U N I V E R S I T Ä T S M E D I Z I N B E R L I N Identifying EPAs for Undergraduate Medical Education Y Holzhausen, A Maaz, A Degel, H Peters Charité Universitätsmedizin Berlin Dieter Scheffner Center for Medical Teaching and Educational Research AMEE 2014

U N I V E R S I T Ä T S M E D I Z I N B E R L I N Traditional curriculum Modular curriculum Reformed curriculum Change of legal frame work Main characteristics: Integrated, modular structure Competency ‐ based Learner ‐ based Patient ‐ based Background

U N I V E R S I T Ä T S M E D I Z I N B E R L I N 3 EPAs (ten Cate, 2005) Widely applied in postgraduate medical education Trend to apply it in undergraduate medical education  AAMC: 13 Core Entrustable Professional Activities for Entering Residency (2014) Background

U N I V E R S I T Ä T S M E D I Z I N B E R L I N 4 Goal of Delphi Study Define Core EPAs for Entering Residency  Outcomes for the modular curriculum Charité Objectives (Association of American Medical Colleges, 2013)

U N I V E R S I T Ä T S M E D I Z I N B E R L I N 5 Participants (n= 46) Physicians of varying medical specialties (25) Experts in curricular planning Round 1 (August 2014) Sample n17 ( 37%) Gender♂ = 65% AgeM = (SD = 8.19) Work Experience (Years)M = (SD =7.6) Teaching Experience (Years)M = (SD = 6.2) Medical Specialties12

U N I V E R S I T Ä T S M E D I Z I N B E R L I N 6 1.Gather a history and perform a physical examination and generate a list of problems 2.Develop and implement a diagnostic plan 3.Interpret diagnostic results and act on them 4.Develop and implement a treatment plan 5.Provide an oral presentation of a clinical encounter 6.Retrieve best evidence for distinct clinical question and the individual patient 7.Obtain informed consent for tests and/or procedures 8.Perform general procedures of a physician 9.Inform, advise and instruct a patient 10.Give or receive a patient handover 11.Document a clinical encounter in the patient record 12.Recognize an emergency situation and act on it List of EPAs

U N I V E R S I T Ä T S M E D I Z I N B E R L I N 7 ItemResponse Relevance of EPA Clarity of title Completeness of description 4-point likert scale (disagree- agree) Acceptance of title Acceptance of description Accept / Change / Complement Difficulty of EPAHigh / Appropriate / Low Additional EPAs Free text Questionnaire

U N I V E R S I T Ä T S M E D I Z I N B E R L I N 8 Results: Relevance of EPAs EPA CVI Rating (Relevance) Mean (SD) 1 Gather a history and perform a physical examination and generate a list of problems (.8) 2Develop and implement a diagnostic plan (.85) 3Interpret diagnostic results and act on them (.92) 4Develop and implement a treatment plan (.93) 5Provide an oral presentation of a clinical encounter (.72) 6Retrieve best evidence for distinct clinical question and the individual patient (.81)

U N I V E R S I T Ä T S M E D I Z I N B E R L I N 9 EPA CVI Rating (Relevance) Mean (SD) 7 Obtain informed consent for tests and/or procedures (.71) 8Perform general procedures of a physician (.71) 9Inform, advise and instruct a patient (1.05) 10Give or receive a patient handover (.71) 11Document a clinical encounter in the patient record (.95) 12Recognize an emergency situation and act on it (.90) Results: Relevance of EPAs

U N I V E R S I T Ä T S M E D I Z I N B E R L I N 10 Results: Difficulty of EPAs

U N I V E R S I T Ä T S M E D I Z I N B E R L I N 11 EPA CVI Rating (Relevance) Difficulty 6 Retrieve best evidence for distinct clinical question and the individual patient Inform, advise and instruct a patient Recognize an emergency situation and act on it Results: Content Validity Index

U N I V E R S I T Ä T S M E D I Z I N B E R L I N 12 Interaction between curriculum experts and faculty members Consequences for the modular curriculum at the Charité Overlap with other EPAs Validation of international EPAs for undergraduate medical education Key Points

U N I V E R S I T Ä T S M E D I Z I N B E R L I N 13 Thank you for your attention Ylva Holzhausen Charité - Universitätsmedizin Berlin Dieter Scheffner Center for Medical Teaching and Educational Research Charitéplatz Berlin Tel

U N I V E R S I T Ä T S M E D I Z I N B E R L I N 14 References 1.ten Cate, O. (2005). Entrustability of professional activities and competency- based training. Medical Education, 39(12), Core entrustable professional´activities for entering residency (CEPAER). Available at

U N I V E R S I T Ä T S M E D I Z I N B E R L I N 15 NeurologyIntensive Care PsychiatryAudiology Psychosomatic MedicineDermatology CardiologyOtolaryngology EndocrinologyGeneral Medicine Geriatric MedicineSurgery NephrologyOncology RheumatologyObstetrics UrologyPediatrics AnesthesiologyNeonatology PoliclinicGynecology Emergency Medical Aid List of Medical Specialties

U N I V E R S I T Ä T S M E D I Z I N B E R L I N 16 Title Gather a history and perform a physical examination and generate a list of problems DescriptionIn the first days of residency, the resident is able to gather a history and to perform a physical examination of an adult patient with a typical presentation and/or a common disease. Following the encounter, the resident is able to generate a structured list of problems. This applies for both the inpatient and outpatient sector. It is expected that the professional activity is executed in a complete and focused fashion and is adapted to the situational requirements. This also includes the searching for typical complaints and signs of relevant illnesses and health problems (differential diagnosis on a patient). The results are expected to be presented by means of a structured summary and list of problems to the supervising physician (main complaints, additional complaints diagnosis and problems). This EPA applies to common diseases/health problems and their typical presentations. This EPA does not apply to: 1)Newborns, babies, children, adolescents and pregnant women; 2) No interdisciplinary diseases/health problems Example of EPA