Workplace-based Assessment Clinical preceptors are the most important teachers of OHSU medical students, guiding them to prepare for a career as future physicians. Clinical preceptors working alongside students in clinical settings are positioned to teach and assess medical students in the core tasks of being a doctor. Workplace-based Assessment The Core EPAs in Clinical Settings The OHSU Core EPA Team

What are Entrustable Professional Activities (EPAs)? An Entrustable Professional Activity is a “unit of professional practice, defined as tasks or responsibilities to be entrusted to the unsupervised execution by a trainee once he or she has attained sufficient clinical competence.” Olle ten Cate, 2013 The Core EPAs provide a practical framework for making sure our students are prepared to perform core physician tasks without direct oversight on day 1 of residency. Put simply, EPAs are EVERYDAY PHYSICIAN ACTIVITIES These everyday physician activities require COMPETENCE and TRUST for UNSUPERVISED practice

13 Core Entrustable Professional Activities (EPAs) for Entering Residency Groups of medical education experts defined the tasks they felt medical students should be expected to perform on day 1 of residency without direct supervision. These are intuitive, and they are the things you do every day as physician while caring for patients. Some of the tasks are relatively straightforward things like: taking a history and performing a physical exam, entering orders and prescriptions, and presenting a patient

13 Core Entrustable Professional Activities (EPAs) for Entering Residency (cont.) 7. Form clinical questions and retrieve evidence 8. Give or receive a patient handover 9. Collaborate as a member of an interprofessional team 10.Recognize a patient requiring urgent / emergent care; initiate evaluation/mgmt 11. Obtain informed consent 12. Perform general procedures of a physician 13. Identify system failures and contribute to safety and improvement Some tasks are more complex and include activities such as obtaining informed consent and identifying system failures

Workplace-Based Assessments (WBAs) Student-Initiated Supervisor-Completed To better assess these entrustable professional activities, we are asking for your help in providing workplace-based assessment of medical students performing EPAs using an easy to use 2 minute app. The student enters the basic facts about the encounter, then hands you their mobile device to complete the assessment. You indicate how much help the student required to perform a task and then narrate (by dictation or typing) one-two sentences about what the student can do to improve or become more independent.

Demo Screen Shots – Student Section Let’s take a closer look at the student’s role. The student will come to you with an EPA in mind. For example, this student is working on entering orders in your clinical setting. The student finds the preceptor, indicates the clinical setting and the amount of time spent working with the preceptor. The student then hands the mobile device to the preceptor to complete the assessment. We expect WBAs to be completed by many different clinical supervisors including residents and allied health professionals for a fuller picture of the student’s strengths and opportunities to improve.

Workplace-based Assessments Coactivity Scale How much help did the student require to complete this activity? "I did it”  “I talked them through it” “I directed them from time to time” “I was available just in case” WBAs ask you to consider the student’s readiness to complete an EPA. Rather than being asked to rate a student’s abilities, the coactivity scale asks how much help the student needed. After the activity, the learner prompts the preceptor for an assessment and the preceptor describes how much help or supervision was given.

Demo Screen Shots – Preceptor Section This is what the preceptor sees: First, a reminder about the components of the EPA is given; Second, the level of assistance the student required is asked; Third, the preceptor may narrate (either by dictation or typing) one-two sentences about what the student can do to improve or become more independent. Finally, the preceptor indicates whether the encounter was complex and provides a digital signature for verification. Done!

Student who are entrusted to perform a specific EPA will eventually receive a badge as an indicator of their preparedness. The workplace-based assessments will provide valuable data for entrustment, but this decision is made by an oversight committee, not an individual. Although the process will be student-driven, each student has a coach who will assist in guiding the student towards proficiency in the EPAs.

The Core EPAs and Workplace-Based Assessment Students benefit from specific teaching and assessment of the core skills of being a doctor in clinical settings Experience across the country shows that students implement feedback in real time if provided Students can build habits, taking responsibility for their own learning To prepare our students to provide safe and compassionate care without direct supervision on Day 1 of Residency Workplace-based assessments are a quick and easy way to provide timely feedback to students on everyday physician activities, the core skills of being a doctor. By this process, students can take ownership of their own learning and make changes to become more independent based on your immediate feedback. As a clinical preceptor, you have a major and important role in preparing OHSU students to provide safe and compassionate care, and to be residency ready. Thank you.