Use of Milestones and Development of Entrustable Professional Activities in 2 Hematology/Oncology Training Programs

Abstract

Background The Next Accreditation System (NAS) increases the focus on educational outcomes and meaningful evaluation of learners. This requires that key clinical faculty develop new assessment formats such as entrustable professional activities (EPAs). Objectives To build and develop milestone-based assessment tools supporting 5 EPAs for a hematology/oncology fellow continuity clinic, and to educate key clinical faculty regarding the Clinical Competency Committee (CCC) and the NAS. Methods Program directors from 2 hematology/oncology fellowship programs developed 5 EPAs for continuity clinic evaluation supported by milestone-based assessment. The program directors met to create a unified CCC charter. Key clinical faculty helped to develop a milestone-based evaluation of fellow continuity clinic through creation of 5 hematology/oncology-specific EPAs. Formal entrustment regarding EPAs was deliberated by the CCC. Results A total of 18 fellows were evaluated. Clinical Competency Committee deliberation at each institution took approximately 10 minutes per fellow for discussion and decision regarding entrustment for all 5 EPAs supporting continuity clinic. One-third of postgraduate year (PGY)–4s, 50% of PGY-5s, and 100% of PGY-6s were deemed competent in all 5 EPAs by the CCC. Conclusions All hematology/oncology trainees in San Antonio were evaluated using milestone-based assessment for continuity clinic, and entrustment decisions regarding 5 EPAs were made by the CCC. This project may provide other programs with a sound basis for adoption and further development of the next generation of evaluation tools at their institutions. Entrustable professional activities that are rotation specific should be used as a starting point for linking to the competencies, subcompetencies, and the reporting milestones.

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.…”

Genetic Counseling Milestones: A Framework for Student Competency Evaluation

“…However, more research is needed on the development of OPAs and the benefits and challenges of implementing this assessment model into graduate medical education. Specialty specific EPAs have been created in several medical specialties, including Hematology/Oncology (Shumway et al 2015) and Internal Medicine (Hauer et al 2013). Publications describing the development of these assessment tools provide a model which could be adapted to the creation of EPAs for genetic counseling supervision (Hauer et al 2013;Shumway et al 2015).…”

“…Specialty specific EPAs have been created in several medical specialties, including Hematology/Oncology (Shumway et al 2015) and Internal Medicine (Hauer et al 2013). Publications describing the development of these assessment tools provide a model which could be adapted to the creation of EPAs for genetic counseling supervision (Hauer et al 2013;Shumway et al 2015). For example, one EPA described in Shumway et al (2015) is titled BWriting chemotherapy orders^.…”

“…Publications describing the development of these assessment tools provide a model which could be adapted to the creation of EPAs for genetic counseling supervision (Hauer et al 2013;Shumway et al 2015). For example, one EPA described in Shumway et al (2015) is titled BWriting chemotherapy orders^. This might be adapted to BIdentify appropriate support resources^for genetic counseling students.…”

The American Society of Hematology Clinical Research Training Institute is associated with high retention in academic hematology

“…In the few published studies evaluating hematology training programs, the primary goal was to evaluate clinical training, not research outcomes. 7,8 CRTI has conducted several types of evaluations from program inception. However, a systematic evaluation of program outcomes has not been undertaken.…”