A Mastery Learning Capstone Course to Teach and Assess Components of Three Entrustable Professional Activities to Graduating Medical Students

Salzman, David H.; McGaghie, William C.; Caprio, Timothy; Hufmeyer, Kathryn Kinner; Issa, Nabil; Cohen, Elaine; Wayne, Diane B.

doi:10.1080/10401334.2018.1526689

Cited by 17 publications

(11 citation statements)

References 31 publications

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“…Our results show that a directed EPA 10 curriculum can improve medical student performance on managing emergencies in a simulated environment and improve entrustment scores. Our findings are similar to those of other studies on EPAs in which direct instruction improved skills, such as giving or receiving a patient handoff, obtaining informed consent, developing a differential diagnosis, and writing orders and prescriptions 34,35 . Additionally, medical students at any level can benefit from direct instruction on EPA 10 as a recent study found that students preferred early and formal training in each core EPA with greater opportunities to gain experience 5 …”

Section: Discussionsupporting

confidence: 85%

Filling the Core EPA 10 assessment void: A framework for individual assessment of Core Entrustable professional activity 10 competencies in medical students

Miller

Gibb

Caretta‐Weyer

et al. 2022

AEM Education and Training

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Objectives:The goal of this study was to develop and evaluate a novel curriculum and assessment tool for Core Entrustable Professional Activity (EPA) 10 competencies and entrustment scoring in a cohort of medical students in their emergency medicine (EM) clerkship using a framework of individualized, ad hoc, formative assessment.Core EPA 10 is an observable workplace-based activity for graduating medical students to recognize a patient requiring urgent or emergent care and initiate evaluation and management.Methods: This is a prospective, pretest-posttest study of medical students during their EM clerkship. Using the Thomas and Kern framework, we created a curriculum of simulation cases about chest pain/cardiac arrest and respiratory distress, which included novel assessment checklists, and instructional videos about recognizing and managing emergencies. Students were individually pretested on EPA 10 competencies using the simulation cases. Two raters scored students using standardized checklists. Students then watched instructional videos, underwent a posttest with the simulation cases, and were scored again by the two raters using the checklists.Differences between pretest and posttest scores were analyzed using paired t-tests and Wilcoxon signed-rank tests.Results: Seventy-three out of 85 (86%) students completed the curriculum. Mean scores from pretest to final posttest in the chest pain/cardiac arrest and respiratory distress cases significantly improved from 14.8/19 (SD 1.91), to 17.1/19 (SD = 1.00), t(68) = 10.56, p < 0.001, and 8.5/13 (SD 1.79), to 11.1/13(SD 0.89), t(67) = 11.15, p < 0.001, respectively. The kappa coefficients were 0.909 (n = 2698, p < 0.001) and 0.931 (n = 1872, p < 0.001). Median modified Chen entrustment scores improved from 1b (i.e., "Watch me do this") to 2b (i.e., "I'll watch you") for the chest pain/cardiac arrest case (p < 0.001) and 1b/2a (i.e., "Watch me do this"/ "Let's do this together") to 3a (i.e. "You go ahead, and I'll double-check all of your findings") for the respiratory distress case (p < 0.001). Conclusion:A new directed curriculum of standardized simulation cases and asynchronous instructional videos improved medical student performance in EPA 10

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Section: Discussionsupporting

confidence: 85%

Filling the Core EPA 10 assessment void: A framework for individual assessment of Core Entrustable professional activity 10 competencies in medical students

Miller

Gibb

Caretta‐Weyer

et al. 2022

AEM Education and Training

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“…41 Mastery grading systems, in which mastery standards are defined and assessments are made along a binary scale (mastered vs not mastered), may alleviate some of the racial and ethnic disparities in assessment described in this study. 42,43 This recommendation is supported by our finding that Asian and URiM residents were no more likely to receive a critical deficiency than White residents.…”

Section: Discussionmentioning

confidence: 57%

Racial and Ethnic Differences in Internal Medicine Residency Assessments

et al. 2022

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ImportancePrevious studies have demonstrated racial and ethnic inequities in medical student assessments, awards, and faculty promotions at academic medical centers. Few data exist about similar racial and ethnic disparities at the level of graduate medical education.ObjectiveTo examine the association between race and ethnicity and performance assessments among a national cohort of internal medicine residents.Design, Setting, and ParticipantsThis retrospective cohort study evaluated assessments of performance for 9026 internal medicine residents from the graduating classes of 2016 and 2017 at Accreditation Council of Graduate Medical Education (ACGME)–accredited internal medicine residency programs in the US. Analyses were conducted between July 1, 2020, and June 31, 2022.Main Outcomes and MeasuresThe primary outcome was midyear and year-end total ACGME Milestone scores for underrepresented in medicine (URiM [Hispanic only; non-Hispanic American Indian, Alaska Native, or Native Hawaiian/Pacific Islander only; or non-Hispanic Black/African American]) and Asian residents compared with White residents as determined by their Clinical Competency Committees and residency program directors. Differences in scores between Asian and URiM residents compared with White residents were also compared for each of the 6 competency domains as supportive outcomes.ResultsThe study cohort included 9026 residents from 305 internal medicine residency programs. Of these residents, 3994 (44.2%) were female, 3258 (36.1%) were Asian, 1216 (13.5%) were URiM, and 4552 (50.4%) were White. In the fully adjusted model, no difference was found in the initial midyear total Milestone scores between URiM and White residents, but there was a difference between Asian and White residents, which favored White residents (mean [SD] difference in scores for Asian residents: −1.27 [0.38]; P &lt; .001). In the second year of training, White residents received increasingly higher scores relative to URiM and Asian residents. These racial disparities peaked in postgraduate year (PGY) 2 (mean [SD] difference in scores for URiM residents, −2.54 [0.38]; P &lt; .001; mean [SD] difference in scores for Asian residents, −1.9 [0.27]; P &lt; .001). By the final year 3 assessment, the gap between White and Asian and URiM residents’ scores narrowed, and no racial or ethnic differences were found. Trends in racial and ethnic differences among the 6 competency domains mirrored total Milestone scores, with differences peaking in PGY2 and then decreasing in PGY3 such that parity in assessment was reached in all competency domains by the end of training.Conclusions and RelevanceIn this cohort study, URiM and Asian internal medicine residents received lower ratings on performance assessments than their White peers during the first and second years of training, which may reflect racial bias in assessment. This disparity in assessment may limit opportunities for physicians from minoritized racial and ethnic groups and hinder physician workforce diversity.

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“…Mastery-based learning requires the learner do as much practice and assessment as required to meet a mastery standard of performance, including competencies beyond procedural skills. 31 Medical interviewing, physical examination, and shared decision-making with patients are the core procedures of family medicine. Family medicine will need to shift from its traditional number metrics approach and adopt more mastery-based learning and assessment across multiple competencies.…”

Section: Advancement Of Mastery-based Learningmentioning

confidence: 99%

The Transformational Path Ahead: Competency-Based Medical Education in Family Medicine

Holmboe

2021

Fam Med

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Competency-based medical education (CBME) is an outcomes-based approach that has taken root in residency training nationally and internationally. CBME explicitly places the patient, family, and community at the center of training with the primary goals of concomitantly improving both educational and clinical outcomes. Family medicine, as the foundational primary care discipline, has always embraced the importance of linking training with health system needs and performance since its inception. While CBME is no longer a new concept, full implementation of this outcomes-based approach has been daunting and challenging. Gaps in the effectiveness, safety, equity, efficiency, timeliness, and patient/family centeredness of health and health care in the United States continue to be persistent and pernicious. These gaps summon family medicine and the entire graduate medical education system to take stock of its current state and to examine how more fully embracing an outcomes-based educational approach can help to close these gaps. This article provides a brief history of the CBME movement, and more importantly, its key underlying educational principles and science. I will explore the key inflection points of progress, including identifying core CBME components, introduction of competency Milestones, experimental pilots of time variable training, advancements in mastery-based learning, and advances in work-based assessment, within the context of family medicine. I will conclude with suggestions for accelerating the adoption and implementation of CBME within family medicine residency training.

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A Mastery Learning Capstone Course to Teach and Assess Components of Three Entrustable Professional Activities to Graduating Medical Students

Cited by 17 publications

References 31 publications

Filling the Core EPA 10 assessment void: A framework for individual assessment of Core Entrustable professional activity 10 competencies in medical students

Filling the Core EPA 10 assessment void: A framework for individual assessment of Core Entrustable professional activity 10 competencies in medical students

Racial and Ethnic Differences in Internal Medicine Residency Assessments

The Transformational Path Ahead: Competency-Based Medical Education in Family Medicine

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