The Development of Entrustable Professional Activities for Internal Medicine Residency Training

Abstract

These EPAs are intended to serve as a starting point or guide for program directors to begin developing meaningful, work-based assessments that inform the evaluation of residents' competence.

Curriculum development for the workplace using Entrustable Professional Activities (EPAs): AMEE Guide No. 99

“…EPAs have now been identified for many graduate medical education programmes including obstetrics/gynaecology (Scheele et al 2013), paediatrics (Gilhooly et al 2014), internal medicine (Caverzagie et al 2015), family medicine (Shaughnessy et al 2013;Schultz et al 2015), psychiatry (Boyce et al 2011), haematology and oncology (Shumway et al 2015) and pulmonary and critical care (Fessler et al 2014a,b). Examples of EPAs from the literature are providing preoperative assessment, managing care of patients with acute common diseases across multiple care settings, providing palliative care, managing common gastro-intestinal infections in non-immunosuppressed and immune-compromised populations, conducting a family education session for schizophrenia, conducting a risk assessment, serving as the primary admitting paediatrician for previously well children suffering from common acute problems, pharmacological management of an anxiety disorder, providing end-of-life care for older adults and office-based counselling in developmental and behavioural paediatrics.…”

“…General internal medicine residency 3 30 Chang et al (2013) Internal medicine (patient-centred med. home programme) Unspecified 25 Shaughnessy et al (2013) Family medicine residency 3 76 O'Keeffe (2014) Developmental-behavioural paediatrics residency Unspecified 14 Englander et al (2014) Undergraduate medical education (AE 2.5 year clinical) 2.5 13 Fessler et al (2014a,b) Pulmonary care residency 1-2 18 Fessler et al (2014a,b) Critical care medicine residency 1-2 13 Rose et al (2014) Gastro-intestinal fellowship 3 13 Caverzagie et al (2015) Internal medicine residency 3 16 Chen et al (in press) Undergraduate medical education pre-clerkship training 2 5 Shumway et al (2015) Haematology/oncology fellowship 2-3 5 Schultz et al (2015) Family medicine 2 35 We recommend that ''conducting a literature review'' not be considered an EPA, as one cannot envision an entrustment decision before which a trainee is not permitted to do this unsupervised. Designing one's personal development plan is actually not part of the necessary tasks that must be carried out by the profession.…”

Entrustable Professional Activities for Pathology

“…In general, core competencies refer to observable skills or abilities of an individual, while EPAs refer to a professional task that often requires skills from across a range of competencies. 10 The Milestones and EPAs differ in several important ways. Whereas Milestones are deliberately intended to serve as a fixed reference for measuring the progress of trainees in all programs of a discipline, EPAs are flexible and can be adapted to the specific needs of individual programs.…”

“…Members were assigned to develop content related to each EPA based on the “guidelines for full EPAs descriptions” and the “components of a fully described EPA” described by ten Cate and colleagues and also based on the example by Caverzagie et al in their EPAs for internal medicine. 8,10,24 Entrustable professional activities were then edited and refined in meetings in April, August, and November 2016.…”

“…Much of the literature to date on EPAs has served to delineate the concept and establish EPAs for various specialties, including internal medicine, 10,11 family medicine, 12,13 pediatrics, 14 developmental-behavioral pediatrics, 15 geriatrics, 16 pulmonary and critical care, 17 hematology/oncology, 18 gastroenterology, 19 and radiology, 20 in the United States and abroad, and for undergraduate medical education. 21,22 In their recent publication in Human Pathology , Powell and Wallschlaeger provide examples of possible EPAs for pathology, give a detailed description of performance of an autopsy as an example of an EPA, and advocate for the development of EPAs for pathology on the national level.…”