Introducing a Psychiatry Clerkship Curriculum Based on Entrustable Professional Activities: an Explorative Pilot Study

Academic Psychiatry https://doi.org/10.1007/s40596-021-01417-y IN BRIEF REPORT Introducing a Psychiatry Clerkship Curriculum Based on Entrustable Professional Activities: an Explorative Pilot Study Severin Pinilla 1,2 3 1 3 3 & Andrea Cantisani & Stefan Klöppel & Werner Strik & Christoph Nissen & Sören Huwendiek 2 Received: 31 August 2020 / Accepted: 4 February 2021 # The Author(s) 2021 Abstract Objective The authors evaluated a reformed psychiatry clerkship curriculum based on entrustable professional activities (EPAs). Methods The authors conducted an exploratory pilot study of a reformed clerkship curriculum based on EPAs. A novel workplace-based assessment format including an entrustment-supervision scale and curricular adaptations were introduced. The Kirkpatrick model was used to evaluate outcomes of the reformed clerkship curriculum on three levels (1 = acceptance, 2 = learning, 3 = change of behavior). Results The pilot student cohort (n = 10) completed a questionnaire, 180 self-assessments (18 per student) on need for supervision, and 63 workplace-based assessments (6.3 per student, in 4 weeks). Level 1: high overall satisfaction with the clerkship (five-point Likert item: average, 4.9; range: 4.0–5.0). Level 2: the overall significant decrease in self-assessed need for supervision before and after the clerkship was two supervision levels (direct to indirect supervision; p < 0.05). The most frequently documented admissions included schizophrenic disorders (n = 11; 28%), affective disorders (n = 10; 25%), substance abuse disorders (n = 5; 13%), and anxiety and stress-related disorders (n = 5; 13%). Level 3: clinical supervisors used history taking, assessing the mental status, and documentation and presentation for workplace-based assessments. According to supervisors’ ratings, there was a decreasing need for supervision from the first to last week of the clerkship. Conclusions Students reacted positively to the reformed clerkship curriculum. The workplace-based assessments with entrustment ratings appeared to support achievement of competency-based learning objectives. Better understanding of how to cover assessment of all core EPAs in the psychiatry clerkship is needed. Keywords Entrustable professional activities . Clerkship . Undergraduate medical education . Workplace-based assessment Competency-based national frameworks with entrustable professional activities (EPAs) have been introduced in the USA, Canada, and Switzerland for undergraduate medical education [1–3]. EPAs are specific patient care responsibilities that trainees, once they have attained sufficient competence, are “entrusted” to perform unsupervised [4]. The Swiss national learning catalog is based on nine core EPAs that are not * Severin Pinilla 1 University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland 2 Institute for Medical Education, University of Bern, Bern, Switzerland 3 University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland specialty specific [1] and are comparable to but still somewhat different than those proposed in the USA by the Association of American Medical Colleges [5]. Currently, in psychiatry, there is only limited evidence available on how to introduce and work with EPAs in clinical training as part of undergraduate medical education [6, 7]. Although two reports are available on assessing EPAs in a psychiatry clerkship curriculum with a rating scale based on expected performance [6, 7], little attention has been paid to using levels of supervision for ad hoc assessment (i.e., entrustment ratings after directly observed clinical activities) of EPAs [8, 9]. The introduction of an EPA-based clinical curriculum typically involves informing students and staff about EPAs as learning goals, for implementation of new teaching activities, and in some cases for reforming workplace-based assessment instruments [10–12]. Observational studies on assessment of EPAs in psychiatry have revealed poor correlation of global performance assessments between student and supervisor Acad Psychiatry ratings per core EPA. Here, students rate their competence higher than supervisors [6], with an expected higher selfassessed level of student performance per EPA later in medical school [7]. Research in other specialties has introduced prospective entrustment-supervision scales for assessment of EPAs, which have not been studied in the context of psychiatry clerkships to date [9, 10]. Although self-assessment of competence is not particularly valuable in terms of validity [13], self-assessment of self-efficacy–related constructs, such as perceived need for supervision or self-entrustment [14], might be more valid in the context of self-regulated learning. Our objective for this exploratory pilot study was to evaluate educational outcomes after introduction of EPAs, a novel assessment format and associated curricular adaptations to a psychiatry core clerkship curriculum. Therefore, we aimed to explore multiple data sources on the first three Kirkpatrick model levels (satisfaction, learning, and behavioral change) as one of the most widely used evaluation models in medical education [12]. Within this program evaluation, we aimed to pilot self-entrusted supervision levels per core EPA before and after the reformed clerkship rotation [14]. The results from this study can inform future curriculum reforms and might be relevant in particular for clinician educators who are planning to, or are already implementing, EPA-based clinical curricula. Methods We conducted an exploratory pilot study of a competencybased clerkship curriculum reform and assessed the educational curriculum reform outcomes on levels 1–3 of the Kirkpatrick model for program evaluation [12]. The educational concepts that informed our curriculum reform process included entrustment in the workplace [4, 15], and competency-based undergraduate learning and teaching [1, 2]. Medical students at our institution have to complete five mandatory core clerkships during the fourth year of their 6year medical curriculum (Bachelor and Masters of Medicine). Each year, our psychiatric teaching hospital provides treatment for approximately 3800 inpatients and over 10,000 outpatients. We train about 10 medical students per month, with each teaching ward taking on one or two medical students per month. Students spent 4 weeks on 10 different wards. The interprofessional staff of a ward typically consists of one attending physician and two residents, in addition to nurses, a psychologist, and a social worker, and takes care of 20–22 hospitalized patients. We do not use grades for clerkship rotations but students have to hand in several mandatory formative assessments: ≥4 workplace-based assessments (with at least one on EPA 1 and one on EPA 2); 4 documented patient admissions with active student participation; and 1 scientific paper or clinical case presentatio (...truncated)