Using an Entrustable Professional Activity to Assess Consultation Requests Called on an Internal Medicine Teaching Service

Abstract

Introduction:The Accreditation Council for Graduate Medical Education's milestones require internal medicine residents to have competency in calling consults. Based on a literature review, we developed an Entrustable Professional Activity (EPA) to delineate the knowledge, skills, and attitudes required for a consultation request and, building on the EPA, implemented an assessment instrument to provide feedback to interns calling consultation requests and assess the quality of their consult questions and the level of supervision required in performing this milestone. Methods: Assessments were done on internal medicine inpatient teaching services. Consultation requests were performed by interns and observed by residents using the assessment instrument. Feedback was provided to the interns. Interns then completed a self-reflection instrument based on the feedback. Results: Twenty-six paired observations were collected over three 1-month rotations. There was a moderate positive correlation (r = .43) comparing resident and intern responses to how they felt about the intern's ability to make a consultation request. There was a strong positive correlation (r = .65) comparing resident opinion of how strong the intern's ability in calling a consult to how well the consult question used the PICO (patient, intervention, comparators, outcomes of interest) framework. Twenty-five out of 28 interns (89%) said they would make a change during their next consultation request due to feedback from their resident. Discussion: Our EPA-based assessment instrument provided an opportunity to give interns feedback and to assess the quality of the consultation requests they made.

An update on current EPAs in graduate medical education: A scoping review

“…A one-year longitudinal study conducted by Ju et al, found that after the implementation of EPAs, physicians showed enhanced confidence levels[ 27 ]. Kang et al found that there is strong positive association between the resident’s appraisal of the intern’s competence to how well they use EPAs framework[ 28 ]. After the implementation of EPAs, most participants were aware of the required criteria for summative entrustment decisions.…”

Entrustable professional activities for apheresis medicine education

“…EPAs have been developed by other medical specialties such as pediatrics, internal medicine, surgery, psychiatry, and family medicine, among others. 1,[5][6][7][8][9][10][11][12] These EPAs are specific for each specialty or subspecialty but have common themes such as being able to provide consultation and competence in performing procedures and providing appropriate clinical care. Until recently, it was typical for just pathology/transfusion medicine and nephrology trainees to undergo apheresis rotations or demonstrate proficiency in apheresis procedures during their graduate or postgraduate medical education.…”

“…EPAs have been developed by other medical specialties such as pediatrics, internal medicine, surgery, psychiatry, and family medicine, among others 1,5–12 . These EPAs are specific for each specialty or subspecialty but have common themes such as being able to provide consultation and competence in performing procedures and providing appropriate clinical care.…”

“…4 Since then, EPAs have been developed for multiple specialties and subspecialties, including internal medicine, pediatrics, family practice, pathology, and subspecialties such as nephrology. 1,[5][6][7][8][9][10][11][12] Apheresis medicine (AM) is a specialty that focuses on the practice of donor and therapeutic apheresis. Unique to AM, medical oversight can be provided by multiple different specialties and/or subspecialties depending on the setting, for example, pathology/transfusion medicine, nephrology, or hematology.…”

“…He introduced certain EPA attributes: part of essential professional work; require knowledge, skill, and attitude; lead to recognized output; confined to qualified personnel; independently executable; and within a period, should be observable and should reflect one or more of the competencies to be acquired 4 . Since then, EPAs have been developed for multiple specialties and subspecialties, including internal medicine, pediatrics, family practice, pathology, and subspecialties such as nephrology 1,5–12 …”