Developing Entrustable Professional Activities as the Basis for Assessment of Competence in an Internal Medicine Residency: A Feasibility Study
Open accessAbstract
Background Graduate medical education programs assess trainees' performance to determine readiness for unsupervised practice. Entrustable professional activities (EPAs) are a novel approach for assessing performance of core professional tasks.Aim To describe a pilot and feasibility evaluation of two EPAs for competency-based assessment in internal medicine (IM) residency.Setting/participants Post-graduate year-1 interns (PGY-1s) and attendings at a large internal medicine (IM) residency program.Program description Two Entrustable professional activities (EPA) assessments (Discharge, Family Meeting) were piloted.Program feasibility evaluation Twenty-eight out of 43 (65.1 %) PGY-1 s and 32/43 (74.4 %) attendings completed surveys about the Discharge EPA experience. Most who completed the EPA assessment (10/12, 83.8 %, PGY-1s; 9/11, 83.3 %, attendings) agreed it facilitated useful feedback discussions. For the Family Meeting EPA, 16/26 (61.5 %) PGY-1s completed surveys, and most who participated (9/12 PGY1s, 75 %) reported it improved attention to family meeting education, although only half recommended continuing the EPA assessment.Discussion From piloting two EPA assessments in a large IM residency, we recognized our reminder systems and time dedicated for completing EPA requirements as inadequate. Collaboration around patient safety and palliative care with relevant clinical services has enhanced implementation and buy-in. We will evaluate how well EPA-based assessment serves the intended purpose of capturing trainees' trustworthiness to conduct activities unsupervised.
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In 2012, the IM Residency Program at Penn State College of Medicine identified coaching for residents, specifically in achieving entrustment in EPAs, as an improvement area.
“In 2012, the IM Residency Program at Penn State College of Medicine identified coaching for residents, specifically in achieving entrustment in EPAs, as an improvement area [28,29].”
A total of 323 disorienting dilemmas with PLPs were identified.
“We identified a total of 323 disorienting dilemmas with PLPs mapped across all 16 EPAs, and four additional themes: (1) work–life balance, (2) career planning, (3) teaching skills, and, (4) research/scholarship [28,29].”
Disorienting dilemmas and professional learning plans mapped to all 16 EPAs and four additional themes: work-life balance, career planning, teaching skills, and research/scholarship.
“Disorienting dilemmas and professional learning plans mapped to all 16 EPAs and four additional themes: work–life balance, career planning, teaching skills, and research/scholarship.”
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Cites
A tutorial on pilot studies: the what, why and how
Thabane, L., Ma, J., Chu, R., Cheng, J., Ismaila, A., Rios, L. P., Robson, R., Thabane, M., Giangregorio, L., & Goldsmith, C. H. (2010) · BMC Medical Research Methodology · doi:10.1186/1471-2288-10-1 · Cited by 3,384 · see citing works
Kripalani, S., LeFevre, F., Phillips, C. O., Williams, M. V., Basaviah, P., & Baker, D. W. (2007) · JAMA · doi:10.1001/jama.297.8.831 · Cited by 2,103 · see citing works
The Next GME Accreditation System — Rationale and Benefits
Nasca, T. J., Philibert, I., Brigham, T. P., & Flynn, T. C. (2012) · New England Journal of Medicine · doi:10.1056/nejmsr1200117 · Cited by 1,621 · see citing works
What is a pilot or feasibility study? A review of current practice and editorial policy
Arain, M., Campbell, M. J., Cooper, C. L., & Lancaster, G. A. (2010) · BMC Medical Research Methodology · doi:10.1186/1471-2288-10-67 · Cited by 1,483 · see citing works
Kripalani, S. B., Jackson, A. T., Schnipper, J. L., & Coleman, E. A. (2007) · Journal of Hospital Medicine · doi:10.1002/jhm.228 · Cited by 817 · see citing works
Tools for Direct Observation and Assessment of Clinical Skills of Medical Trainees
Kogan, J. R., Holmboe, E. S., & Hauer, K. E. (2009) · JAMA · doi:10.1001/jama.2009.1365 · Cited by 602 · see citing works
Self-citationLurie, S. J., Mooney, C. J., & Lyness, J. M. (2009) · Academic Medicine · doi:10.1097/acm.0b013e3181971f08 · Cited by 365 · see citing works
Medical competence: The interplay between individual ability and the health care environment
ten Cate, O., Snell, L. S., & Carraccio, C. L. (2010) · Medical Teacher · doi:10.3109/0142159x.2010.500897 · Cited by 356 · see citing works
Twelve tips for teaching reflection at all levels of medical education
Aronson, L. (2010) · Medical Teacher · doi:10.3109/0142159x.2010.507714 · Cited by 334 · see citing works
Charting the Road to Competence: Developmental Milestones for Internal Medicine Residency Training
Green, M. L., Aagaard, E., Caverzagie, K. J., et al. (2009) · Journal of Graduate Medical Education · doi:10.4300/01.01.0003 · Cited by 281 · see citing works
Mulder, H., ten Cate, O., Daalder, R., & Berkvens, J. (2010) · Medical Teacher · doi:10.3109/0142159x.2010.513719 · Cited by 206 · see citing works
Bernabeo, E. C., Holtman, M. C., Ginsburg, S., Rosenbaum, J. R., & Holmboe, E. S. (2011) · Academic Medicine · doi:10.1097/acm.0b013e318212c2c9 · Cited by 152 · see citing works
Identifying Entrustable Professional Activities in Internal Medicine Training
Hauer, K. E., Kohlwes, J., Cornett, P., Hollander, H., ten Cate, O., Ranji, S. R., Soni, K., Iobst, W., & O'Sullivan, P. (2013) · Journal of Graduate Medical Education · doi:10.4300/jgme-d-12-00060.1 · Cited by 147 · see citing works
Self-citationAssessment of competence and progressive independence in postgraduate clinical training
Dijksterhuis, M. G. K., Voorhuis, M., Teunissen, P. W., Schuwirth, L., ten Cate, O., Braat, D. D. M., & Scheele, F. (2009) · Medical Education · doi:10.1111/j.1365-2923.2009.03509.x · Cited by 140 · see citing works
Beyond Competencies and Milestones: Adding Meaning Through Context
Carraccio, C. L., & Burke, A. E. (2010) · Journal of Graduate Medical Education · doi:10.4300/jgme-d-10-00127.1 · Cited by 130 · see citing works
ten Cate, O., & Young, J. Q. (2012) · BMJ Quality & Safety · doi:10.1136/bmjqs-2012-001213 · Cited by 96 · see citing works
Deketelaere, A., Kelchtermans, G., Struyf, E., & Leyn, P. D. (2006) · Medical Education · doi:10.1111/j.1365-2929.2006.02551.x · Cited by 79 · see citing works
MEDICAL EDUCATION IN THE UNITED STATES
VEDOVA, G. D. (1929) · JAMA · doi:10.1001/jama.1929.02710070023008 · Cited by 67 · see citing works
A SAFE DC: A conceptual framework for care of the homeless inpatient
Best, J. A., & Young, A. (2009) · Journal of Hospital Medicine · doi:10.1002/jhm.568 · Cited by 21 · see citing works
Medical Education In The United States, 1960–1987
Jolly, P. (1988) · Health Affairs · doi:10.1377/hlthaff.7.2.144 · Cited by 15 · see citing works
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Gonzalo, J. D., Wolpaw, D. R., Krok, K. L., Pfeiffer, M. P., & McCall-Hosenfeld, J. S. (2019) · Medical Education Online · doi:10.1080/10872981.2019.1591256 · Cited by 39 · see citing works
Exploring how feedback reflects entrustment decisions using artificial intelligence
Gin, B. C., ten Cate, O., O'Sullivan, P. S., Hauer, K. E., & Boscardin, C. (2022) · Medical Education · doi:10.1111/medu.14696 · Cited by 37 · see citing works
Self-citation
- Authors
- Hauer, K. E., Soni, K., Cornett, P., Kohlwes, J., Hollander, H., Ranji, S. R., ten Cate, O., Widera, E., Calton, B., & O’Sullivan, P. S.
- Affiliations
- University of California, San Francisco (US)
- San Francisco VA Medical Center (US)
- Corresponding author
- Hauer, Karen E.
- ORCID
- Venue
- Journal of General Internal Medicine
- Published
- 2013-04-18
- Volume
- 28
- Issue
- 8
- Pages
- 1110-1114
- ISSN
- 0884-8734 (ISSN-L)
- 1525-1497
- PMC
- PMC3710378
- OpenAlex
- W2087317592
- Cited by
- 83
- References
- 20
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 4 · 2023: 3 · 2022: 5 · 2021: 8 · 2020: 5 · 2019: 6 · 2018: 9 · 2017: 10 · 2016: 4 · 2015: 12 · 2014: 11
- FWCI
- 9.18
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Journal of General Internal Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
- Keywords
- entrustable professional activities, competency-based assessment, internal medicine residency, graduate medical education, discharge planning, family meetings, trainee feedback, palliative care, patient safety
- MeSH terms
- Clinical Competence, Commission on Professional and Hospital Activities, Feasibility Studies, Humans, Internal Medicine, Internship and Residency, Pilot Projects, United States
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