Building a competency-based workplace curriculum around entrustable professional activities: The case of physician assistant training

Abstract

Background and aim: Competency-based medical education (CBME) is increasingly dominating clinical training, but also poses questions as to its practical implementation. There is a need for practical guidelines to translate CBME to the clinical work floor. This article aims to provide a practical model, based on the concept of entrustable professional activities (EPAs) to make this translation, derived from curriculum building for physician assistants (PAs). Method: For the training of PAs at the Utrecht University of Applied Sciences, a three-step model was developed to guide competency-based curriculum development, teaching and assessment. It includes specific guidelines for the identification, systematic description and planning of EPAs. Results: The EPA concept appeared to be a useful tool to build competency-based clinical workplace curricula. Implementation of the curriculum requires use of trainee portfolios and progress interviews, statements of rewarded responsibility and training of supervisors. The individualised approach and flexibility that true CBME implies is brought into practice with this model. Discussion: The model may also be transferred to other domains of clinical training, among which postgraduate training for medical specialties.

Entrustment and Mapping of Observable Practice Activities for Resident Assessment

“…9 The number and size of EPAs in a curriculum has been the subject of debate. In 2010, ten Cate and colleagues stated: 10 To answer the question, how many EPAs should constitute the curriculum, one should primarily think of requirements at graduation…This will typically list anywhere from five to 15 EPAs, being not too detailed.…”

Transforming Primary Care Training—Patient-Centered Medical Home Entrustable Professional Activities for Internal Medicine Residents

“…EPAs have been defined for residency training in obstetrics and gynecology, anesthesiology, and for neurology physician assistant training. [35][36][37]40 Our work, then, extends EPA scholarship to internal medicine and the PCMH.…”

“…These are similar, in time scale, to EPAs articulated in other specialties. [35][36][37]40 Longitudinal EPAs, such as "track and coordinate care during inter-visit periods" or "supporting a patient in her self-management of a chronic illness," describe care that unfolds over time. These EPAs require a longitudinal relationship between a resident and patient, or between a resident and the care team, or both.…”

“…Our EPAs can frame curriculum reform for teaching practices in varying stages of PCMH redesign. 36,37,41 We suggest Scheele's criteria for prioritizing EPA implementation. 41 In this schema, highpriority EPAs for implementation include those which 1) are critically important in daily practice, 2) address high-risk or error-prone activities, and 3) integrate multiple competencies.…”

Cognitive and Psychomotor Entrustable Professional Activities: Can Simulators Help Assess Competency in Trainees?

“…Creating entrustable professional activities allows faculty to identify and select the most important, representative, and critical tasks that should be mastered [30]. Scheele et al [34] recommended focusing on those tasks critically important in daily practice or that address highrisk or error-prone activities; certainly the list of competencies listed by the Accreditation Council for Graduate Medical Education include care of patients with ankle fractures, knee osteoarthritis, and hip fractures [1].…”