sctc meeting – may 23, 2012
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SCTC Meeting – May 23, 2012. Entrustable Professional Activities (EPAs): The Competencies and Milestones in Context Carol Carraccio , MD,MA Director, Competency-based Assessment Programs. Objectives. - PowerPoint PPT PresentationTRANSCRIPT
SCTC Meeting – May 23, 2012
SCTC Meeting – May 23, 2012
Entrustable Professional Activities (EPAs): The Competencies and
Milestones in Context
Carol Carraccio, MD,MADirector, Competency-based Assessment Programs
ObjectivesObjectives
• Answer the question: What are EPAs & why do we need them when we have competencies and milestones?
• Explain the added value of EPAs to assessment
• Discuss example EPAs- their descriptions and step by step mapping to competencies and milestones
• Explain why identifying EPAs is a team sport
Setting the StageSetting the Stage
Setting the StageSetting the Stage
Where Do We Go From Here?Where Do We Go From Here?
• The Good News About Milestones– Like the competencies they are context-free
• The Bad News About Milestones– Like the competencies they are context-free
• Translation: Current milestones span the continuum so no need to write new milestones for subspecialties but need to embed existing milestones into subspecialty EPAs
The Milestones as “Building Blocks”
in the Context of Clinical Experience:
Introducing EPAs
.
The Milestones as “Building Blocks”
in the Context of Clinical Experience:
Introducing EPAs
.
ten Cate O, Scheele F. Viewpoint: Competency-based postgraduate training: Can we bridge the gap between theory and clinical practice? Academic Medicine. Jun 2007;82(6):542-547
Context Matters
Entrustable Professional Activities
Entrustable Professional Activities
• In aggregate- represent the essential professional work that defines a discipline
• Lead to a recognized outcome• Are observable and measurable• Require integration of competencies
(KSA) across domains• Map to competencies and their
milestones
The Good Doctor:
PUTTING IT ALL TOGETHER
EPAs
DOMAINS OF COMPETENCE
COMPETENCIES
MILESTONES
Domains of EPAs Competence Competencies Milestones
The “Entrustable” in an EPAThe “Entrustable” in an EPA
• Ability to perform an activity at a desired level of performance without direct supervision
• Trust is (should be) based on directly observed, consistent performance over time
• We constantly, often subconsciously, make entrustment decisions based on needed level of supervision- need to formalize this process
Why Focus on Entrustment? Why Focus on Entrustment?
• Adds meaning to assessment
“Do you trust this person to provide care for a patient referred with an acute cardiac problem without direct supervision?”
Versus
“Is this person competent in PBLI, SBP, etc?”
Summary: Why EPAs?Summary: Why EPAs?
• Make sense to faculty, trainees, and the public
• Situate competencies and milestones in the clinical context in which we live
• Align what we assess with what we do
• Add meaning to assessment by focusing on integration of competencies in care delivery
• Make assessment more practical by clustering 51 series of milestones into meaningful professional activities
Identifying EPAs: Begin With the End in Mind
Identifying EPAs: Begin With the End in Mind
• What does a suspecialist do in everyday practice?
• Translates into the EPAs for subspecialty training
EPAs for SubspecialtiesEPAs for Subspecialties
• Three Broad Categories
– Common across the generalist/subspecialist role
– Common across subspecialties
– Subspecialty-specific
EPAs Common to Generalists/Subspecialists
EPAs Common to Generalists/Subspecialists
• Provide consultation to other health care providers caring for children
• Provide consultation using a variety of media (e.g. telephone, e-mail, webcast, video conferencing)
• Facilitate the transition from pediatric to adult health care
• Perform operational functions in a group practice setting
• Improve care for a population of patients • Lead a health care team • Facilitate handovers to another healthcare provider
either within or across settings
EPAs Common Across Subspecialties
EPAs Common Across Subspecialties
• Contribute to the scholarly work of the subspecialty
• Engage in meaningful MOC to fill knowledge/skills gaps and demonstrate deliberate practice
• Co-manage patients with generalists and other subspecialists
• Effectively perform the procedures key to the subspecialty
Subspecialty Specific EPAsSubspecialty Specific EPAs
• Sub-categories– Care for patients with acute ______ problems
– Provide a medical home for patients with chronic _____ problems
– Care for patients who require ______ (some unique non-procedural skill (e.g., management s/p transplantation)
• For subspecialties like cardiology who require additional training for EP consider an EPA on EP for which general cardiology fellows are not expected to achieve entrustment
EPA WorksheetEPA Worksheet1. EPA Title Improve care for a population of patients2. Activity Description
The 21st century health care professional needs to understand population health in order to optimize care. Populations can be defined by socio-demographics, disease states, and/or active practice patients to name a few.
The functions required:
•Apply knowledge of population health •Function in an interdependent health care team •Collaborate with others to improve systems •Recognize one’s professional responsibility to populations, communities and society at large•Utilize technology (e.g. patient registries and databases) •Demonstrate adaptability in developing and implementing improvement plans•Utilize risk/benefit and cost/benefit analysis
EPA Worksheet (continued)EPA Worksheet (continued)
3. Judicious Mapping to Domains of Competence
___ Patient Care___ Medical Knowledge_x_ Practice-Based Learning/Improvement___ Interpersonal & Communication Skills_x_ Professionalism_x_ Systems-Based Practice_x_ Personal & Professional Development
Modified from the work of ten Cate
EPA Worksheet (continued)EPA Worksheet (continued)
4. Judicious Mapping to Competencies • Practice-based Learning and Improvement
– Systematically analyze practice using quality improvement methods, and implement changes with the goal of practice improvement
– Use information technology to optimize learning and care delivery
• Professionalism– Develop a professional identify, including
understanding, appreciation, and internalization of the professional role as it relates to patient, community, or specialty
EPA Worksheet (continued)EPA Worksheet (continued)
4. Judicious Mapping to Competencies • Systems-based Practice
– Incorporate considerations of cost awareness and risk-benefit analysis
– Advocate for quality patient care and optimal patient care systems
– Know how to advocate for the promotion of health and the prevention of disease and injury in populations
• Personal & Professional Development– Flexibility and maturity in adjusting to change
with the capacity to alter one’s own behaviors
EPA Worksheet (continued)EPA Worksheet (continued)
5. List specific knowledge, skills and attitudes that are needed to execute the EPA well?
Curriculum KSA specific to:• Quality improvement methods• Information technology• Professional identity• Cost awareness • Risk-benefit analysis• Quality care and care systems• Advocacy• Flexibility and maturity in adjusting to change
Next Steps for EPAs: Assessment
Next Steps for EPAs: Assessment
Create a matrix (handout)• Using milestones for each competency at
each level of performance • Synthesize behaviors across
domains/competencies by level of performance
• Create clinical vignettes that describe the integration of behaviors across competencies at each level of performance
• Garner consensus about which level of performance correlates with “entrustment” of a learner and whether entrustment is required for that professional activity
Example Subspecialty EPA Worksheet
Example Subspecialty EPA Worksheet
1. EPA Title Provide care to patients who present with acute renal problems
2. Activity Description The functions required:•Apply in-depth knowledge of the field in implementing a focused diagnostic work-up and management plan•Communicate with the patient and family and engage them to the extent possible in shared decision making•Communicate with the referring physician and other team members involved in care•Support the emotional response of patients and families to uncertain or fear inducing diagnoses, treatments, and/or prognoses
Example Subspecialty EPA Worksheet
Example Subspecialty EPA Worksheet
3. Judicious Mapping to Domains of Competence
_X__ Patient Care_X__ Medical Knowledge___ Practice-Based Learning/Improvement_X__Interpersonal & Communication Skills___ Professionalism__ Systems-Based Practice___ Personal & Professional Development
Modified from the work of ten Cate
Example Subspecialty EPA Worksheet
Example Subspecialty EPA Worksheet
4. Judicious Mapping to Competencies
• Patient Care – Make informed diagnostic & therapeutic
decisions that result in optimal clinical judgment
– Develop & carry out management plans
• Medical Knowledge– Demonstrate sufficient knowledge of the
basic & clinically supportive sciences in the subspecialty
Example Subspecialty EPA Worksheet
Example Subspecialty EPA Worksheet
4. Judicious Mapping to Competencies
• Interpersonal and Communication Skills– Communicate effectively with patients, families
and the public, as appropriate, across a broad range of socioeconomic and cultural backgrounds
– Communicate effectively with physicians, other health professionals, and health related agencies
– Demonstrate the insight and understanding into the emotion and human response to emotion that allow one to appropriately develop and manage human interactions
Example Subspecialty EPA Worksheet
Example Subspecialty EPA Worksheet
5. List specific knowledge, skills and attitudes that are needed to execute the EPA well?
Curriculum KSA specific to:• Epidemiology, signs, symptoms, presenting
features & up to date management of HUS, ATN…
• Interpreting diagnostic imaging & testing…• Delivering bad news • Basic elements of emotional intelligence ….
Take Home MessagesTake Home Messages
Milestones + EPAs: Both are Critical to Meaningful
Assessment
Take Home Messages Take Home Messages
• Milestones: A granular approach to assessment– Address the learner at the level of a competency
(e.g., gather essential information…)– Allow drill down to smaller elements of behavior
that provide the substance of formative feedback, remediation, and a learning roadmap
• EPAs: A holistic approach to assessment – Integrate competencies within a clinical context– Assess clusters of behaviors required to care for
patients
Identifying EPAs for Subspecialties:
COLLABORATION IS KEY
Take Home MessagesTake Home Messages
Thank you!Thank you!