Changing Medical Education When Change Is Hard: Implementing an Interdepartmental Entrustable Professional Activity

Abstract

Background: Entrustable professional activities (EPAs) are a new tool for assessing learners that represents a significant movement in graduate medical education (GME) toward competency-based assessment and serves as a bridge between milestones and clinical practice. Whenever a major change is implemented to any system, resistance to change is expected. Many change management models have been proposed to overcome this resistance; a newer model is outlined in the book Switch. The objective was to describe the change management principles used to institute an EPA. Methods: The model introduced in Switch was used as a framework for implementing a trauma resuscitation EPA in a joint effort between the departments of surgery and emergency medicine (EM) at the University of Wisconsin Hospitals and Clinics. The Department of Emergency Medicine used the principles of change management, completing 295 faculty evaluations of trauma resuscitations compared to the Department of Surgery, whose faculty completed 50 evaluations between the study period of July 2018 through October 2019. A survey completed winter 2019 of EM faculty was used to determine the most important principles toward successful implementation.Results: Twenty-seven of 35 (78% response rate) of EM faculty identified key concepts from Switch as being instrumental in the successful implementation. Internal discussion of the implementation approach used by the Department of Surgery identified several limitations that would have been overcome by using these same change management principles. Conclusion:We conclude that the principles of change management provide a useful framework for successfully implementing EPAs into GME.A lthough change is a predictable constant in the modern health care environment, it frequently meets conscious and unconscious resistance.Overcoming this resistance and facilitating adaptation to change requires a thoughtful approach, and graduate medical education (GME) is no exception.

Innovation in education for quality of care: a scoping review

“…(22) Medical education establishment has a recognized renitence to change. (23) Several barriers have been identi ed to the integration of innovation in medical education, including lack of skills and resources. (24-26) Despite some recognizable efforts to include quality of care and quality improvement in education and training of health professionals.…”