From Words to Action: Introduction of Core EPA Toolkits AAMC WGEA SLC, Utah February 27, 2017 Tracy Bumsted, MD, MPH Associate Professor, Pediatrics Associate Dean, UME Tomo Ito, MS.Ed Administrative Manager, Curriculum & Student Affairs

We Have No Financial Disclosures or Conflicts of Interest to Report

Objectives By the end of today’s workshop, you will be able to: Describe the key elements of the Core EPA toolkits Provide examples of how the toolkits can be used for learner education and assessment, faculty development, and entrustment decision-making Discuss opportunities for EPA implementation within unique institutional contexts

We Present On Behalf of the Members of the AAMC Core EPA Pilot Tracy Bumsted, MD, MPH, FAAP Associate Professor, Pediatrics Associate Dean, Undergraduate Medical Education Tomo Ito, M.S.Ed Administrative Manager, Curriculum and Student Affairs

Institution Members of the AAMC Core EPA Pilot Columbia University College of Physicians and Surgeons Florida International University Herbert Wertheim College of Medicine 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 University of Texas Health Sciences Center at Houston Vanderbilt University School of Medicine Virginia Commonwealth University School of Medicine Yale School of Medicine

Flash drives on your table contain files you can copy to your laptops https://www.aamc.org/initiatives/coreepas Flash drives on your table contain files you can copy to your laptops

Timeline for 90 Minute Workshop Brief Introductions – Name, Position, Institution Overview: EPAs and Core EPA Pilot Entrustment Concepts Rollout of Core EPA Pilot Toolkits – 1st “public” viewing! Table exercises and discussion – EPA toolkits 1, 6, 9 Large group discussion : Using the toolkits within your unique institutional contexts Direct Teaching, Assessment, Faculty/Resident Development, Entrustment Decision-Making Wrap-Up: How can the Pilot best help you?

EPA Overview

First, A Few Definitions Entrustable Professional Activities: Units of professional practice, defined as tasks or responsibilities that trainees are entrusted to perform unsupervised once they have attained sufficient specific competence. Competency: An observable ability of a health professional, integrating multiple components such as knowledge, skills, values, and attitudes. Milestones: A behavioral descriptor that marks a level of performance for a given competency

Charge to Core EPA Drafting Panel To delineate those activities that all entering residents should be expected to perform on day 1 of residency without direct supervision, regardless of specialty. Direct Supervision: The supervising physician is physically present with the learner and the patient. Indirect Supervision (2 levels): Direct Supervision Immediately Available – supervising physician is physically within the hospital [or care site] and is immediately available to provide direct supervision. Direct Supervision Available – supervising physician is not physically present…but is immediately available by telephone/electronic modalities and is able to provide direct supervision.

ENTRUSTABLE Professional Activities Entrustment refers to the ability to effectively perform a professional activity unsupervised. Brings trust and supervision into assessment which are intuitive for faculty working with trainees. Entrustment decisions allows inference about a learner’s competence. Slide courtesy of Robert Englander, MD

See the “Purple Book” (Core EPAs for Entering Residency Curriculum Developers’ Guide)

EPA  Domain of Competence  Competencies  Milestones

EPAs are intuitive Example: Hosting a Dinner Party (Medical) Knowledge (Patient) Care and Procedures Interpersonal Communication Professionalism Systems-Based Practice Practice-Based Learning and Improvement

Entrustment Concepts

Elements of Entrustment Based largely on the work of Tara J. Kennedy, MD, MEd Supervisor’s assessment of a trainee’s trustworthiness for independent clinical work takes into consideration four dimensions: Knowledge, Skills, Values, Attitudes – Competency Discernment – knowing your limits Truthfulness - truth telling, absence of deception Conscientiousness – doing what is right, principled Kennedy et al, Acad Med 2008;83(10Suppl):S89-92.

Rollout of Core EPA Toolkits 1, 6, 9 First “public viewing” of Toolkits! THESE ARE DRAFTS Remaining 10 toolkits are in final stages of drafting, and are coming soon.

Purpose of Core EPA Toolkits To create an accessible format that can support: Faculty development Learner development Design of curricular and assessment tools

Background of Core EPA Toolkits One page schematics created by EPA teams Teams determined most important “key functions” Students will be able to see what behavior is expected, developmental journey to entrustment Faculty can better diagnose the specific problem for any given learner Toolkits help create curricula and tools for assessment

Background of Core EPA Toolkits In GME, concept of supervision is well-established: In the room Outside the room From home We are still struggling in UME to determine the supervision scale to use

Background of Core EPA Toolkits All Core EPA toolkits have: User guide One page schematic Supervisory scale – TBD Appendix 1 – related resources from AAMC, literature Tools listed support assessment of the EPA Appendix 2 – behaviors and vignettes from the purple book

Table Exercises and Discussion

Table Exercises and Discussion For the EPA toolkit at your table, pick one aspect to discuss with 2-3 members at the table: Direct teaching Assessment Faculty/Resident Development Entrustment Decision-Making Then, one person from each aspect will report out to large group: Opportunities and challenges posed by the construct Answering the Question: How might you use the toolkit at your institution?

EPA 1 Toolkit Gather a history & perform a physical exam Direct teaching Assessment Faculty/Resident Development Entrustment Decision-Making One person from each aspect reports out to large group: Opportunities and challenges posed by the construct Answering the Question: How might you use the toolkit at your institution?

EPA 6 Toolkit Provide an oral presentation of a clinical encounter Direct teaching Assessment Faculty/Resident Development Entrustment Decision-Making One person from each aspect reports out to large group: Opportunities and challenges posed by the construct Answering the Question: How might you use the toolkit at your institution?

EPA 9 Toolkit Collaborate as a member of an interprofessional team Direct teaching Assessment Faculty/Resident Development Entrustment Decision-Making One person from each aspect reports out to large group: Opportunities and challenges posed by the construct Answering the Question: How might you use the toolkit at your institution?

How OHSU is Thinking About Implementing EPAs (Still a Work in Progress

43 OHSU Competencies for MD degree Students will need to be “entrusted” for all 43 in order to graduate Plus AAMC 13 Core EPAs

What information will be used to award the EPA badges?

Entrustment Group: Award EPA Badges for Programmatic Entrustment

Wrap-Up: How Can the AAMC Core EPA Pilot Best Help You?

Objectives By the end of today’s workshop, you will be able to: Describe the key elements of the Core EPA toolkits Provide examples of how the toolkits can be used for learner education and assessment, faculty development, and entrustment decision-making Discuss opportunities for EPA implementation within unique institutional contexts

Thank You!