Module 4- Topic 3 - Competencies and Entrustable Professional Activities PDF

Competencies and Entrustable Professional Activities QHPE 610 Innovation in Curriculum Plan and Design Learning Objectives Identify the concept of Competency-based medical education Describe the entrustable Professional Activities Discuss the benefits of entrustable Professional Activi...

Competencies and Entrustable Professional Activities QHPE 610 Innovation in Curriculum Plan and Design Learning Objectives Identify the concept of Competency-based medical education Describe the entrustable Professional Activities Discuss the benefits of entrustable Professional Activities in curricula design Determine measures to incorporate EPAs into your curriculum planning 2 What is Competency? Habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice are important for the benefit of the individual and community being served. 3 Competency-Based Medical Education (CBME) Some of the important aspects of CBME are as follows: It is an approach to ensure that the graduates develop the competencies required to fulfill the needs of patients. It encompasses the medical education program's design, implementation, assessment, and evaluation. It utilizes the organizing framework of competencies. It is a standardized level of proficiency to guarantee that all learners have a sufficient level of proficiency. 4 What characterizes CBME? Focuses on outcomes/competencies Structures educational experiences around competencies Independent of time: de-emphasizes time-based training Learner-centred: promises greater accountability and flexibility 5 Traditional Versus Competency-Based Medical Education Variable Traditional Educational Model CBME Driving force for curriculum tool Knowledge acquisition Knowledge application Driving force for process Teacher Learner Path of learning Hierarchal Non-hierarchical Responsibility of content Teacher Teacher Teacher and student Goal of educational encounter Knowledge and skill acquisition Knowledge and skill application Type of assessment Single assessment measure (e.g., Multiple assessment measures test) (e.g., direct observation) Assessment tool Proxy Authentic (mimics real profession Setting for evaluation Removed In clinical and professional settings Timing of assessment Emphasis on summative Emphasis on formative Program completion Fixed time Variable time 6 The Accreditation Council of Graduate Medical Education (ACGME) competencies In 1999, the ACGME introduced the six broad areas of competence, which now guide teaching and assessment in most of the residencies and medical schools. 7 Canadian Medical Education Framework It is a national, needs-based, outcome- oriented, competency framework initiative of the Royal College of Physicians and Surgeons of Canada. It addresses the roles physicians take up while meeting societal needs. Residency programs have incorporated CanMEDS into the regular curriculum of residents. Medical education must be multidimensional and impart competence beyond medical experts to effectively respond to society. 8 General Medical Council: Tomorrows’ Doctors Doctor as a scholar/scientist Doctor as a practitioner Doctor as a researcher 9 Key Features of the Effective Assessment in CBME Continuous and frequent/more formative Criterion-based Authentic or work-based Use of effective assessment tools A more qualitative approach to assessment Use of multiple tools for assessment 10 Entrustable Professional Activities (EPAs) How do we define EPAs? EPAs are units of professional practice, defined as tasks or responsibilities that trainees are entrusted to perform unsupervised once they have attained sufficient specific competence. 11 Defining EPAs Acts requiring trust by peers, patients, and Entrustable the community. Professional Confined to a person qualifications. Activities Tasks or responsibilities to be performed. 12 Why EPA? The reasons are: It is an ideal assessment framework to translate competencies into clinical practice. It provides a safe and justifiable way to gradually increase the responsibilities and autonomy of trainees. Supervisors entrust trainees once they achieve adequate competencies. 13 Benefits of EPA Benefits of EPAs in UGE and GME : In the case of EPAs, supervisors entrust trainees once they achieve adequate competencies. They are independently executable, observable, and measurable in their process and outcome. They are units of professional practice, which can be described as discrete tasks. They provide a safe and justifiable way to gradually increase the responsibilities and autonomy of trainees. They can be sequenced with increasing difficulty, risk, or sophistication. 14 Comparison Comparison of the Benefits and Disadvantages of the Two Conceptual Frameworks Considered: Competencies and EPAs 15 Relationship Between the Core EPAs for Entering Residency and School or Specialty-Specific EPAs 16 Relationship Between the Core EPAs for Entering Residency and School or Specialty-Specific EPAs (Cont.) 17 13 Core EPAs EPAs that residents must be able to perform without direct supervision on their first day of residency: 1. Gather a history and perform a physical education 2. Prioritize a differential diagnosis following a clinical encounter 3. Recommend and interpret common diagnostic and screening tests 4. Enter and discuss orders/prescriptions 5. Document a clinical encounter in the patient record 6. Provide an oral presentation of a clinical encounter 7. Form clinical questions and retrieve evidence to advance patient care 8. Give or receive a patient handover to transition care responsibly 18 13 Core EPAs (Cont.1) 9. Collaborate as a member of an interdisciplinary team 10. Recognize a patient requiring urgent or emergent care and initiate evaluation and management 11. Obtain informed consent for tests and/or procedures 12. Perform general procedures of a physician 13. Identify system failures and contribute to a culture of safety and improvement 19 13 Core EPAs (Cont.2) 20 EPA Implementation Plan Requirements: Alignment with curricular vision An existing training framework Established process to identify, elaborate, and validate Involvement and education of stakeholders/staff Piloting 21 Quality Assurance Following the development of EPAs, it is very important to evaluate their alignment with their purpose and identify substandard EPAs. The EQual rubric is of high reliability when it comes to evaluating EPAs. It uses a criterion-based approach grounded in peer-reviewed literature. EQual is a tool used for developing a better understanding of the shortcomings and strengths in educational frameworks. 22 Quality Assurance (Cont.) 23 Think and Reflect Dr. Ali is a PGY 1. He has been asked by his attending physician to acquire the history from Mr. Mohamed, who came complaining of knee pain. Task: Acquire history and perform Knee examination. Question 1: Is this task an EPA? Why? If yes, look at the next slide and complete the form. 24 Think and Reflect (Cont.) 25 Summary EPAs are the essential means to translate competencies into observable and measurable clinical practice. EPAs can enhance the transparency of trainees’ assessments. EPAs can be a bridge for the education continuum between UME and GME. EPAs can align with emergent healthcare needs and improve healthcare outcomes. Increasing awareness of the benefits and implementation steps is of paramount importance. 26 References Carraccio, C., Wolfsthal, S. D., Englander, R., Ferentz, K., & Martin, C. (2002). Shifting paradigms. Academic Medicine, 77(5), 361–367. https://doi.org/10.1097/00001888-200205000-00003 Desai, C., Shah, N., Jorwekar, G., Badyal, D., & Singh, T. (2016). Competency-based medical education: An overview and application in pharmacology. Indian Journal of Pharmacology, 48(7), 5. https://doi.org/10.4103/0253-7613.193312 Englander, R., Flynn, T., Call, S., Carraccio, C., Cleary, L., Fulton, T. B., Garrity, M. J., Lieberman, S. A., Lindeman, B., Lypson, M. L., Minter, R. M., Rosenfield, J., Thomas, J., Wilson, M. C., Aschenbrener, C. A. (2016). Toward defining the foundation of the MD degree. Academic Medicine, 91(10), 1352–1358. https://doi.org/10.1097/acm.0000000000001204 Epstein, R. M. (2002). Defining and assessing professional competence. JAMA, 287(2), 226. https://doi.org/10.1001/jama.287.2.226 Frank, J. R., & Danoff, D. (2007). The CanMEDS initiative: Implementing an outcomes-based framework of physician competencies. Medical Teacher, 29(7), 642–647. https://doi.org/10.1080/01421590701746983 General Medical Council. (n.d.). Tomorrow’s doctors: Education outcomes and standards for undergraduate medical education. http://www.gmc-uk.org/Tomorrow_s_Doctors_1214.pdf_48905759.pdf Shorey, S., Lau, T. C., Lau, S. T., & Ang, E. (2019). Entrustable professional activities in health care education: A scoping review. Medical Education, 53(8), 766–777. https://doi.org/10.1111/medu.13879 Swing, S. R. (2007). The ACGME outcome project: Retrospective and prospective. Medical Teacher, 29(7), 648–654. https://doi.org/10.1080/01421590701392903 Taylor, D. R., Park, Y. S., Egan, R., Chan, M. K., Karpinski, J., Touchie, C., Snell, L. S., Tekian, A. (2017). EQual, a novel rubric to evaluate entrustable professional activities for quality and structure. Academic Medicine, 92, S110–S117. https://doi.org/10.1097/acm.0000000000001908 27 Credits The following faculty is attributed with the slides and ideas of this session: Dr. Shireen Suliman 28