Entrustable professional activities as a training and assessment framework in undergraduate medical education: A case study of a multi-institutional pilot

John A Encandela; Lynn Shaull; Amy Jayas; Jonathan M Amiel; David R Brown; Vivian T Obeso; Michael S Ryan; Dorothy A Andriole; Core Entrustable Professional Activities for Entering Residency Pilot

doi:10.1080/10872981.2023.2175405

Entrustable professional activities as a training and assessment framework in undergraduate medical education: A case study of a multi-institutional pilot

Med Educ Online. 2023 Dec;28(1):2175405. doi: 10.1080/10872981.2023.2175405.

Authors

John A Encandela¹, Lynn Shaull², Amy Jayas³, Jonathan M Amiel⁴, David R Brown⁵, Vivian T Obeso⁶, Michael S Ryan⁷, Dorothy A Andriole⁸; Core Entrustable Professional Activities for Entering Residency Pilot

Affiliations

¹ Associate Proessor of Psychiatry and Executive Director of the Teaching & Learning Center at the Yale School of Medicine, New Haven, Connecticut.
² Senior Research Specialist at the Association of American Medical Colleges, Washington, DC, USA.
³ Research Analyst at the Association of American Medical Colleges, Washington, DC, USA.
⁴ Professor of Psychiatry and Senior Associate Dean at Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA.
⁵ Professor and Chief of Family and Community Medicine at Florida International University Herbert Wertheim College of Medicine, Miami, FL, USA.
⁶ Associate Professor of Medicine and Associate Dean for Curriculum and Medical Education at Florida International University Herbert Wertheim College of Medicine, Miami, FL, USA.
⁷ , Professor of Pediatrics and Associate Dean for Assessment, Evaluation, Research, Scholarly Innovation in Medical Education at the University of Virginia School of Medicine, Charlottesville, VA, USA.
⁸ Senior Director of Medical Research at the Association of American Medical Colleges, Washington, DC, USA.

Abstract

In 2014, the Association of American Medical Colleges (AAMC) published 13 Core Entrustable Professional Activities (EPAs) that graduating students should be able to perform with indirect supervision when entering residency. A ten-school multi-year pilot was commissioned to test feasibility of implementing training and assessment of the AAMC's 13 Core EPAs. In 2020-21, a case study was employed to describe pilot schools' implementation experiences. Teams from nine of ten schools were interviewed to identify means and contexts of implementing EPAs and lessons learned. Audiotapes were transcribed then coded by investigators using conventional content analysis and a constant comparative method. Coded passages were organized in a database and analyzed for themes. Consensus among school teams regarding facilitators of EPA implementation included team commitment to piloting EPAs; agreement that: proximal EPA adoption with curriculum reform facilitates EPA implementation; EPAs 'naturally fit' in clerkships and provided opportunity for schools to reflect on and adjust curricula and assessments; and inter-school collaboration bolstered individual school progress. Schools did not make high-stakes decisions about student progress (e.g., promotion, graduation), yet EPA assessment results complemented other forms of assessment in providing students with robust formative feedback about their progress. Teams had varied perceptions of school capability to implement an EPA framework, influenced by various levels of dean involvement, willingness, and capability of schools to invest in data systems and provide other resources, strategic deployment of EPAs and assessments, and faculty buy-in. These factors affected varied pace of implementation. Teams agreed on the worthiness of piloting the Core EPAs, but substantial work is still needed to fully employ an EPA framework at the scale of entire classes of students with enough assessments per EPA and with required data validity/reliability. Recommendations stemming from findings may help inform further implementation efforts across other schools adopting or considering an EPA framework.

Keywords: Entrustable Professional Activities; Multi-institution pilot; Readiness for residency; Undergraduate medical education; Work-based assessments.

Publication types

Review

MeSH terms

Clinical Competence
Competency-Based Education
Education, Medical, Undergraduate* / methods
Humans
Internship and Residency*
Multicenter Studies as Topic
Reproducibility of Results
Students, Medical*

Grants and funding

The work was supported by the Association of American Medical Colleges