an example of an EPA, and advocate for the development of EPAs for pathology on the national level.…”