Identifying entrustable professional activities in internal medicine training.
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ABSTRACT:
SUBMITTER: Hauer KE
PROVIDER: S-EPMC3613318 | biostudies-other | 2013 Mar
REPOSITORIES: biostudies-other
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Project description:BackgroundWhether written comments in entrustable professional activities (EPAs) translate into high-quality feedback remains uncertain.ObjectiveWe aimed to evaluate the quality of EPA feedback completed by faculty and senior residents.MethodsUsing retrospective descriptive analysis, we assessed the quality of feedback from all EPAs for 34 first-year internal medicine residents from July 2019 to May 2020 at Western University in London, Ontario, Canada. We assessed feedback quality on 4 domains: timeliness, task orientation, actionability, and polarity. Four independent reviewers were blinded to names of evaluators and learners and were randomized to assess each EPA for the 4 domains. Statistical analyses were completed using R 3.6.3. Chi-square or Fisher's exact test and Cochran-Armitage test for trend were used to compare the quality of feedback provided by faculty versus student assessors, and to compare the effect of timely versus not timely feedback on task orientation, actionability, and polarity.ResultsA total of 2471 EPAs were initiated by junior residents. Eighty percent (n=1981) of these were completed, of which 61% (n=1213) were completed by senior residents. Interrater reliability was almost perfect for timeliness (κ=0.99), moderate for task orientation (κ=0.74), strong for actionability (κ=0.81), and moderate for polarity (κ=0.62). Of completed EPAs, 47% (n=926) were timely, 85% (n=1697) were task oriented, 83% (n=1649) consisted of reinforcing feedback, 4% (n=79) contained mixed feedback, and 12% (n=240) had neutral feedback. Thirty percent (n=595) were semi- or very actionable.ConclusionsThe written feedback in the EPAs was task oriented but was neither timely nor actionable. The majority of EPAs were completed by senior residents rather than faculty.
| S-EPMC9934834 | biostudies-literature
Project description:BackgroundGraduate medical education programs assess trainees' performance to determine readiness for unsupervised practice. Entrustable professional activities (EPAs) are a novel approach for assessing performance of core professional tasks.AimTo describe a pilot and feasibility evaluation of two EPAs for competency-based assessment in internal medicine (IM) residency.Setting/participantsPost-graduate year-1 interns (PGY-1s) and attendings at a large internal medicine (IM) residency program.Program descriptionTwo Entrustable professional activities (EPA) assessments (Discharge, Family Meeting) were piloted.Program feasibility evaluationTwenty-eight out of 43 (65.1 %) PGY-1 s and 32/43 (74.4 %) attendings completed surveys about the Discharge EPA experience. Most who completed the EPA assessment (10/12, 83.8 %, PGY-1s; 9/11, 83.3 %, attendings) agreed it facilitated useful feedback discussions. For the Family Meeting EPA, 16/26 (61.5 %) PGY-1s completed surveys, and most who participated (9/12 PGY1s, 75 %) reported it improved attention to family meeting education, although only half recommended continuing the EPA assessment.DiscussionFrom piloting two EPA assessments in a large IM residency, we recognized our reminder systems and time dedicated for completing EPA requirements as inadequate. Collaboration around patient safety and palliative care with relevant clinical services has enhanced implementation and buy-in. We will evaluate how well EPA-based assessment serves the intended purpose of capturing trainees' trustworthiness to conduct activities unsupervised.
| S-EPMC3710378 | biostudies-literature
Project description:BACKGROUND: Increasing complexity of medical care, coupled with limits on resident work hours, has prompted consideration of extending Internal Medicine training. It is unclear whether further hour reductions and extension of training beyond the current duration of 3 years would be accepted by trainees. OBJECTIVE: We aimed to determine if further work-hour reductions and extension of training would be accepted by trainees and whether resident burnout affects their opinions. DESIGN: A postal survey was sent to all 143 Internal Medicine residents at the University of Colorado School of Medicine in May 2004. MEASUREMENTS: The survey contained questions related to opinions on work-hour limits using a 5-point Likert scale ranging from strongly agree to strongly disagree. Burnout was measured using the Maslach Burnout Inventory, organized into three subscales: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment, with burnout defined as high EE or DP. RESULTS: Seventy-four percent (106/143) of residents returned the survey. The vast majority (84%) of residents disagreed or strongly disagreed with extending training to 4 or 5 years. Burnout residents were less averse to extending training (strongly agree or agree, 18.9% vs 4.3%, P = .04). The majority of residents (68.9%) disagreed or strongly disagreed with establishing a 60-hour/week limit. Residents who met the criteria for burnout were more likely to agree that a 60-hour limit would be better than an 80-hour limit (strongly agree or agree, 22% vs 8%, P = .02). CONCLUSIONS: In this program, most Internal Medicine residents are strongly opposed to extending their training to 4 or 5 years and would prefer the current 80 hours/week cap. A longer, less intense pace of Internal Medicine training seems to be less attractive in the eyes of current trainees.
| S-EPMC1824782 | biostudies-other
Project description:BackgroundA residency program's intern cohort is comprised of individuals from different medical schools that place varying levels of emphasis on Core Entrustable Professional Activities for Entering Residency (CEPAERs). Program directors have expressed concerns about the preparedness of medical school graduates. Though guiding principles for implementation of the CEPAERs have been published, studies using this framework to assess interns' baseline skills during orientation are limited.ObjectiveA CEPAER-based objective structured clinical examination (OSCE) was implemented with the aims to (1) assess each intern's baseline clinical skills and provide formative feedback; (2) determine an intern's readiness for resident responsibilities; (3) inform individualized education plans; and (4) address identified gaps through curricular change.MethodsDuring orientation, all 33 interns from internal medicine (categorical, preliminary, and medicine-psychiatry) participated in the OSCE. Six 20-minute stations evaluated 8 EPAs. Faculty completed a global assessment, and standardized patients completed a communications checklist and global assessment. All interns completed a self-assessment of baseline skills and a post-OSCE survey.ResultsStations assessing handoffs, informed consent, and subjective, objective, assessment, and plan (SOAP) note were the lowest-performing stations. Interns performed lower in skills for which they did not report previous training. Formal instruction was incorporated into didactic sessions for the lowest-performing stations. The majority of interns indicated that the assessment was useful, and immediate feedback was beneficial.ConclusionsThis OSCE during orientation offers just-in-time baseline information regarding interns' critical skills and may lead to individualized feedback as well as continuous curricular improvement.
| S-EPMC6476083 | biostudies-literature
Project description:BackgroundTraditional teaching concepts in medical education do not take full advantage of current information technology. We aimed to objectively determine the impact of Tablet PC enhanced training on learning experience and MKSAP® (medical knowledge self-assessment program) exam performance.MethodsIn this single center, prospective, controlled study final year medical students and medical residents doing an inpatient service rotation were alternatingly assigned to either the active test (Tablet PC with custom multimedia education software package) or traditional education (control) group, respectively. All completed an extensive questionnaire to collect their socio-demographic data, evaluate educational status, computer affinity and skills, problem solving, eLearning knowledge and self-rated medical knowledge. Both groups were MKSAP® tested at the beginning and the end of their rotation. The MKSAP® score at the final exam was the primary endpoint.ResultsData of 55 (tablet n = 24, controls n = 31) male 36.4%, median age 28 years, 65.5% students, were evaluable. The mean MKSAP® score improved in the tablet PC (score Δ + 8 SD: 11), but not the control group (score Δ- 7, SD: 11), respectively. After adjustment for baseline score and confounders the Tablet PC group showed on average 11% better MKSAP® test results compared to the control group (p<0.001). The most commonly used resources for medical problem solving were journal articles looked up on PubMed or Google®, and books.ConclusionsOur study provides evidence, that tablet computer based integrated training and clinical practice enhances medical education and exam performance. Larger, multicenter trials are required to independently validate our data. Residency and fellowship directors are encouraged to consider adding portable computer devices, multimedia content and introduce blended learning to their respective training programs.
| S-EPMC5378330 | biostudies-literature
Project description:General internal medicine (GIM) has predominantly been perceived as a joint specialty to be completed alongside specialty training in the United Kingdom. The Internal Medicine (IMT) Stage 2 curriculum was released in August 2022;1 in October 2022 the Round 2 Specialty Training recruitment included applications for the pilot GIM training programme, and in February 2023 NHS England commenced the 3-year programme. The GIM programme aims to provide run-through training for GIM to Certificate of Completion of Training (CTT). This report establishes the initial recruitment demographics of trainees, as well as an analysis of the successful applicants' perspectives on the programme and their motivations for applying.
| S-EPMC11293301 | biostudies-literature
Project description:BackgroundEntrustable professional activities (EPAs) have been defined to promote the workplace participation of undergraduate medical students, generally in the context of high-income countries with a focus on the secondary and tertiary health care sectors. These EPAs have limited applicability to training and health care contexts in low- to middle-income countries that have a focus on primary health care, for instance, the context of community medicine. The purpose of this article is to report the process and results of defining EPAs for undergraduate medical training in a community health care setting.MethodsA modified Delphi study was performed to develop EPAs for the training of medical students in community medicine during their first and second years of education at the Marília Medical School (FAMEMA), Brazil. The supervision level was operationalized in terms of a student's ability to perform the EPA autonomously in an effective and safe manner with supervision readily available on request. Panellists (9 physicians and 6 nurses) rated the completeness of the proposed list of EPAs and EPA categories on four-point Likert scales. The threshold for consensus among panellists was a mean content validity index of at least 80%.ResultsConsensus was reached after two Delphi rounds, resulting in 11 EPAs for undergraduate medical education and training in community medicine. These EPAs were organized into three overarching EPA domains: integrality of care for individual health needs in all phases of the life cycle (5 EPAs), integrality of care for family health needs (3 EPAs), and integrality of care for community health needs (3 EPAs). For each EPA, descriptions of the following categories were created: title; specifications and limitations; conditions and implications of the entrustment decision; knowledge, skills, and attitudes; links to competencies; and assessment sources.ConclusionThe resulting 11 EPAs for training medical students in community medicine expand the application of the EPA framework to both early undergraduate medical education and the context of primary health care. This report can support and guide other medical schools in their attempts to train students in primary health care contexts and to incorporate EPAs into their curricula.
| S-EPMC9598029 | biostudies-literature
Project description:We developed a musculoskeletal education intervention for internal medicine residents consisting of lectures, anatomic models, and a joint injection clinic. Written tests, observed musculoskeletal exams, and self-confidence scales were administered to 27 internal medicine residents before and after the intervention. Improvement was found in observed physical exam and self-reported confidence levels in performing knee injections. Confidence in shoulder injection skills improved, but remained low. Improved scores on written examination, though statistically significant, were not educationally significant. This single-institution pilot study demonstrates that a simple educational program results in improved knee and shoulder examination skills and confidence in performing knee injections.
| S-EPMC1484790 | biostudies-literature
Project description:BackgroundFew internal medicine residency programs provide formal ultrasound training. This study sought to assess the feasibility of simulation based ultrasound training among first year internal medicine residents and measure their comfort at effectively using ultrasound to perform invasive procedures before and after this innovative model of ultrasound training.MethodsA simulation based ultrasound training module was implemented during intern orientation that incorporated didactic and practical experiences in a simulation and cadaver laboratory. Participants completed anonymous pre and post surveys in which they reported their level of confidence in the use of ultrasound technology and their comfort in identifying anatomic structures including: lung, pleural effusion, bowel, peritoneal cavity, ascites, thyroid, and internal jugular vein. Survey items were structured on a 5-point Likert scales (1 = extremely unconfident, 5 = extremely confident).ResultsSeventy-five out of seventy-six interns completed the pre-intervention survey and 55 completed the post-survey. The mean confidence score (SD) increased to 4.00 (0.47) (p < 0.0001). The mean (SD) comfort ranged from 3.61 (0.84) for peritoneal cavity to 4.48 (0.62) for internal jugular vein. Confidence in identifying all anatomic structures showed an increase over the pre-intervention means (p < 0.002).ConclusionA simulation based ultrasound learning module can improve the self-reported confidence with which residents identify structures important in performing invasive ultrasound guided procedures. Incorporating an ultrasound module into residents' education may address perceived need for ultrasound training, improve procedural skills, and enhance patient safety.
| S-EPMC3196730 | biostudies-literature
Project description:BackgroundAlthough supervision is an important part of residency training, its scope and how it relates to other types of support, such as mentoring, precepting and feedback, remain unclear. While clinical supervision consists of ongoing instructions and feedback in the workplace setting, educational supervision is a formalized component of postgraduate medical educational and supports the process that facilitates a trainee's progression throughout their training. Since medical specialties have different supervisory traditions, this study focuses on educational supervision in internal medicine. Our aim was to investigate what is known about educational supervision practices in internal medicine and the role of educational supervision in supporting residents' learning.MethodsWe conducted a scoping review of the literature on educational supervision in residency training in internal medicine based on Levac et al.'s modification of Arksey and O'Malley's six-step framework. The literature search was performed in the following databases: Medline, Embase, Web of Science and the Educational Resources Information Center. In addition, we conducted a handsearch in Medical Teacher and Google Scholar. We followed the PRISMA guidelines for systematic research.ResultsEighteen of the 3,284 identified articles were included in the analysis. We found few empirical studies describing how educational supervision is conducted and what effect routine educational supervision has on residents' learning. Our findings suggest that the terminology can be confusing and that educational supervision practices in internal medicine has a weak theoretical foundation.ConclusionThe distinction between educational supervision and other support structures, such as mentoring and feedback, has not been clearly defined in the research literature. We argue that shared terminology is needed to better understand current educational practices and to facilitate clear communication about how to help residents learn.
| S-EPMC10486128 | biostudies-literature