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The Role of Generic Competencies in the Entrustment of Professional Activities: A Nationwide Competency-Based Curriculum Assessed.

ABSTRACT: Entrustable professional activities (EPAs) seek to translate essential physician competencies into clinical practice. Until now, it is not known whether EPA-based curricula offer enhanced assessment and feedback to trainees.This study examined program directors' and senior residents' justifications for entrustment decisions and what role generic, cross-specialty competencies (such as communication skills, collaboration, and understanding health care systems) play in these decisions.Entrustment decisions for all Dutch obstetrics and gynecology residents between January 2010 and April 2014 were retrieved from their electronic portfolios. Justifications for entrustment were divided into 4 categories: the resident's experience, his or her technical performance, the presence of a generic competency, and training. Template analysis was used to analyze in depth the types of justifications, which play a role in entrustment decisions.A total of 5139 entrustment decisions for 375 unique residents were extracted and analyzed. In 59% of all entrustment decisions, entrusting a professional task to a resident was justified by the experience of the resident. Generic competencies were mentioned in 0.5% of all entrustment decisions. Template analysis revealed that the amount of exposure and technical skills are leading factors, while the quality of the performance was not reported to be of any influence.Entrustment decisions only rarely are based on generic competencies, despite the introduction of competency frameworks and EPAs. For program directors, a leading factor in entrustment decisions is a resident's exposure to an activity, and the quality of a resident's performance appears to play only a minor role.

SUBMITTER: van Loon KA

PROVIDER: S-EPMC5058587 | biostudies-literature | 2016 Oct

REPOSITORIES: biostudies-literature

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The Role of Generic Competencies in the Entrustment of Professional Activities: A Nationwide Competency-Based Curriculum Assessed.

van Loon Karsten A KA Teunissen Pim W PW Driessen Erik W EW Scheele Fedde F

Journal of graduate medical education 20161001 4

<h4>Background</h4>Entrustable professional activities (EPAs) seek to translate essential physician competencies into clinical practice. Until now, it is not known whether EPA-based curricula offer enhanced assessment and feedback to trainees.<h4>Objective</h4>This study examined program directors' and senior residents' justifications for entrustment decisions and what role generic, cross-specialty competencies (such as communication skills, collaboration, and understanding health care systems) ...[more]

PMID: 27777665

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Project description:Background: Postgraduate training curricula should not be based on time-spans or predefined numbers of performed procedures. One approach to link competencies to clinical tasks is the concept of Entrustable Professional Activities (EPA). The goal of this study was the definition, ranking and validation of EPAs for anaesthesiology postgraduate training and the creation of an anaesthesiologic core curriculum. Methods: Anaesthesiologists of different levels of training participated in the study (single-center, cross-sectional) . First, an expert group defined a preliminary list of EPAs. Then a first Delphi round (n= 47 participants) was applied to identify daily anaesthesiology tasks with the goal to define EPAs. From the first Delphi round a new set of EPAs was defined, using the template and mapping method. Through an alignment process, conducted by the expert group, the preliminary EPAs and the new set of EPAs from the first Delphi round were summarised into a new list of EPAs. This list was presented to the study participants in a second Delphi round (n=80 participants), with the goal to validate and rank each EPA and to define the year of entrustment. For this purpose, participants were asked in the second Delphi round if each EPA should be included into an anaesthesiology core curriculum and in which year of training entrustment should take place. Furthermore, they were asked to rank each EPA on a numeric scale, defining its importance. From this numeric scale, the content validity index (CVI) for each EPA was calculated. Consensus of the results from the second Delphi round was calculated, using the one-way random effects model to calculate Intra-Class-Correlations (ICC). Percentages of agreement among the whole set of EPAs of this study and a previously published set of EPAs were computed. Results: A core-curriculum comprising of 39 EPAs was developed. The EPAs were subdivided into superior/high and inferior/low scoring EPAs, reflecting their importance and were mapped to the year of entrustment. The results reached high consensus among the different participating anaesthesiologist groups (overall agreement was 0.96 for the CVI of each EPA and 0.83 for the year in which the EPAs should be entrusted). Agreement with the previously defined set of EPAs was 73.3%. Conclusion: This study provides a further step in transforming postgraduate anaesthesiology training into a more contemporary approach. Other studies are necessary to complete and amend the presented core curriculum of EPA based postgraduate anaesthesiology training.

Project description:Background: In October 2018, the University of Witten/Herdecke (UW/H) launched the new reformed medical education programme called Medicine 2018+. A major innovation compared to the existing model programme was the introduction of thematic focuses. A longitudinal communication skills curriculum was integrated into the new thematic focus "professional and personal development - inner work" (IAP). With the start of the new programme, the IAP curriculum has been built step-by-step over time, i.e. the first four semesters have already been implemented, the following semesters are being planned. Project description: IAP aims to provide students with patient-centred medicine. Five areas of competence were defined: Doctor-patient communication, team competence, staying healthy, my paths to becoming a doctor, medicine and society. The focus of this article is on the communication curriculum. The first year of study focusses on the training of basic communication skills. In the 2nd year of study, students practice these basic skills in small groups with simulated patients (SP), whereby the emphasis in the 3rd semester is on history taking and in the 4th semester is on sharing information. In the 3rd semester, students complete a communication station in an OSCE. From the 5th semester onwards, the focus of training is on the consolidation of basic and advanced communication skills, which can be applied in clinical clerkships, and the reflection of clinical experiences. Key didactic elements are, in addition to teaching the theoretical basics, experience-based small group work with and without SP, feedback and reflection. The evaluation of the summer semester 2020 showed high agreement ratings of the students regarding the overall satisfaction with the individual courses (83-100% agreement). Discussion: The introduction of IAP has been very positively received by the students. Challenges are the adequate handling of the increasing student workload when planning new courses, the implementation of a longitudinal e-portfolio as well as the recruitment and training of clinical teachers and SPs. Conclusion: As the evaluation results of the summer semester 2020 show, the first steps of implementing a longitudinal communication curriculum at UW/H have been successful. Helpful strategies were the orientation on published examples from other faculties as well as regular feedback and discussions with students and teachers in order to adapt and integrate educational considerations into the existing model programme in Witten.

Dataset Information

The Role of Generic Competencies in the Entrustment of Professional Activities: A Nationwide Competency-Based Curriculum Assessed.

Publications

The Role of Generic Competencies in the Entrustment of Professional Activities: A Nationwide Competency-Based Curriculum Assessed.

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