Development of Entrustable Professional Activities (EPAs) for Public Health and Preventive Medicine (PHPM) PHPC CPD Event - May 24, 2015 Kieran Moore MD, CCFP(EM), FCFP, MPH, DTM&H, FRCPC Program Director, Queen’s University Brent Moloughney, MD, MSc, FRCPC Public Health Consultant

Conflict of Interest Disclaimer No relationship with commercial entities such as:  Pharmaceutical organization  Medical device company  Communications firm 2

Acknowledgements PHPM Program Directors across Canada Participants at Queen’s Workshop (March 2015) 3

Overview What are EPAs? Why EPAs? Approach to development Current status Next steps 4

Entrustable Professional Activities (EPAs) Capture the work that is central/critical to a specialty - in aggregate, represent the essential professional work that defines a discipline. Link competencies/milestones to practice in an integrated/holistic manner Be more explicit about assessing and documenting performance of specific activities/tasks Support graded supervision – entrust the activity to a trainee to execute once obtained adequate competence Being pursued by multiple disciplines around the world 5

CBME Increasing shift to competency-based medical education (CBME) – Explicit competencies to be acquired – Stages of competence development defined by achievement of competency-based milestones – More frequent, direct observation to evaluate Detailed lists of competencies to be acquired (Objectives of Training) – Provide clarity of what is expected – But, Potentially overwhelming for residents and faculty Competence requires integration of competencies 6

Objectives of Training – Analytic Approach ten Cate. ICRE

EPAs - Synthetic Approach ten Cate. ICRE

9 Royal College CanMEDS 2015

Royal College: EPAs and Milestones RC intends to use milestones and EPAs to redesign specialist training and assessment – Milestone is observable marker of an individual's ability along a developmental continuum – EPA is the task that must be accomplished - each EPA integrates multiple milestones Vision for application: – Use milestones to design educational activities and teach specific abilities, skills and attitudes – Assess overall achievement of various milestones using an EPA 10 publications/dialogue/vol15_2/epa_milestones

11 EPAs are the tasks that must be accomplished, whereas milestones are the abilities of the individual

Example* EPA: Manage an infectious disease outbreak Milestones (examples) – Transition to discipline (post-MD clinical) Elicit relevant information for a suspect reportable disease – Foundations (coursework) Describe steps in an outbreak investigation – Core (early rotations) Assume under direct supervision a support role (e.g., case finding plan; generate case definition; etc.) – Transition to practice (late rotation) Assume under minimal supervision the lead role (e.g., declare outbreak; organize team; plan/implement investigation; etc.) 12 *Calgary EPA Curriculum

Initiative Goal Establish a national core set of PHPM EPAs with corresponding milestones that are supported by case-based learning scenarios and simulations. 13

Path to PHPM EPAs 14

PHPM EPAs – draft v1 15

‘Optional’ EPAs Diversity of PHPM practice that extends beyond formal government-mandated public health institutions These career paths while mentioned in introduction to Objectives of Training, not directly addressed in the competencies or core EPAs Strong interest expressed by Program Directors to develop one or more optional EPAs, e.g., – PHPM-oriented clinical practice – Broader health system leadership/stewardship 16

Next Steps 17

Further Information PHPM EPA development resources: pm/competency_by_design_initiative/resources pm/competency_by_design_initiative/resources Kieran Moore: Brent Moloughney: 18