Facilitators and Inhibitors to Assessing Entrustable Professional Activities in Pediatric Residency

Schumacher, Daniel J.; Martini, Abigail; Kinnear, Benjamin; Kelleher, Matthew; Balmer, Dorene F.; Ovalle, Victoria Wurster; Carraccio, Carol

doi:10.1016/j.acap.2020.11.013

Cited by 14 publications

(18 citation statements)

References 28 publications

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“…25,48 Using entrustment of specific skills and activities as a framework for feedback may facilitate formative conversations. 49 For example, Warm et al use frontline entrustment decisions in a predominantly formative fashion, though they are aggregated to inform later summative decisions. 50 The interdependent nature of performance within a health care team adds complexity to the use of entrustment for either formative or summative purposes at an individual level [51][52][53] and is an area that deserves further investigation.…”

Section: Introductionmentioning

confidence: 99%

Entrustment Unpacked: Aligning Purposes, Stakes, and Processes to Enhance Learner Assessment

et al. 2021

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Educators use entrustment, a common framework in competency-based medical education, in multiple ways, including frontline assessment instruments, learner feedback tools, and group decision making within promotions or competence committees. Within these multiple contexts, entrustment decisions can vary in purpose (i.e., intended use), stakes (i.e., perceived risk or consequences), and process (i.e., how entrustment is rendered). Each of these characteristics can be conceptualized as having 2 distinct poles: (1) purpose has formative and summative, (2) stakes has low and high, and (3) process has ad hoc and structured. For each characteristic, entrustment decisions often do not fall squarely at one pole or the other, but rather lie somewhere along a spectrum. While distinct, these continua can, and sometimes should, influence one another, and can be manipulated to optimally integrate entrustment within a program of assessment. In this article, the authors describe each of these continua and depict how key alignments between them can help optimize value when using entrustment in programmatic assessment within competency-based medical education. As they think through these continua, the authors will begin and end with a case study to demonstrate the practical application as it might occur in the clinical learning environment.

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Section: Introductionmentioning

confidence: 99%

Entrustment Unpacked: Aligning Purposes, Stakes, and Processes to Enhance Learner Assessment

et al. 2021

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“…Entrustable professional activities (EPAs) have become an increasingly popular assessment framework to formally capture the myriad ad hoc entrustment decisions that occur on a daily basis in clinical settings with learners. 1,2 While these decisions are sometimes deliberate, taking into account information about a trainee's past experiences and readiness for autonomy, they are also commonly automatic and occur at a subconscious level (e.g., would I trust this resident to care for this patient with gallbladder disease? ), and can have distinct consequences for both patient outcomes and resident training.…”

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confidence: 99%

A Phased Approach: The General Surgery Experience Adopting Entrustable Professional Activities in the United States

et al. 2021

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Entrustable professional activities (EPAs) have been increasingly used as an assessment framework to formally capture the myriad ad hoc entrustment decisions that occur on a daily basis in clinical settings with learners present. Following the definition of Core EPAs for Entering Residency by the Association of American Medical Colleges in 2014, the American Board of Surgery (ABS) began to explore the utility of EPAs as a framework to support competency-based resident

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“…9,10 In a follow-up study focusing on EPA implementation experiences at these sites, programs varied widely in how they integrated EPA experiences into the curriculum. 11 Furthermore, programs with assessment processes that align with the conceptual framework of EPAs (direct observation in the workplace) are more successful in assessing and judging learner performance based on EPA entrustment-supervision scales. 12 These findings of the variation in implementation based on program context underscore the need to determine indispensable core elements that preserve the educational integrity of assessment using the EPA framework.…”

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confidence: 99%

Identifying Core Components of EPA Implementation: A Path to Knowing if a Complex Intervention Is Being Implemented as Intended

et al. 2021

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Purpose Competency-based assessment, using entrustable professional activities (EPAs), is rapidly being implemented worldwide without sufficient agreement on the essential elements of EPA-based assessment. The rapidity of implementation has left little time to understand what works in what circumstances and why or why not. The result is the attempted execution of a complex service intervention without a shared mental model for features needed to remain true to implementing an EPA assessment framework as intended. The purpose of this study was to identify the essential core components necessary to maintain integrity in the implementation of this intended intervention. Method A formal consensus-building technique, the Delphi process, was used to identify core components for implementing an EPA-based assessment framework. Twelve EPA experts from the United States, Canada, and the Netherlands participated in this process in February and March 2020. In each Delphi round, participants rated possible core components on a scale from 1 to 6, with 1 reflecting the worst fit and 6 the best fit for EPA-based assessment implementation. Predetermined automatic inclusion and exclusion criteria for candidate core components were set at ≥ 80% of participants assigning a value of 5 or 6 and ≥ 80% assigning a value of 1 or 2, respectively. Results After 3 rounds, participants prioritized 10 of 19 candidate core components for inclusion: performance prediction, shared local mental model, workplace assessment, high-stakes entrustment decisions, outcomes based, value of the collective, informed clinical competency committee members, construct alignment, qualitative data, and entrustment decision consequences. The study closed after 3 rounds on the basis of the rankings and comments. Conclusions Using the core components identified in this study advances efforts to implement an EPA assessment framework intervention as intended, which mitigates the likelihood of making an incorrect judgment that the intervention demonstrates negative results.

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Facilitators and Inhibitors to Assessing Entrustable Professional Activities in Pediatric Residency

Cited by 14 publications

References 28 publications

Entrustment Unpacked: Aligning Purposes, Stakes, and Processes to Enhance Learner Assessment

Entrustment Unpacked: Aligning Purposes, Stakes, and Processes to Enhance Learner Assessment

A Phased Approach: The General Surgery Experience Adopting Entrustable Professional Activities in the United States

Identifying Core Components of EPA Implementation: A Path to Knowing if a Complex Intervention Is Being Implemented as Intended

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