Longitudinal Assessment of Resident Performance Using Entrustable Professional Activities
Entrustable professional activities (EPAs) are an emerging workplace-based, patient-oriented assessment approach with limited empirical evidence. To measure the development of pediatric trainees' clinical skills over time using EPA-based assessment data. Prospective cohort study of categorical...
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Published in | JAMA network open Vol. 3; no. 1; p. e1919316 |
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Main Authors | , , , , , , , , , , , , , , , , , , |
Format | Journal Article |
Language | English |
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United States
American Medical Association
03.01.2020
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Abstract | Entrustable professional activities (EPAs) are an emerging workplace-based, patient-oriented assessment approach with limited empirical evidence.
To measure the development of pediatric trainees' clinical skills over time using EPA-based assessment data.
Prospective cohort study of categorical pediatric residents over 3 academic years (2015-2016, 2016-2017, and 2017-2018) assessed on 17 American Board of Pediatrics EPAs. Residents in training at 23 pediatric residency programs in the Association of Pediatric Program Directors Longitudinal Educational Assessment Research Network were included. Assessment was conducted by clinical competency committee members, who made summative assessment decisions regarding levels of supervision required for each resident and each EPA. Data were collected from May 2016 to November 2018 and analyzed from November to December 2018.
Longitudinal, prospective assessment using EPAs.
Trajectories of supervision levels by EPA during residency training and how often graduating residents were deemed ready for unsupervised practice in each EPA.
Across the 5 data collection cycles, 1987 residents from all 3 postgraduate years in 23 residency programs were assigned 25 503 supervision level reports for the 17 general pediatrics EPAs. The 4 EPAs that required the most supervision across training were EPA 14 (quality improvement) on the 5-level scale (estimated mean level at graduation, 3.7; 95% CI, 3.6-3.7) and EPAs 8 (transition to adult care; mean, 7.0; 95% CI, 7.0-7.1), 9 (behavioral and mental health; mean, 6.6; 95% CI, 6.5-6.6), and 10 (resuscitate and stabilize; mean, 6.9; 95% CI, 6.8-7.0) on the expanded 5-level scale. At the time of graduation (36 months), the percentage of trainees who were rated at a supervision level corresponding to "unsupervised practice" varied by EPA from 53% to 98%. If performance standards were set to align with 90% of trainees achieving the level of unsupervised practice, this standard would be met for only 8 of the 17 EPAs (although 89% met this standard for EPA 17, performing the common procedures of the general pediatrician).
This study presents initial evidence for empirically derived practice readiness and sets the stage for identifying curricular gaps that contribute to discrepancy between observed practice readiness and standards needed to produce physicians able to meet the health needs of the patient populations they serve. Future work should compare these findings with postgraduation outcomes data as a means of seeking validity evidence. |
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AbstractList | Entrustable professional activities (EPAs) are an emerging workplace-based, patient-oriented assessment approach with limited empirical evidence.
To measure the development of pediatric trainees' clinical skills over time using EPA-based assessment data.
Prospective cohort study of categorical pediatric residents over 3 academic years (2015-2016, 2016-2017, and 2017-2018) assessed on 17 American Board of Pediatrics EPAs. Residents in training at 23 pediatric residency programs in the Association of Pediatric Program Directors Longitudinal Educational Assessment Research Network were included. Assessment was conducted by clinical competency committee members, who made summative assessment decisions regarding levels of supervision required for each resident and each EPA. Data were collected from May 2016 to November 2018 and analyzed from November to December 2018.
Longitudinal, prospective assessment using EPAs.
Trajectories of supervision levels by EPA during residency training and how often graduating residents were deemed ready for unsupervised practice in each EPA.
Across the 5 data collection cycles, 1987 residents from all 3 postgraduate years in 23 residency programs were assigned 25 503 supervision level reports for the 17 general pediatrics EPAs. The 4 EPAs that required the most supervision across training were EPA 14 (quality improvement) on the 5-level scale (estimated mean level at graduation, 3.7; 95% CI, 3.6-3.7) and EPAs 8 (transition to adult care; mean, 7.0; 95% CI, 7.0-7.1), 9 (behavioral and mental health; mean, 6.6; 95% CI, 6.5-6.6), and 10 (resuscitate and stabilize; mean, 6.9; 95% CI, 6.8-7.0) on the expanded 5-level scale. At the time of graduation (36 months), the percentage of trainees who were rated at a supervision level corresponding to "unsupervised practice" varied by EPA from 53% to 98%. If performance standards were set to align with 90% of trainees achieving the level of unsupervised practice, this standard would be met for only 8 of the 17 EPAs (although 89% met this standard for EPA 17, performing the common procedures of the general pediatrician).
This study presents initial evidence for empirically derived practice readiness and sets the stage for identifying curricular gaps that contribute to discrepancy between observed practice readiness and standards needed to produce physicians able to meet the health needs of the patient populations they serve. Future work should compare these findings with postgraduation outcomes data as a means of seeking validity evidence. This cohort study measures the development of pediatric resident clinical skills using assessments based on entrustable professional activities. Importance Entrustable professional activities (EPAs) are an emerging workplace-based, patient-oriented assessment approach with limited empirical evidence. Objective To measure the development of pediatric trainees’ clinical skills over time using EPA-based assessment data. Design, Setting, and Participants Prospective cohort study of categorical pediatric residents over 3 academic years (2015-2016, 2016-2017, and 2017-2018) assessed on 17 American Board of Pediatrics EPAs. Residents in training at 23 pediatric residency programs in the Association of Pediatric Program Directors Longitudinal Educational Assessment Research Network were included. Assessment was conducted by clinical competency committee members, who made summative assessment decisions regarding levels of supervision required for each resident and each EPA. Data were collected from May 2016 to November 2018 and analyzed from November to December 2018. Interventions Longitudinal, prospective assessment using EPAs. Main Outcomes and Measures Trajectories of supervision levels by EPA during residency training and how often graduating residents were deemed ready for unsupervised practice in each EPA. Results Across the 5 data collection cycles, 1987 residents from all 3 postgraduate years in 23 residency programs were assigned 25 503 supervision level reports for the 17 general pediatrics EPAs. The 4 EPAs that required the most supervision across training were EPA 14 (quality improvement) on the 5-level scale (estimated mean level at graduation, 3.7; 95% CI, 3.6-3.7) and EPAs 8 (transition to adult care; mean, 7.0; 95% CI, 7.0-7.1), 9 (behavioral and mental health; mean, 6.6; 95% CI, 6.5-6.6), and 10 (resuscitate and stabilize; mean, 6.9; 95% CI, 6.8-7.0) on the expanded 5-level scale. At the time of graduation (36 months), the percentage of trainees who were rated at a supervision level corresponding to “unsupervised practice” varied by EPA from 53% to 98%. If performance standards were set to align with 90% of trainees achieving the level of unsupervised practice, this standard would be met for only 8 of the 17 EPAs (although 89% met this standard for EPA 17, performing the common procedures of the general pediatrician). Conclusions and Relevance This study presents initial evidence for empirically derived practice readiness and sets the stage for identifying curricular gaps that contribute to discrepancy between observed practice readiness and standards needed to produce physicians able to meet the health needs of the patient populations they serve. Future work should compare these findings with postgraduation outcomes data as a means of seeking validity evidence. ImportanceEntrustable professional activities (EPAs) are an emerging workplace-based, patient-oriented assessment approach with limited empirical evidence. ObjectiveTo measure the development of pediatric trainees' clinical skills over time using EPA-based assessment data. Design, Setting, and ParticipantsProspective cohort study of categorical pediatric residents over 3 academic years (2015-2016, 2016-2017, and 2017-2018) assessed on 17 American Board of Pediatrics EPAs. Residents in training at 23 pediatric residency programs in the Association of Pediatric Program Directors Longitudinal Educational Assessment Research Network were included. Assessment was conducted by clinical competency committee members, who made summative assessment decisions regarding levels of supervision required for each resident and each EPA. Data were collected from May 2016 to November 2018 and analyzed from November to December 2018. InterventionsLongitudinal, prospective assessment using EPAs. Main Outcomes and MeasuresTrajectories of supervision levels by EPA during residency training and how often graduating residents were deemed ready for unsupervised practice in each EPA. ResultsAcross the 5 data collection cycles, 1987 residents from all 3 postgraduate years in 23 residency programs were assigned 25 503 supervision level reports for the 17 general pediatrics EPAs. The 4 EPAs that required the most supervision across training were EPA 14 (quality improvement) on the 5-level scale (estimated mean level at graduation, 3.7; 95% CI, 3.6-3.7) and EPAs 8 (transition to adult care; mean, 7.0; 95% CI, 7.0-7.1), 9 (behavioral and mental health; mean, 6.6; 95% CI, 6.5-6.6), and 10 (resuscitate and stabilize; mean, 6.9; 95% CI, 6.8-7.0) on the expanded 5-level scale. At the time of graduation (36 months), the percentage of trainees who were rated at a supervision level corresponding to "unsupervised practice" varied by EPA from 53% to 98%. If performance standards were set to align with 90% of trainees achieving the level of unsupervised practice, this standard would be met for only 8 of the 17 EPAs (although 89% met this standard for EPA 17, performing the common procedures of the general pediatrician). Conclusions and RelevanceThis study presents initial evidence for empirically derived practice readiness and sets the stage for identifying curricular gaps that contribute to discrepancy between observed practice readiness and standards needed to produce physicians able to meet the health needs of the patient populations they serve. Future work should compare these findings with postgraduation outcomes data as a means of seeking validity evidence. |
Author | West, Daniel C Newhall, Lauren Tolentino, Jonathan Griego, Elena C Gifford, Kimberly Herman, Bruce E Hemond, Joni Carraccio, Carol Englander, Robert Hudson, Valera Famiglietti, Hannah Turner, Teri Schwartz, Alan Li, Su-Ting Schumacher, Daniel J Millstein, Leah McNeal Trice, Kenya Baughn, Julie Giudice, Erin |
AuthorAffiliation | 1 Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 21 American Board of Pediatrics, Chapel Hill, North Carolina 16 Department of Pediatrics, Mayo Medical School, Rochester, Minnesota 17 Department of Pediatrics, New York University, New York 6 Association of Pediatric Program Directors Longitudinal Educational Assessment Research Network, McLean, Virginia 11 Department of Pediatrics, Texas Children’s Hospital/Baylor College of Medicine, Houston 5 Department of Medical Education, University of Illinois at Chicago 8 Department of Pediatrics at the University of California Davis Health, Sacramento 14 Department of Pediatrics, Children’s Hospital of Georgia/Augusta University, Augusta 9 Department of Pediatrics, University of Maryland School of Medicine, Baltimore 15 Department of Pediatrics, University of North Carolina, Chapel Hill 3 Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania 12 Department of Pediatrics, Universi |
AuthorAffiliation_xml | – name: 16 Department of Pediatrics, Mayo Medical School, Rochester, Minnesota – name: 5 Department of Medical Education, University of Illinois at Chicago – name: 4 Department of Pediatrics, University of Pennsylvania, Philadelphia – name: 10 Department of Pediatrics, Seattle Children’s Hospital, Seattle, Washington – name: 13 Department of Pediatrics, University of Minnesota Medical School, Minneapolis – name: 17 Department of Pediatrics, New York University, New York – name: 11 Department of Pediatrics, Texas Children’s Hospital/Baylor College of Medicine, Houston – name: 21 American Board of Pediatrics, Chapel Hill, North Carolina – name: 18 Department of Pediatrics, Stony Brook University, Stony Brook, New York – name: 20 Department of Pediatrics, Dartmouth University, Lebanon, New Hampshire – name: 7 Department of Pediatrics, University of Illinois at Chicago – name: 8 Department of Pediatrics at the University of California Davis Health, Sacramento – name: 2 University of Cincinnati College of Medicine, Cincinnati, Ohio – name: 6 Association of Pediatric Program Directors Longitudinal Educational Assessment Research Network, McLean, Virginia – name: 12 Department of Pediatrics, University of Utah, Salt Lake City – name: 15 Department of Pediatrics, University of North Carolina, Chapel Hill – name: 1 Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio – name: 19 Department of Internal Medicine, Stony Brook University, Stony Brook, New York – name: 3 Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania – name: 14 Department of Pediatrics, Children’s Hospital of Georgia/Augusta University, Augusta – name: 9 Department of Pediatrics, University of Maryland School of Medicine, Baltimore |
Author_xml | – sequence: 1 givenname: Daniel J surname: Schumacher fullname: Schumacher, Daniel J organization: University of Cincinnati College of Medicine, Cincinnati, Ohio – sequence: 2 givenname: Daniel C surname: West fullname: West, Daniel C organization: Department of Pediatrics, University of Pennsylvania, Philadelphia – sequence: 3 givenname: Alan surname: Schwartz fullname: Schwartz, Alan organization: Department of Pediatrics, University of Illinois at Chicago – sequence: 4 givenname: Su-Ting surname: Li fullname: Li, Su-Ting organization: Department of Pediatrics at the University of California Davis Health, Sacramento – sequence: 5 givenname: Leah surname: Millstein fullname: Millstein, Leah organization: Department of Pediatrics, University of Maryland School of Medicine, Baltimore – sequence: 6 givenname: Elena C surname: Griego fullname: Griego, Elena C organization: Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington – sequence: 7 givenname: Teri surname: Turner fullname: Turner, Teri organization: Department of Pediatrics, Texas Children's Hospital/Baylor College of Medicine, Houston – sequence: 8 givenname: Bruce E surname: Herman fullname: Herman, Bruce E organization: Department of Pediatrics, University of Utah, Salt Lake City – sequence: 9 givenname: Robert surname: Englander fullname: Englander, Robert organization: Department of Pediatrics, University of Minnesota Medical School, Minneapolis – sequence: 10 givenname: Joni surname: Hemond fullname: Hemond, Joni organization: Department of Pediatrics, University of Utah, Salt Lake City – sequence: 11 givenname: Valera surname: Hudson fullname: Hudson, Valera organization: Department of Pediatrics, Children's Hospital of Georgia/Augusta University, Augusta – sequence: 12 givenname: Lauren surname: Newhall fullname: Newhall, Lauren organization: Department of Pediatrics, Children's Hospital of Georgia/Augusta University, Augusta – sequence: 13 givenname: Kenya surname: McNeal Trice fullname: McNeal Trice, Kenya organization: Department of Pediatrics, University of North Carolina, Chapel Hill – sequence: 14 givenname: Julie surname: Baughn fullname: Baughn, Julie organization: Department of Pediatrics, Mayo Medical School, Rochester, Minnesota – sequence: 15 givenname: Erin surname: Giudice fullname: Giudice, Erin organization: Department of Pediatrics, University of Maryland School of Medicine, Baltimore – sequence: 16 givenname: Hannah surname: Famiglietti fullname: Famiglietti, Hannah organization: Department of Pediatrics, New York University, New York – sequence: 17 givenname: Jonathan surname: Tolentino fullname: Tolentino, Jonathan organization: Department of Internal Medicine, Stony Brook University, Stony Brook, New York – sequence: 18 givenname: Kimberly surname: Gifford fullname: Gifford, Kimberly organization: Department of Pediatrics, Dartmouth University, Lebanon, New Hampshire – sequence: 19 givenname: Carol surname: Carraccio fullname: Carraccio, Carol organization: American Board of Pediatrics, Chapel Hill, North Carolina |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/31940042$$D View this record in MEDLINE/PubMed |
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Snippet | Entrustable professional activities (EPAs) are an emerging workplace-based, patient-oriented assessment approach with limited empirical evidence.
To measure... Importance Entrustable professional activities (EPAs) are an emerging workplace-based, patient-oriented assessment approach with limited empirical evidence.... ImportanceEntrustable professional activities (EPAs) are an emerging workplace-based, patient-oriented assessment approach with limited empirical evidence.... This cohort study measures the development of pediatric resident clinical skills using assessments based on entrustable professional activities. |
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SubjectTerms | Medical Education Online Only Original Investigation Pediatrics Supervision |
Title | Longitudinal Assessment of Resident Performance Using Entrustable Professional Activities |
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