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2. Milestones and EPAs in the Royal College CBD Model March 27, 2015 Hosted by: Dr. Jolanta Karpinski

3. At the end of this session you will be able to:
Objectives
At the end of this session you will be able to:
Define the terms milestone and Entrustable Professional Activity (EPA)
Describe the application of these concepts within the Competence by Design framework
Describe the application of these concepts within a residency program
Identify some next steps in your use of milestones and EPAs

4. What is Competency-Based Medical Education?
A model to prepare physicians for practice that is:
oriented to outcomes desired in physician;
based on patient needs;
based on the needs of the learner, with more accountability and flexibility; and
focused on achieving skills and performance, instead of time-spent in training.
Adapted from: Frank JR, Snell L, Dath, D, Sherbino, J, Holmboe ES, et al. Competency-based medical education: theory to practice. Med Teacher. 2010;32:

5. Outcomes Based Education
Julio Frenk et al, Lancet 2010; 376 :

6. What is CBD? How Does CanMEDS 2015 Fit?
Competence by Design (CBD) is
Multi-year, transformational change initiative aimed at introducing a competency-based medical education (CBME) model to specialty education;
CanMEDS 2015 is
Foundational project of CBD,
Focused on updating the existing CanMEDS Framework and introducing generic milestones across the continuum
Series IV of the Framework is now available
The final version will be released at ICRE 2015 in October 2015 along with an updated version of the evergreen Milestones Guide

7. Key Concepts in CBD
Stages of physician development
Milestones
Entrustable Professional Activities (EPAs)

9. Definitions
What is a milestone?
A defined, observable marker of an individual's ability along a developmental continuum
What is an Entrustable Professional Activity (EPA)?
An essential task of a "discipline" that an individual can be trusted to perform independently in a given context

10. Abilities within a CanMEDS Role.
Milestones in CBD
A defined, observable marker of an individual’s ability along a developmental continuum.
Generic from CanMEDS 2015.
Abilities within a CanMEDS Role.
Bound to a stage in the progression of physician development.

11. Examples of Generic Milestones: Medical Expert

12. EPAs in CBD
In the setting of residency training.
A Royal College Entrustable Professional Activity (RCEPA) is a responsibility or task in the clinical setting that may be delegated to a resident by their supervisor once sufficient competence has been demonstrated.
Linked to a specified stage of progression.

13. Examples of EPAs In the real world Parallel park In medicine
Run a code
Images via: bing.com

14. Key Concept of EPAs: Entrustment
“What can I safely delegate with indirect supervision?”

15. Question Period

16. Using Milestones and EPAs

17. Abilities expected of a resident at a defined stage of training
Milestones and EPAs
Curriculum
Assessment
Abilities expected of a resident at a defined stage of training
Meaningful, measurable markers of progression of competence

18. Connecting Milestones and EPAs
The key difference between EPAs and milestones is that EPAs are the tasks or activities that must be accomplished, whereas milestones are the abilities of the individual.

19. Examples of an EPA from Medical Oncology
Medical Oncology EPA: the task that must be accomplished
Initial care for urgent and emergent oncologic situations.

20. Examples of Milestones from Medical Oncology
Medical Oncology Milestones: the abilities needed to accomplish the task
Recognize urgent and emergent oncologic issues, including but not limited to, pain crisis, febrile neutropenia, uncontrolled diarrhea, hypocalcemia, epidural cord compression and malignant bowel obstruction.
Select and administer appropriate interventions for urgent and emergent oncologic issues .
Identify the limits of their own expertise and appropriately seek assistance and supervision

21. Connection to CBD Julio Frenk et al, Lancet 2010; 376 :1923-58. EPAs
Milestones
EPAs
Julio Frenk et al, Lancet 2010; 376 :

22. Medical Oncology Example: Milestones and EPA
Milestones which make up the Medical Oncology EPA (abilities needed to accomplish the task)
Recognize urgent and emergent oncologic issues, including but not limited to, pain crisis, febrile neutropenia, uncontrolled diarrhea, hypocalcemia, epidural cord compression and malignant bowel obstruction.
Select and administer appropriate interventions for urgent and emergent oncologic issues.
Identify the limits of their own expertise and appropriately seek assistance and supervision.
Medical Oncology EPA (the task that must be accomplished)
Initial care for urgent and emergent oncologic situations.

23. What is a Milestone?
A milestone is an observable marker of an individual's ability along a developmental continuum.
Milestones are used for planning and teaching

24. What is an EPA?
An Entrustable Professional Activity (EPA) is a task in the clinical setting that may be delegated to a resident by their supervisor once sufficient competence has been demonstrated.
EPAs are used for overall assessment

25. Benefits of Milestones and EPAs
Link clinical activities with learning and assessment,
Clearly defined targets for acquiring competency and meeting standards throughout training,
Better preparation to serve patients and communities, and
Strive towards mastery of skills and abilities beyond training and throughout practice.

26. As a Teacher………
Focus on specific clinical activities with residents at different stages,
Focus on teaching towards specific milestones within a stage, and
Conduct assessments of specific EPAs.

27. Question Period

28. Milestones within Each Stage of Residency

29. Milestones within an EPA
Typically, each EPA integrates multiple milestones.

30. Milestones and EPAs within Four Stages of Residency

31. Problem with an EPA? Unpack the Milestones

32. Progression of Competence

33. Question Period

34. Developing Milestones and EPAs

35. Milestones and EPAs in CBD
With CBD, specialty-specific milestones and EPAs will become part of the standards of training for each specialty and subspecialty
Development of new standards of training will be done by the Specialty Committee including
Determining stages of training for the discipline (duration/focus),
Crafting milestones, and
Developing EPAs.

36. Milestones and EPAs in CBD…
Milestones will make up a Pathway of Competency requirements
Map the expected progress of a resident’s abilities
Link to learning opportunities and educational activities
EPAs will link to required training experiences and assessment strategies

37. CBD Discipline Rollout: Proposed Implementation Plan

38. What Can Individual Programs or Teachers Do Now?
Ensure solid understanding of CBD concepts
Focus on progression of abilities
What do you expect of the resident at this point in training?
Consider some EPAs in your clinical environment
Manage BP in clinic

39. Question Period

40. Your Input Matters
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