Entrustable Professional Activity 10: Case Simulation and Assessment—STEMI With Cardiac Arrest

Kman, Nicholas; Thompson, Laura; Hess, Jamie; Dora‐Laskey, Aaron; Sule, Harsh; Moadel, Tiffany; Yarris, Lalena M.

doi:10.15766/mep_2374-8265.10517

Cited by 11 publications

(10 citation statements)

References 4 publications

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“…Kman et al . proposed an EPA test for clerkship through simulation of a diagnosis of a myocardial infarction with ST-segment elevation with cardiac arrest [ 14 ]. Approximately 86% of students reached the judgment of entrustment at the end of the test.…”

Section: H Ow To Transition To Practicementioning

confidence: 99%

A competency-based approach to critical care education

Chuang

Hsieh

2018

Tzu Chi Med J

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The medical education environment is rapidly changing. Competency-based medical education (CBME) is a great advance, but operationalizing competencies for teaching and assessment is problematic. Entrustable professional activities (EPAs) can revitalize CBME by connecting competencies to practice, creating flexibility in programs. CBME requires and deepens the nature of workplace-based assessments. It is important to use EPAs to verify residents’ ability to care for critically ill patients unsupervised in simulation education.

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Section: H Ow To Transition To Practicementioning

confidence: 99%

A competency-based approach to critical care education

Chuang

Hsieh

2018

Tzu Chi Med J

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“…There is a published case of STEMI in MededPORTAL [7] that can complement this case. Our simulation is unique in its particular emphasis on collaborative teamwork, communication skills between medical and nonmedical staff, and administrative process, so that this team can achieve the appropriate time to definitive treatment with door-to-balloon time ≤90 minutes.…”

Section: Introductionmentioning

confidence: 98%

ST-Elevation Myocardial Infarction: A Simulation Case for Evaluation of Interprofessional Performance in a Hospital

Habib

Ginanjar

Mansjoer

et al. 2019

Emergency Medicine International

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Introduction Interprofessional collaboration between units in a hospital is essential in order to reach desired time for primary percutaneous intervention (PCI) in acute ST-Segment Elevation Myocardial Infarction (STEMI) cases. We developed a simulation to engage various medical and nonmedical staff in interprofessional and interunit team collaboration. Method We used a scenario in this simulation. Beginning in the emergency department, it detailed a 50-year-old male presenting with progressive chest pain since 7 hours before admission. The emergency team directly examined the patient, and STEMI diagnosis was made, followed by sending the patient to the cardiac catheterization laboratory to undergo primary PCI. A resuscitation kit was required for the simulation. An evaluation sheet was prepared to evaluate every step of patient management. Three judges observed the simulation. At the end of the simulation, debriefing was done, and recommendation for the simulation was discussed. Besides medical activities during patient management, interprofessional communication, administration activities, consultations, and handover process were also evaluated. Results The team achieved the appropriate door-to-electrocardiogram (ECG) time in 8 minutes, but overall target was delayed since door-to-skin puncture time was reached in 110 minutes. Some factors that contributed to these conditions were long waiting time during patient admission, several attempts for telephone consultation to the cardiologist, and prolonged admission process in the cardiac catheterization laboratory. Conclusions The simulation was well received by both participant and our institution, stating that it is a valuable resource for developing interdisciplinary learning program. This simulation also contributed to the development of the clinical pathway, STEMI protocol, in our institution.

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“…As UME continues to adopt competency-based medical education, EPAs offer a complementary assessment system based on holistic, observable, and behavioral determinants of performance [ 8 , 9 ]. Current approaches to EPA assessment leverage existing medical school clerkships, simulation centers, or capstone programs [ 10 , 11 ]. Although convenient, these traditional methods of student assessment often fail to collect adequate data for competency decisions across all 13 EPAs.…”

Section: Introductionmentioning

confidence: 99%

Assessment of Entrustable Professional Activities Using a Web-Based Simulation Platform During Transition to Emergency Medicine Residency: Mixed Methods Pilot Study

et al. 2021

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Background The 13 core entrustable professional activities (EPAs) are key competency-based learning outcomes in the transition from undergraduate to graduate medical education in the United States. Five of these EPAs (EPA2: prioritizing differentials, EPA3: recommending and interpreting tests, EPA4: entering orders and prescriptions, EPA5: documenting clinical encounters, and EPA10: recognizing urgent and emergent conditions) are uniquely suited for web-based assessment. Objective In this pilot study, we created cases on a web-based simulation platform for the diagnostic assessment of these EPAs and examined the feasibility and acceptability of the platform. Methods Four simulation cases underwent 3 rounds of consensus panels and pilot testing. Incoming emergency medicine interns (N=15) completed all cases. A maximum of 4 “look for” statements, which encompassed specific EPAs, were generated for each participant: (1) performing harmful or missing actions, (2) narrowing differential or wrong final diagnosis, (3) errors in documentation, and (4) lack of recognition and stabilization of urgent diagnoses. Finally, we interviewed a sample of interns (n=5) and residency leadership (n=5) and analyzed the responses using thematic analysis. Results All participants had at least one missing critical action, and 40% (6/15) of the participants performed at least one harmful action across all 4 cases. The final diagnosis was not included in the differential diagnosis in more than half of the assessments (8/15, 54%). Other errors included selecting incorrect documentation passages (6/15, 40%) and indiscriminately applying oxygen (9/15, 60%). The interview themes included psychological safety of the interface, ability to assess learning, and fidelity of cases. The most valuable feature cited was the ability to place orders in a realistic electronic medical record interface. Conclusions This study demonstrates the feasibility and acceptability of a web-based platform for diagnostic assessment of specific EPAs. The approach rapidly identifies potential areas of concern for incoming interns using an asynchronous format, provides feedback in a manner appreciated by residency leadership, and informs individualized learning plans.

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Entrustable Professional Activity 10: Case Simulation and Assessment—STEMI With Cardiac Arrest

Cited by 11 publications

References 4 publications

A competency-based approach to critical care education

A competency-based approach to critical care education

ST-Elevation Myocardial Infarction: A Simulation Case for Evaluation of Interprofessional Performance in a Hospital

Assessment of Entrustable Professional Activities Using a Web-Based Simulation Platform During Transition to Emergency Medicine Residency: Mixed Methods Pilot Study

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