General Internal Medicine (GIM): do the Puzzle Pieces Portray the Picture? A Continuous Quality Improvement Process for Entrustable Professional Activities (EPAs)

Abstract

Defining General Internal Medicine (GIM) has been difficult due to the tension between ensuring flexibility for varied environments and the need for national standards. With the launch of competency-based medical education, the Royal College of Physicians and Surgeons of Canada Specialty Committee in GIM (SCGIM) (national standard-setting body) had the opportunity to explicitly define the discipline via elaboration of the GIM competencies and Entrustable Professional Activities (EPAs). Defining the EPAs is the essence of defining the tasks of the discipline. We describe our SCGIM approach to the continuous review of the theoretical written documentation around EPAs in the “real world environment” in order to continuously refine the EPAs and ensure they are facilitating skill attainment. Major lessons learned (1) centralized feedback with simple reporting and multiple input is best; (2) there is tension between theory (perfect EPAs) and practical implementation; (3) it takes time to see how the EPAs are performing. RésuméIl a été difficile de définir la médecine interne générale (MIG) en raison de la tension entre la nécessité d’assurer la souplesse pour des environnements variés et le besoin de normes nationales. Grâce au lancement de la formation médicale par compétences, le comité de spécialité en MIG (CSMIG) du Collège royal des médecins et chirurgiens du Canada (organisme national de normalisation) a eu l’occasion de définir explicitement la discipline en élaborant les compétences en MIG et les activités professionnelles confiables (APC). Définir les APC consiste essentiellement à définir les tâches de la discipline. Nous décrivons notre approche du CSMIG de l’examen continu de la documentation théorique écrite concernant les APC « en situation réelle » pour améliorer continuellement les APC et veiller à ce qu’elles facilitent l’acquisition des compétences. Principales leçons apprises : a) la rétroaction centralisée avec des rapports simples et des commentaires multiples convi-ent le mieux; b) il existe une tension entre la théorie (APC parfaites) et l’application dans la pratique; c) il faut du temps avant de constater le rendement des 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

“…Postgraduate specialty training programs in Canada accredited by the Royal College of Physicians and Surgeons of Canada are in the early stages of implementing CBME, branded as "Competence By Design" (CBD). [20][21][22] In this model, EPAs are considered the authentic tasks of a discipline (the outcomes based on which training should be oriented around). Nested within each EPA are milestones -CanMEDS competencies tailored by a specialty -that serve as observable markers of competence across the continuum of training.…”