Medical Students’ Views on Implementing the Core EPAs: Recommendations From Student Leaders at the Core EPAs Pilot Institutions

Abstract

In 2014, the Association of American Medical Colleges recruited 10 institutions across the United States to pilot the 13 Core Entrustable Professional Activities for Entering Residency (Core EPAs). The goal was to establish a competency-based framework to prepare graduating medical students for the transition to residency. Within the Core EPAs pilot, medical students play an influential role in the development and implementation of EPA-related curricula. Student engagement was a priority for the Core EPAs institutions given students’ roles as the end users of the curriculum, thus they may offer valuable insight into its design and implementation. Here, the authors provide the perspective of medical students who serve as leaders in the Core EPAs pilot at their respective institutions. They describe student leadership models across the pilot institutions as well as 6 key challenges to implementation of the Core EPAs: (1) How and when should the Core EPAs be introduced? (2) Who is responsible for driving the assessment process? (3) What feedback mechanisms are required? (4) What systems are required for advising, mentoring, or coaching students? (5) Should EPA performance contribute to students’ grades? and (6) Should entrustment decisions be tied to graduation requirements? Using a polarity management framework to address each challenge, the authors describe inherent tensions, approaches used by the Core EPAs pilot institutions, and student-centered recommendations for resolving each tension. By sharing the experiences and perspectives of students engaged in the Core EPAs pilot, the authors hope to inform implementation of EPA-oriented assessment practices and feedback across institutions in the United States.

Entrustable professional activities versus competencies and skills: Exploring why different concepts are often conflated

“…(Carraccio et al, 2002;Frank et al, 2010;McGaghie et al, 1978). In undergraduate programs, entrustment decisions are often also theoretical, reflecting an intention to trust or an decision on trustworthiness, rather that an actual entrustment decision (Brown et al, 2021;Geraghty et al, 2021;Postmes et al, 2021). This leaves the power of entrustment decisions underutilized and EPAs may subsequently become just educational objectives.…”

A Question of Scale? Generalizability of the Ottawa and Chen Scales to Render Entrustment Decisions for the Core EPAs in the Workplace

“…In a recent publication, medical students recommended against linking EPA assessments to grades on the basis that it would hinder with the developmental perspective of progression toward entrustment. 42 From a philosophical standpoint, we agree with this perspective and this was a significant driver toward our decision to decouple the WBAs from grades. However, in conversations with our student leaders, many admitted that the absence of direct ties to grades led to lower prioritization in requesting feedback provided.…”

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

“…Trainees found that asynchronous, individual testing provided psychological safety, and residency directors believed that the score reports could guide the development of individualized learning plans early in residency training. Psychological safety and targeted, individualized feedback are desirable outcomes consistent with other EPA-based studies [ 21 - 23 ].…”