1. 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

2. 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 2 1995 Traditional curriculum 2000 2005 2010 2015 Modular curriculum Reformed curriculum Change of legal frame work Main characteristics: Integrated, modular structure Competency ‐ based Learner ‐ based Patient ‐ based Background

3. 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

4. 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)

5. 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 = 45.47 (SD = 8.19) Work Experience (Years)M = 18.56 (SD =7.6) Teaching Experience (Years)M = 14.29 (SD = 6.2) Medical Specialties12

6. 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

7. 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

8. 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 94.1 3.59 (.8) 2Develop and implement a diagnostic plan88.2 3.29 (.85) 3Interpret diagnostic results and act on them82.4 3.29 (.92) 4Develop and implement a treatment plan76.5 3.12 (.93) 5Provide an oral presentation of a clinical encounter94.1 3.63 (.72) 6Retrieve best evidence for distinct clinical question and the individual patient 58.8 2.82 (.81)

9. 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 88.2 3.59 (.71) 8Perform general procedures of a physician88.2 3.41 (.71) 9Inform, advise and instruct a patient62.5 2.81 (1.05) 10Give or receive a patient handover88.2 3.59 (.71) 11Document a clinical encounter in the patient record76.5 3.18 (.95) 12Recognize an emergency situation and act on it70.6 3.24 (.90) Results: Relevance of EPAs

10. 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

11. 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 58.8 70.6 29.4 9Inform, advise and instruct a patient62.5 58.8 41.2 12Recognize an emergency situation and act on it70.6 29.4 Results: Content Validity Index

12. 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

13. 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 1 10117 Berlin Tel. +49 30 450 576 457 ylva.holzhausen@charite.de

14. 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), 1176-1177. 2.Core entrustable professional´activities for entering residency (CEPAER). Available at https://www.mededportal.org/icollaborative/resource/887

15. 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

16. 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