1. To Entrust or Not to Entrust
To Entrust or Not to Entrust? Defining a Program of Assessment in Undergraduate Medical Education Utilizing the Core EPAs for Entering Residency
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Holly Caretta-Weyer, MD, MHPE(c)
Oregon Health & Science University
Background
Innovation Design
Current Entrustment Committee Workflow
Competency-based medical education is rapidly emerging as the predominant paradigm across the continuum of medical education; however, residency program directors have increasingly expressed concerns that many medical school graduates are not prepared for many of the patient care responsibilities expected of them on day one of residency. While graduate medical education (GME) programs utilize a clinical competency committee to aggregate assessment data and report milestone achievement regarding their residents to the ACGME on a biannual basis in order to track progress toward graduation and independent practice, there is not currently a comparable systematic competency assessment process in undergraduate medical education (UME).
This assessment data is collated in real time into an electronic portfolio (developed de novo for our institution), and produces a display dashboard designed for review by members of the EC. Students, in consultation with their faculty coach, trigger the review for summative entrustment decisions by the EC. Using this program of assessment, we will begin to render formal summative entrustment decisions in Spring 2018.
Review longitudinal Qualified Assessor quantitative and qualitative data re: the 43 UME competencies
Review ad hoc entrustment decisions and qualitative comments for the 13 Core EPAs
Review select narrative assessment comments
Review all professionalism monitoring forms
Review artifacts and evidence submitted by the student in support of entrustment
Review other fan diagram assessments including multi-source or 360-degree assessments
Review in situ observations by the members of the Entrustment Committee
Entrustment Review Schedule
Figure 1. OHSU utilizes both a bottom-up competency assessment approach as well as a top-down global EPA-based approach, which complement one another.
Figure 2. This fan diagram represents the original programmatic assessment construct for the formation of the OHSU UME Entrustment Committee.
First Review: Transition to clinical experiences Second Review: Following completion of 4-6 clinical rotations  Entrustment Review
Third Review: Following completion of core clinical experiences prior to sub-internships
Fourth Review: 6 months prior to anticipated graduation  Entrustment Review
Fifth Review: 1-2 months prior to graduation  Summative Entrustment Decision
Summative Entrustment Process
Create a process to describe and maintain formal entrustment decisions by a trained group of administrators and faculty,
Base entrustment decisions on a longitudinal view of each learner’s performance,
Include day-to-day ad hoc workplace entrustment judgments by clinical supervisors in the body of evidence supporting formal entrustment decisions,
Explicitly measure attributes of learners’ trustworthiness as foundational to all the Core EPAs (in addition to EPA-specific knowledge and skills),
Gather multimodal performance evidence from multiple assessors,
Ensure a process for formative feedback, and
Ensure that each learner is an active participant in entrustment decisions.
Impact/Utility
This assessment data is collated in real time into an electronic portfolio (developed de novo for our institution), and produces a display dashboard designed for review by members of the Entrustment Committee. Students, in consultation with their faculty coach, trigger the review for summative entrustment decisions by the Entrustment Committee similar to the P&T process for faculty.
Figure 4. OHSU is using the Ottawa Coactivity scale for workplace-based assessment and the Chen Supervisory Scale with a target of level 3a for summative entrustment.
Figure 3. Demo of the handheld MedHub application for use in workplace-based assessment of the Core EPAs. This includes coactivity language and narrative feedback.