Core Entrustable Professional Activities for Entering Residency Pilot Group Update: Considerations for Medical Science Educators

Med.Sci.Educ. (2016) 26:797–800 DOI 10.1007/s40670-016-0282-3 COMMENTARY Core Entrustable Professional Activities for Entering Residency Pilot Group Update: Considerations for Medical Science Educators Kimberly D. Lomis 1 & Michael S. Ryan 2 & Jonathan M. Amiel 3 & Patrick M. Cocks 4 & Margaret O. Uthman 5 & Karin F. Esposito 6 Published online: 6 July 2016 # International Association of Medical Science Educators 2016 Introduction One important goal of undergraduate medical education (UME) is to prepare students for their clinical duties as interns. Increasingly, program directors in graduate medical education (GME) have noted significant variability in medical school graduates’ readiness to perform routine clinical activities, and this may affect patient care during July transitions [1]. In response, the Association of American Medical Colleges (AAMC) convened an experienced panel, including a student, a resident, a basic scientist, and clinical educators, to identify the most important activities that interns should be able to perform without direct supervision on the first day of residency. A national reactor panel of medical educators provided iterative feedback. In May 2014, the AAMC published a cur- * Kimberly D. Lomis 1 Office of Undergraduate Medical Education, Vanderbilt University School of Medicine, 201 Light Hall, Nashville, TN 37232, USA 2 Clinical Medical Education, Virginia Commonwealth University, 1201 E. Marshall St, Richmond, VA 23220, USA 3 Office of Education, Columbia University College of Physicians & Surgeons, 630 West 168th Street, Room 3-401, New York, NY 10032, USA 4 NYU School of Medicine, Bellevue Hospital Center, 550 First Avenue, Room NBV-16N30, New York, NY 10016, USA 5 University of Texas McGovern Medical School, 6431 Fannin St, Houston, TX 77030, USA 6 Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street, AHCII 662, Miami, FL 33199, USA riculum developer’s guide, entitled Core Entrustable Professional Activities for Entering Residency [2] (Table 1). Entrustable professional activities (EPAs) describe units of work that represent routine activities of physicians, as distinguished from competencies, which describe observable abilities of an individual [3]. Both constructs are important to fostering the development of trainees. Successful performance of an EPA requires that the trainee synthesize multiple competencies in a cohesive manner in order to care for a patient. If the trainee performs the task in a satisfactory manner, it can be inferred that the trainee possesses the associated competencies. If, however, the performance is not satisfactory, it is helpful to refer back to the associated competencies to provide clear feedback and develop a plan for improvement. EPAs together constitute the core activities of the professional [3]. The term entrustment is intentional and should carry significant implications for both assessors and learners. The construct of entrustment dispels the notion that it is sufficient to simply possess knowledge, skills, and attitudes. Ultimately, supervisors must trust the learner to perform relevant tasks in the care of patients, without direct supervision. Clinical supervisors make implicit, ad hoc, entrustment decisions every day [4]. The intent of the EPA framework is to capitalize upon this intuitive clinical perspective on performance. To prepare students to succeed in this competencybased framework, it will be necessary not only to teach and assess knowledge, skills, and attitudes relevant to EPAs throughout the UME curriculum; it is equally critical to promote and monitor the development of key attributes that engender trust. Formal entrustment decisions using multiple sources of evidence can ensure that each individual graduate is prepared for internship. In an effort to provide guidance to the medical education community regarding the implementation of the EPA framework in undergraduate medical education, the AAMC 798 Med.Sci.Educ. (2016) 26:797–800 Table 1 The 13 Core Entrustable Professional Activities for Entering Residency 1. Gather a history and perform a physical examination 2. Prioritize a differential diagnosis following a clinical encounter 3. Recommend and interpret common diagnostic and screening tests 4. Enter and discuss orders and 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 responsibility 9. Collaborate as a member of an inter-professional 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 initiated a pilot. Teams from ten schools (Table 2) were convened to explore how to promote readiness for entrustment by the time students enter residency. The pilot group has reviewed literature, engaged in active discussions, and initiated development of tools for teaching and assessments. After a year of deliberation, this group generated a list of guiding principles for UME institutions planning to enact the EPA framework [5]. This commentary represents the current thinking of the Steering Committee for the Core EPA Pilot regarding the implications of EPAs for medical science educators. Medical Science Educators and EPAs in the Pre-Clerkship Phase of Medical Training Entrustment is fundamentally a workplace construct. However, successful performance of EPAs in residency relies upon a developmental process that begins early in medical training and requires experiences that are vertically integrated throughout the curriculum. Many of the core EPAs can be described as a collection of smaller components, or Bstepping stones,^ that build to the ultimate task. Some of these components must be introduced and practiced at early stages of training, before the student is ready to participate in the direct care of patients [6]. Table 2 The 10 Core EPA Pilot Schools Columbia University College of Physicians and Surgeons Florida International University Herbert Wertheim College of Medicine McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth) Michigan State University College of Human Medicine New York University School of Medicine Oregon Health & Science University School of Medicine University of Illinois College of Medicine Vanderbilt University School of Medicine Virginia Commonwealth University School of Medicine Yale School of Medicine The Curriculum and Assessment Concept Group for the Core EPA Pilot recommends a system-based approach to the incorporation of content and assessments relevant to EPAs throughout each institution’s curriculum. As integral membe (...truncated)