1. 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

2. We Have No Financial Disclosures or Conflicts of Interest to Report

3. 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

4. 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

5. 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

6. Flash drives on your table contain files you can copy to your laptops
Flash drives on your table contain files you can copy to your laptops

7. 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?

8. EPA Overview

9. 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

10. 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.

11. 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

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

13. EPA  Domain of Competence  Competencies  Milestones

15. 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

16. Entrustment Concepts

17. 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.

18. 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.

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

20. 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

21. 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

22. 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

23. Table Exercises and Discussion

24. 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?

25. 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?

26. 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?

27. 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?

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

29. 43 OHSU Competencies for MD degree
Students will need to be “entrusted” for all 43 in order to graduate
Plus AAMC 13 Core EPAs

32. What information will be used to award the EPA badges?

33. Entrustment Group: Award EPA Badges for Programmatic Entrustment

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

35. 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

36. Thank You!