The Implementation of Entrustable Professional Activities in Postgraduate Medical Education in the Netherlands: Rationale, Process, and Current Status

Graaf, Jacqueline de; Bolk, Marieke H.H.; Dijkstra, Auk; Horst, Marieke van der; Hoff, Reinier G.; Cate, Olle ten

doi:10.1097/acm.0000000000004110

Cited by 32 publications

(64 citation statements)

References 29 publications

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“…First, there is the issue of selection and publication bias as only published EPA frameworks of medical postgraduate and/or fellow training programmes were included. A recent paper that includes a summary of the types of EPAs used by all specialty training programmes in the Netherlands found similar logics and can be seen as a partial ‘grey literature’ confirmation 26 . In our review, the rationales for the initial EPA frameworks as relates to key stakeholder groups were usually not described.…”

Section: Discussionmentioning

confidence: 87%

“…They have primarily been used to develop curricula and create workplace assessment procedures for specialty training; however, defining the essential tasks is not always clear‐cut. Furthermore, EPAs are increasingly formulated by national or even international bodies with unique priorities, mandates and purposes 22–26 . This limits the freedom to choose or identify EPAs locally and serves to acknowledge summative entrustment decisions beyond a programme, institution or country.…”

Section: Discussionmentioning

confidence: 99%

“…Next, eligible articles included few (n = 2) from surgical specialties, potentially leading to an underestimation of ‘procedures’ as a logic. The importance of this type of logic, however, is supported by its higher occurrence in the Netherlands 26 . Some reported EPAs could be categorised in more than one logic category; depending on the set of EPAs, an EPA may be a patient category in the one set and a service in the other.…”

Section: Discussionmentioning

confidence: 99%

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The logic behind entrustable professional activity frameworks: A scoping review of the literature

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Introduction Entrustable professional activities (EPAs), discrete profession‐specific tasks requiring integration of multiple competencies, are increasingly used to help define and inform curricula of specialty training programmes. Although guidelines exist to help guide the developmental process, deciding what logic to use to draft a preliminary EPA framework poses a crucial but often difficult first step. The logic of an EPA framework can be defined as the perspective used by its developers to break down the practice of a profession into units of professional work. This study aimed to map dominant logics and their rationales across postgraduate medical education and fellowship programmes. Methods A scoping review using systematic searches within five electronic databases (Medline, Embase, Google Scholar, Scopus and Web of Science) was performed. Dominant logics of included papers were identified using inductive coding and iterative analysis. Results In total, 42 studies were included. Most studies were conducted in the United States (n = 22; 52%), Canada (n = 6; 14%) and the Netherlands (n = 4; 10%). Across the reported range of specialties, family medicine (n = 4; 10%), internal medicine (n = 4; 10%), paediatrics (n = 3; 7%) and psychiatry (n = 3; 7%) were the most common. Three dominant logics could be identified, namely, ‘service provision’, ‘procedures’ and/or ‘disease or patient categories’. The majority of papers (n = 37; 88%) used two or more logics when developing EPA frameworks (median = 3, range = 1–4). Disease or patient groups and service provision were the most common logics used (39% and 37%, respectively). Conclusions Most programmes used a combination of logics when trying to capture the essential tasks of a profession in EPAs. For each of the three dominant logics, the authors arrived at a definition and identified benefits, limitations and examples. These findings may potentially inform best practice guidelines for EPA development.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The logic behind entrustable professional activity frameworks: A scoping review of the literature

et al. 2022

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“…The number of EPAs in our proposed framework resembles the study on EPAs (20 title statements) for the Master’s program in HPE at the University of Michigan Medical School [ 29 ]. The recent report on EPAs in all Dutch specialty programs aligns with this notion as well [ 34 ]. The overlaps between our framework and EPAs proposed for the Master’s program in HPE [ 29 ] may support common activities for HPE scholars.…”

Section: Discussionmentioning

confidence: 88%

Developing entrustable professional activities for doctoral graduates in health professions education: obtaining a national consensus in Iran

Zaeri

Gandomkar

2022

BMC Med Educ

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Background The number of doctoral programs in health professions education (HPE) is expanding. Entrustable professional activities (EPAs) can be a mechanism to define the expected activities of the HPE doctorate to inform training and assessment processes. The purpose of this study was to develop and reach a consensus on EPAs for HPE doctoral graduates. Methods We used a modified Nominal Group Technique (NGT) to elicit EPA titles followed by two rounds of a modified Delphi survey to seek consensus on the EPAs among groups of experts (HPE doctoral graduates and Board of HPE Examiners members) at the national level in Iran between July 2019 and July 2020. Results A total number of 92 initial EPA titles, which emerged from brainstorming in the NGT meeting, was reduced to 27 titles during the clarification process. The final EPA framework consisted of 24 EPA titles with descriptions, arranged in three categories: Research and scholarship (6 EPAs), Educational development (11 EPAs) and Educational management (7 EPAs). All final EPAs scored ≥80% agreement at the national level. Conclusions The proposed EPAs framework can be used to improve the HPE doctorate training and to inform employment decisions. A future international consensus procedure could use these EPA outcomes as a starting point.

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“…Indeed, ten Cate and colleagues present the Dutch experience with implementing EPAs across specialties nationally and how these efforts have similarly allowed time-variable training, meeting the goals of educators, while also facilitating the Dutch government goal of cutting costs for medical education as a whole. 19 We believe competency-based, time-variable training is the future, and the articles in the supplement demonstrate the practical use of EPAs in ultimately achieving this goal. Our vision for the future is continued expansion and escalation of this type of work to align EPA phenotypes worldwide in the next decade as more wide-ranging implementation continues.…”

Section: Epa Phenotypes Vary: Opportunities For Aligning Across Train...mentioning

confidence: 96%

Entrustable Professional Activities: Reflecting on Where We Are to Define a Path for the Next Decade

Schumacher

Turner

2021

Academic Medicine

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The Implementation of Entrustable Professional Activities in Postgraduate Medical Education in the Netherlands: Rationale, Process, and Current Status

Abstract: Postgraduate medical education in the Netherlands has adopted competencybased education since the turn of the century. In 2006, the CanMEDS competency framework was introduced.

Cited by 32 publications

References 29 publications

The logic behind entrustable professional activity frameworks: A scoping review of the literature

The logic behind entrustable professional activity frameworks: A scoping review of the literature

Developing entrustable professional activities for doctoral graduates in health professions education: obtaining a national consensus in Iran

Entrustable Professional Activities: Reflecting on Where We Are to Define a Path for the Next Decade

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