Entrustable Professional Activities: An Analysis of Faculty Time, Trainee Perspectives and Actionability

Abstract

The Royal College of Physicians and Surgeons of Canada introduced Competence by Design (CBD) as an educational model along with Entrustable Professional Activities (EPAs) as markers of achievement that could be directly observed on a frequent basis. In 2017, the University of Calgary Internal Medicine (IM) program piloted CBD. The purpose of this study was to (1) assess whether written feedback from EPAs were actionable, valuable, and disruptive to workflow and (2) assess the time required to complete an EPA. MethodsSeven Foundations of Discipline EPAs were used with 31 PGY-1 Calgary IM residents. The study used quantitative and qualitative data. Following a discussion on an EPA and completion of both the quantitative and written feedback, residents were asked to comment on the value of the encounter and the degree of disruption to workflow. Assessors provided time to complete an EPA. Data were anonymized. Trainee comments were coded for value and disruption, and assessor’s written feedback was coded for actionability. ResultsOne hundred and five EPA encounters were submitted. The majority of the comments provided to trainees were not actionable (94.3%, n = 99/105). While most residents did not comment on value (73.3%, n = 77/105) or disruption (44.8%, n = 47/105) of the encounter, those that did generally found the encounters valuable (25.7%, n = 27/105) and nondisruptive (35.2%, n = 37/105). A minority found the process nonvaluable (1%, n = 1/105) and disruptive (20%, n = 21/105). The mean time to complete an EPA form and provide feedback was 8.6 min. ConclusionMost written feedback was not actionable, suggesting a potential role for faculty development to guide assessors and help them coach trainees on EPAs. RÉSUMÉLe Collège royal des médecins et chirurgiens du Canada a introduit la compétence par conception (CPC) comme modèle d’enseignement, ainsi que les activités professionnelles confiables (APC) comme marqueurs de réussite qui pourraient être observés directement et souvent. En 2017, le programme de médecine interne (MI) de l’Université de Calgary a testé la CPC. L’objectif de cette étude était : 1) d’évaluer si la rétroaction écrite des APC était exploitable, utile et perturbatrice pour le déroulement du travail; 2) d’évaluer le temps nécessaire pour mener à bien une APC. MéthodesSept APC d’acquisition des fondements de la discipline ont été utilisées chez 31 résidents de première année en MI de l’Université de Calgary. L’étude a utilisé des données quantitatives et qualitatives. Après avoir discuté d’une APC et terminé la rétroaction quantitative et écrite, les résidents ont été invités à faire des commentaires sur l’utilité de la rencontre et le degré de perturbation du déroulement du travail. Les évaluateurs ont accordé du temps pour compléter une APC. Les données ont été anonymisées. Les commentaires des stagiaires ont été codés en fonction de l’utilité et du degré de perturbation, et la rétroaction écrite des évaluateurs a été codée en fonction de l’exploitabilité. RésultatsAu total, 105 rencontres d’APC ont été soumises. La majorité des commentaires fournis aux stagiaires n’étaient pas exploitables (94,3 %, n = 99/105). Bien que la plupart des résidents n’aient pas fait de commentaires sur l’utilité (73,3 %, n = 77/105) ou la perturbation (44,8 %, n = 47/105) de la rencontre, ceux qui l’ont fait ont généralement trouvé les rencontres très utiles (25,7 %, n = 27/105) et non perturbatrices (35,2 %, n = 37/105). Une minorité a trouvé le processus inutile (1 %, n = 1/105) et perturbateur (20 %, n = 21/105). Le temps moyen pour remplir un formulaire d’APC et fournir une rétroaction était de 8,6 minutes. ConclusionLa plupart des rétroactions écrites n’étaient pas exploitables, ce qui suggère un rôle que pourrait jouer le perfectionnement du corps professoral afin de guider les évaluateurs et de les aider à encadrer les stagiaires qui effectuent les APC.

Does the Implementation of Competency-Based Medical Education Impact the Quality of Narrative Feedback? A Retrospective Analysis of Assessment Data in a Canadian Internal Medicine Residency Program

“…Tensions between assessment and feedback may emerge as an unintended consequence and inhibit residents from getting constructive, actionable feedback and coaching, despite the central importance of these activities in CBME. 35,36 The quantity of feedback may generally increase, but the quality may worsen. 26,36 Most assessment tools are designed to capture numeric rating scales before narrative comments, and this is perceived to reduce the quality of verbal and documented feedback.…”

“…35,36 The quantity of feedback may generally increase, but the quality may worsen. 26,36 Most assessment tools are designed to capture numeric rating scales before narrative comments, and this is perceived to reduce the quality of verbal and documented feedback. 30 Attending physicians who provide high-quality feedback appear to be more discriminating, providing significantly lower ratings for residents in all six core competencies, and across a greater range.…”

The Impact of Electronic Data to Capture Qualitative Comments in a Competency-Based Assessment System

“…Our present study sheds light on an important aspect of the response process for generating high-quality data about trainee performance. Others have examined time burden on faculty [ 26 ] with WBA, engagement of faculty [ 27 ] in the assessment process, biases they exhibit [ 28 ], and even perceptions of their role within these systems [ 16 , 17 ].…”

A qualitative study of Canadian resident experiences with Competency-Based Medical Education

“…25 A few studies of early implementation suggest potential threats to engagement including issues with quality of feedback, disruptions to workflow from frequent assessments, and threats to natural feedback processes. [26][27][28][29][30] Additionally, studies of Triple C have mostly evaluated faculty perspectives and educational outcomes, with few exploring the experiences of trainees directly, although the importance of active learner buy-in and participation in all elements of the model is emphasized. 17,[31][32][33] Given that there are few published studies that explore the trainee perspectives of this model, despite the importance of trainee engagement, we sought to explore the resident experience with CBME programs in Canada.…”

“…By understanding their perceptions and experiences, targeted interventions could be created to harness the advantages of CBME and address potential weaknesses, such as shortcomings in assessment processes and uptake by relevant stakeholders. [26][27][28][29]…”