The development of a framework of entrustable professional activities for the intern year in Ireland

Abstract

Background: Entrustable Professional Activities (EPAs) are units of professional practice that capture essential competencies in which trainees must become proficient before undertaking them independently. EPAs provide supervisors with a solid justification for delegating an activity to trainees. This study aimed to develop and ensure face validity of a set of EPAs for junior doctors in the first year of clinical practice in the Republic of Ireland. Methods: An iterative eight stage consensus building process was used to develop the set of EPAs. This process was based on international best practice recommendations for EPA development. A series of surveys and workshops with stakeholders was used to develop a framework of EPAs and associated competencies. An external stakeholder consultation survey was then conducted by the Irish Medical Council. The framework of EPAs was then benchmarked against the 13 core EPAs developed by the Association of American Medical Colleges (AAMC). Results: A framework of seven EPAs, and associated competencies resulted from this study. These EPAs address all core activities that junior doctors should be readily entrusted with at the end of the intern year, which is the first year of clinical practice in the Republic of Ireland. Each EPA contains a series of defined competencies. The final EPAs were found to be comparable to the AAMC core EPAs for entering residency. Conclusions: A framework of EPAs for interns in Ireland that are appropriate for the intern year has been developed by key stakeholders. The implementation of the EPAs in practice is the next step, and is likely to result in an improved intern training process and increased patient safety.

Multi-stakeholder Validation of Entrustable Professional Activities in Family Medicine

“…Overview of sample: A total of 57 participants initiated the survey, with 49 fully completing it, yielding a completion rate of 86%. The responders covered all dimensions of the social accountability pentagram [21][22] : policy makers (5), health administrators (4), family physicians (22 -20 involved with family medicine residency teaching, 2 not involved), other health professionals (6), family medicine residents (7) and members of public/patient (15). Participants were allowed to select multiple roles they belonged to, thus the total participant number does not equal that of the participants breakdown.…”

“…[1][2][3][4] The lack of consistency in acquired skills can lead to unsatisfactory patient experience and outcomes, 1,5 as well as graduate doctors being more uncertain in their abilities. 1,2,6,7 One increasingly common method to enhance patient safety and the uniformity of learned skills in graduating medical residents is to incorporate Entrustable Professional Activities (EPAs) into a Competency-based Medical Education (CMBE) framework. [8][9][10][11] CBME is an outcomes-based approach structuring a medical education program using an organized framework of competencies (e.g.…”

A Review of Entrustable Professional Activities in Pharmacy Education

“…4,5 Ideally, an EPA framework should consist of a set of support documents or templates that provide guidance to researchers and educators when developing the EPA statements. 7 Development of an EPA framework also relies on educational institutions and workplace requirements aligning. 2 One study reports that adaptive workplaces and quality trained organisations have demonstrated successful development of an EPA framework.…”

Entrustable professional activities for early health professionals: What's next?

“…There are a number of benefits of replacing time‐based apprenticeship models, in which competence is assumed following a set period, with an EPA approach in which documented evidence for skill acquisition is required to advance 4 . From a patient safety perspective, EPAs are meant to ensure that early health professionals can deliver safe patient care rather than simply assuming it; EPAs provide entry‐level health professionals with a clear understanding of the activities they are expected to perform and what competencies are required to advance to the next stage of training; they can also provide early health professionals with the confidence to seek assistance when they encounter unfamiliar tasks or situations.…”

“…First and foremost, EPAs must be supported by evidence that they constitute meaningful descriptions of the activities performed by the early health professional 5 . Unfortunately, this has been identified as a weakness for some EPAs 1,6‐8 despite there being a wide variety of methods reported for doing so (eg surveys to assess whether the EPAs are an accurate reflection of work activities, 4,9 review of entry‐level job descriptions 10 ). At their heart, EPAs provide a stimulus for work analysis that can help identify and define the tasks performed by early health professionals 5 .…”