u n i v e r s i t Ä t s m e d i z i n b e r l i n identifying epas for undergraduate medical...
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U N I V E R S I T Ä T S M E D I Z I N B E R L I NU N I V E R S I T Ä T S M E D I Z I N B E R L I N
Identifying EPAs for
Undergraduate Medical
Education
Y Holzhausen, A Maaz, A Degel, H Peters
Charité Universitätsmedizin BerlinDieter Scheffner Center for Medical
Teaching and Educational Research
AMEE 2014
U N I V E R S I T Ä T S M E D I Z I N B E R L I N 2
1995
Traditional curriculum
2000 2005 2010 2015
Modular curriculumReformed curriculum
Change of legal frame work
Main characteristics:
• Integrated, modular structure
• Competency‐based
• Learner‐based
• Patient‐based
Background
U N I V E R S I T Ä T S M E D I Z I N B E R L I N 3
• EPAs (ten Cate, 2005)
• Widely applied in postgraduate medical education
• Trend to apply it in undergraduate medical education
AAMC: 13 Core Entrustable Professional Activities for Entering Residency (2014)
Background
U N I V E R S I T Ä T S M E D I Z I N B E R L I N 4
Goal of Delphi Study
• Define Core EPAs for Entering Residency Outcomes for the modular curriculum Charité
Objectives
(Association of American Medical Colleges, 2013)
U N I V E R S I T Ä T S M E D I Z I N B E R L I N 5
Participants (n= 46)• Physicians of varying medical specialties (25)
• Experts in curricular planning
Round 1 (August 2014)
Sample
n 17 ( 37%)
Gender ♂ = 65%
Age M = 45.47 (SD = 8.19)
Work Experience (Years) M = 18.56 (SD =7.6)
Teaching Experience (Years) M = 14.29 (SD = 6.2)
Medical Specialties 12
U N I V E R S I T Ä T S M E D I Z I N B E R L I N 6
1. Gather a history and perform a physical examination and generate a list of problems
2. Develop and implement a diagnostic plan
3. Interpret diagnostic results and act on them
4. Develop and implement a treatment plan
5. Provide an oral presentation of a clinical encounter
6. Retrieve best evidence for distinct clinical question and the individual patient
7. Obtain informed consent for tests and/or procedures
8. Perform general procedures of a physician
9. Inform, advise and instruct a patient
10. Give or receive a patient handover
11. Document a clinical encounter in the patient record
12. Recognize an emergency situation and act on it
List of EPAs
U N I V E R S I T Ä T S M E D I Z I N B E R L I N 7
Item Response
Relevance of EPA
Clarity of title
Completeness of description
4-point likert scale (disagree- agree)
Acceptance of title
Acceptance of description
Accept / Change / Complement
Difficulty of EPA High / Appropriate / Low
Additional EPAs Free text
Questionnaire
U N I V E R S I T Ä T S M E D I Z I N B E R L I N 8
Results: Relevance of EPAs
EPA CVI Rating(Relevance)
Mean (SD)
1 Gather a history and perform a physical examination and generate a list of problems
94.1 3.59(.8)
2 Develop and implement a diagnostic plan 88.2 3.29(.85)
3 Interpret diagnostic results and act on them 82.4 3.29(.92)
4 Develop and implement a treatment plan 76.5 3.12(.93)
5 Provide an oral presentation of a clinical encounter 94.1 3.63(.72)
6 Retrieve best evidence for distinct clinical question and the individual patient
58.8 2.82(.81)
U N I V E R S I T Ä T S M E D I Z I N B E R L I N 9
EPA CVI Rating(Relevance)
Mean(SD)
7 Obtain informed consent for tests and/or procedures
88.2 3.59(.71)
8 Perform general procedures of a physician 88.2 3.41(.71)
9 Inform, advise and instruct a patient 62.5 2.81(1.05)
10 Give or receive a patient handover 88.2 3.59(.71)
11 Document a clinical encounter in the patient record 76.5 3.18(.95)
12 Recognize an emergency situation and act on it 70.6 3.24(.90)
Results: Relevance of EPAs
U N I V E R S I T Ä T S M E D I Z I N B E R L I N 10
Results: Difficulty of EPAs
EPA12
EPA11
EPA10
EPA9
EPA8
EPA7
EPA6
EPA5
EPA4
EPA3
EPA2
EPA1
0 10 20 30 40 50 60 70 80 90 100
easyappropriatedifficult
U N I V E R S I T Ä T S M E D I Z I N B E R L I N 11
EPA CVI Rating(Relevance)
Difficulty
6 Retrieve best evidence for distinct clinical question and the individual patient
58.8 70.629.4
9 Inform, advise and instruct a patient 62.5 58.841.2
12 Recognize an emergency situation and act on it 70.6 70.629.4
Results: Content Validity Index
U N I V E R S I T Ä T S M E D I Z I N B E R L I N 12
• Interaction between curriculum experts and faculty members
• Consequences for the modular curriculum at the Charité
• Overlap with other EPAs
• Validation of international EPAs for undergraduate medical education
Key Points
U N I V E R S I T Ä T S M E D I Z I N B E R L I N 13
Thank you for your attention
Ylva Holzhausen
Charité - Universitätsmedizin Berlin
Dieter Scheffner Center for Medical Teaching and Educational Research
Charitéplatz 1
10117 Berlin
Tel. +49 30 450 576 457
U N I V E R S I T Ä T S M E D I Z I N B E R L I N 14
References
1. ten Cate, O. (2005). Entrustability of professional activities and competency-based training. Medical Education, 39(12), 1176-1177.
2. Core entrustable professional´activities for entering residency (CEPAER).
Available at https://www.mededportal.org/icollaborative/resource/887
U N I V E R S I T Ä T S M E D I Z I N B E R L I N 15
Neurology Intensive Care
Psychiatry Audiology
Psychosomatic Medicine Dermatology
Cardiology Otolaryngology
Endocrinology General Medicine
Geriatric Medicine Surgery
Nephrology Oncology
Rheumatology Obstetrics
Urology Pediatrics
Anesthesiology Neonatology
Policlinic Gynecology
Emergency Medical Aid
List of Medical Specialties
U N I V E R S I T Ä T S M E D I Z I N B E R L I N 16
Title Gather a history and perform a physical examination and generate a list of problems
Description In the first days of residency, the resident is able to gather a history and to perform a physical examination of an adult patient with a typical presentation and/or a common disease. Following the encounter, the resident is able to generate a structured list of problems.
This applies for both the inpatient and outpatient sector. It is expected that the professional activity is executed in a complete and focused fashion and is adapted to the situational requirements. This also includes the searching for typical complaints and signs of relevant illnesses and health problems (differential diagnosis on a patient). The results are expected to be presented by means of a structured summary and list of problems to the supervising physician (main complaints, additional complaints diagnosis and problems).
This EPA applies to common diseases/health problems and their typical presentations.
This EPA does not apply to:1)Newborns, babies, children, adolescents and pregnant women;2) No interdisciplinary diseases/health problems
Example of EPA