Continued Supervision for the Common Pediatric Subspecialty Entrustable Professional Activities May Be Needed Following Fellowship Graduation

Turner, David A.; Schwartz, Alan; Carraccio, Carol; Herman, Bruce; Weiss, Pnina; Baffa, Jeanne M.; Chess, Patricia R.; Curran, Megan L.; Dammann, Christiane E.L.; High, Pamela; Hsu, Deborah; Pitts, Sarah; Sauer, Cary G.; Aye, Tandy; Fussell, Jill J.; Kesselheim, Jennifer C.; Mahan, John D.; McGann, Kathleen A.; Myers, Angie; Mink, Richard

doi:10.1097/acm.0000000000004091

Cited by 27 publications

(33 citation statements)

References 17 publications

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“…The high response rate suggests these results are representative of the perceptions of the broader pediatric pulmonology PD community, though one might speculate whether the sheer volume of reminders (as many as eight individual contacts) may have influenced responses. Nonetheless, the findings here are consistent with similar residency and fellowship studies ( 10 , 11 ). The methodology used to calculate an individual PD’s minimum tolerable standard for graduation (preferred level minus one for a subset of respondents) is inherently speculative.…”

supporting

confidence: 91%

Crossing the Entrustment Chasm: Do We Trust Graduating Fellows to Practice without Supervision?

Bonachea

2021

ATS Scholar

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supporting

confidence: 91%

Crossing the Entrustment Chasm: Do We Trust Graduating Fellows to Practice without Supervision?

Bonachea

2021

ATS Scholar

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“…Should we accept default progression as a core component of prospective entrustment decision making? How do we reconcile that with evidence that demonstrates some graduates are not prepared to provide care core to their specialty? 37–42 How do we reconcile it with reports that training directors would not allow some graduates to care for their loved ones? 43 How do we defend this given concerns with ‘failure to fail’? 44,45 This default pathway seems to represent an absence of deliberate prospective entrustment decisions rather than a phenotype of prospective entrustment decision making 46 . Systems factors (e.g.…”

Section: Discussionmentioning

confidence: 99%

Making prospective entrustment decisions: Knowing limits, seeking help and defaulting

et al. 2022

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Introduction Many studies focused on entrustment have not considered prospective entrustment decisions, where clinical competency and entrustment committees determine how much supervision trainees will require in the future for tasks occurring in not completely known contexts. The authors sought to explore factors that influence and determine prospective entrustment decisions made by members of such committees in graduate medical education (GME) and undergraduate medical education (UME). Methods The authors conducted a constructivist grounded theory study with 23 faculty participants from GME and UME clinical competency and entrustment committees in the United States between October 2020 and March 2021. Interviews sought to explore factors and considerations participants weigh in making prospective entrustment decisions about trainees. Data collection and analysis occurred in an iterative fashion, ensuring constant comparison. Theoretical sampling was used to confirm, disconfirm and elaborate on the evolving results. Results Trainees' ability to know limits and seek help is the foundation of participants' prospective entrustment decision making. Most participants, however, describe a presumption of trainee readiness to progress and describe commonly making default prospective entrustment decisions unless ‘red flags’ in performance are present. Although participants desire sufficient and trusted data about trainee performance to inform decisions, they often lack it. Finally, the perceived permanence and consequences of prospective entrustment decisions influence how participants weigh other factors contributing to prospective entrustment decisions. Conclusion Trainees' ability to know limits and seek help appears to be the foundation of prospective entrustment decision making. Training programmes should strive to collect and employ robust data supporting and questioning the presence of these attributes.

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“…(Kunac et al, 2021) They can also decrease the urgency for thoughtful assessment of readiness for entrustment during training and increases the need for supervision after training, because trainees are left without the experience of full autonomy and responsibility at the time of graduation. (Mattar et al, 2013;Turner et al, 2021) If entrustment decisions do not lead to a new status of autonomy for an EPA, even if they are made with strong validity evidence (Touchie et al, 2021), entrustment "decisions" become a paper exercise. Complaints that EPA's become tick-box exercises for learners and assessors because entrustment decisions have lost their meaning (or never acquired their true meaning) easily explain why EPAs then only serve to acknowledge competence and then become a competency.…”

Section: Entrustment Decision Making Without Consequences For Clinica...mentioning

confidence: 99%

Entrustable professional activities versus competencies and skills: Exploring why different concepts are often conflated

Cate

Schumacher

2022

Adv in Health Sci Educ

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Despite explanations in the literature, a returning question in the use of entrustable professional activities (EPAs) is how to distinguish them from competencies and skills. In this article, we attempt to analyze the causes of the frequent confusion and conflation of EPAs with competencies and skills, and argue why the distinction is important for education, qualification and patient safety. ‘Tracheotomy’, ‘lumbar puncture’, ‘interprofessional collaboration’ for example are colloquially called ‘skills’, but its is a person’s ability to perform these activities that is the actual skill; the EPA is simply the activity itself. We identify two possible causes for the confusion. One is a tendency to frame all educational objectives as EPAs. Many objectives of medical training can be conceptualized as EPAs, if ‘the ability to do X’ is the corresponding competency; but that does not work for all. We offer ways to deal with objectives of training that are not usefully conceptualized as EPAs. A more fundamental cause relates to entrustment decisions. The permission to contribute to health care reflects entrustment. Entrustment decisions are the links or pivots between a person’s readiness for the task and the actual task execution. However, if entrustment decisions do not lead to increased autonomy in the practice of health care, but only serve to decide upon the advancement to a next stage of training, EPAs can become the tick boxes learners feel they need to collect to ‘pass’. Gradually, then, EPAs can loose their original meaning of units of practice for which one becomes qualified.

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Continued Supervision for the Common Pediatric Subspecialty Entrustable Professional Activities May Be Needed Following Fellowship Graduation

Cited by 27 publications

References 17 publications

Crossing the Entrustment Chasm: Do We Trust Graduating Fellows to Practice without Supervision?

Crossing the Entrustment Chasm: Do We Trust Graduating Fellows to Practice without Supervision?

Making prospective entrustment decisions: Knowing limits, seeking help and defaulting

Entrustable professional activities versus competencies and skills: Exploring why different concepts are often conflated

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