Fidelity to Best Practices in EPA Implementation: Outcomes Supporting Use of the Core Components Framework From the University of Virginia Entrustable Professional Activity Program

Abstract

ProblemThe rapid expansion of entrustable professional activity (EPA) assessment programs has led to calls to ensure fidelity in implementation and integrity in meeting the goals of competencybased medical education. Initiated in July 2017, in advance of the articulated core components of EPA implementation, this article describes the structure and outcomes of the University of Virginia (UVA) EPA Program and provides support for the identified essential components.

How well do workplace‐based assessments support summative entrustment decisions? A multi‐institutional generalisability study

“…1 Data from singleinstitution studies demonstrate limited evidence regarding the validity and reliability of existing scales that may be used to conduct workplace-based assessments (WBAs) for the Core EPAs. [2][3][4][5][6][7][8][9][10][11][12][13][14] Due to growing interest around competency-based assessment across the continuum of training [15][16][17] and increasing uptake of the Core EPA framework for assessment across medical schools, 18 it is imperative to determine the validity and reliability of WBAs, particularly if they are used as a component in making summative entrustment decisions.…”

“…5 As a consequence, one scale may be better suited for a given EPA than the other, and vice versa. 28 Several authors have proposed that faculty development strategies may also influence reliability [29][30][31] with some hypothesising that a group of designated assessors (DA) may instil a consistent frame of reference, 8,32 and thus, more desirable outcomes. The empirical evidence supporting the role of these factors is limited, however, with mixed outcomes in terms of EPAs and scales, 3,5,28 contradictory notions regarding faculty development [29][30][31] and only theoretical support for DA programmes.…”

“…The empirical evidence supporting the role of these factors is limited, however, with mixed outcomes in terms of EPAs and scales, 3,5,28 contradictory notions regarding faculty development [29][30][31] and only theoretical support for DA programmes. 8,32 Among the Core EPA pilot institutions, members used a variety of implementation approaches, including several proposed to enhance the reliability of WBAs. The purpose of this study was to take advantage of different strategies used across institutions engaged in Core EPA implementation to determine the reliability of WBAs.…”

Summative Entrustment Decisions in UME: Outcomes of a Binding Entrustment Committee Decision

“…The final summative decision determines which students are recommended for advancement or remediation at the juncture of their fourth year. 4 In this report, we provide a summary of the first 2 years of data related to this program.…”

“…Approach: In 2017, the UVA-SOM integrated a comprehensive Core EPA program into its curriculum 4 requiring workplace-based assessments (WBAs) across all clerkships. WBAs are completed by front-line residents and attending physicians as well as a group of trained designated faculty raters.…”