Twelve tips to develop entrustable professional activities.

Entrustable professional activities (EPAs), units of professional practice that require proficient integration of multiple competencies and can be entrusted to a sufficiently competent learner, are increasingly being used to define and inform curricula of health care professionals. The process of developing EPAs can be challenging and requires a deep yet pragmatic understanding of the concepts underlying EPA construction. Based on recent literature and the authors' lessons learned, this article provides the following practical and more or less sequential recommendations for developing EPAs: [1] Assemble a core team; [2] Build up expertise; [3] Establish a shared understanding of the purpose of EPAs; [4] Draft preliminary EPAs; [5] Elaborate EPAs; [6] Adopt a framework of supervision; [7] Perform a structured quality check; [8] Use a Delphi approach for refinement and/or consensus; [9] Pilot test EPAs; [10] Attune EPAs to their feasibility in assessment; [11] Map EPAs to existing curriculum; [12] Build a revision plan.

Entrustable professional activities (EPAs) for teachers in medical education: Has the time come?

On a daily basis, patients put their trust in the healthcare system for safe and high-quality healthcare. However, what evidence do we have as an educational community that our supervising faculty members are competent to fulfill this responsibility? Few, if any, requirements exist for faculty members to have continuous professional development in the field of medical education. Many faculty "love to teach", however, this love of teaching does not make them competent to teach or assess the competence of trainees whom they supervise. Faculty members who have a significant role as a teacher in the clinical setting should be assessed with regards to their baseline competence in applicable teaching EPAs. When competence is reached, an entrustment decision can be made. Once proficient or expert, a statement of awarded responsibility (STAR) may be granted. The time has come to reach beyond the "standards" of the old adage "see one, do one, teach one" in medical education. In this personal view, the authors outline an argument for and list the potential benefits for teachers, learners, and patients when we assess clinical teachers using EPAs within a competency-based medical education framework.

A case for competency-based anaesthesiology training with entrustable professional activities: an agenda for development and research.

Competency frameworks are based on what are considered to be the general essential qualities of a doctor. Competencies, being behavioural descriptors, need a strong link to clinical practice to allow trainers to observe and then use them in assessing trainees' performance. The emerging concept of entrustable professional activities (EPAs) may serve as such a link. An EPA is a description of an essential clinical task that frames competencies in the context of clinical practice. A full set of EPAs defines a specialty and constitutes the curriculum of specialty training. After observation of satisfactory performance on an EPA, the resident should be permitted to perform that activity without direct supervision. The terms of this should allow a trainer to provide justification for this decision. This makes graded assumption of responsibilities possible. We describe the potential benefits of working with EPAs in anaesthesiology training and set an agenda for curriculum development and research in this area.

Building a competency-based workplace curriculum around entrustable professional activities: The case of physician assistant training.

BACKGROUND AND AIM: Competency-based medical education (CBME) is increasingly dominating clinical training, but also poses questions as to its practical implementation. There is a need for practical guidelines to translate CBME to the clinical work floor. This article aims to provide a practical model, based on the concept of entrustable professional activities (EPAs) to make this translation, derived from curriculum building for physician assistants (PAs). METHOD: For the training of PAs at the Utrecht University of Applied Sciences, a three-step model was developed to guide competency-based curriculum development, teaching and assessment. It includes specific guidelines for the identification, systematic description and planning of EPAs. RESULTS: The EPA concept appeared to be a useful tool to build competency-based clinical workplace curricula. Implementation of the curriculum requires use of trainee portfolios and progress interviews, statements of rewarded responsibility and training of supervisors. The individualised approach and flexibility that true CBME implies is brought into practice with this model. DISCUSSION: The model may also be transferred to other domains of clinical training, among which postgraduate training for medical specialties.

ADEA-ADEE Shaping the Future of Dental Education III: Assessment in competency-based dental education: Ways forward.

Assessment in competency-based dental education continues to be a recognized area for growth and development within dental programs around the world. At the joint American Dental Education Association (ADEA) and the Association for Dental Education in Europe (ADEE) 2019 conference, Shaping the Future of Dental Education III, the workshop on assessment was designed to continue the discussion started in 2017 at the ADEA-ADEE Shaping the Future of Dental Education II.1 The focus of the 2019 conference involved examining the potential of entrustable professional activities (EPAs) and current thinking about workplace-based assessment (WBA) within competency-based education in the 21st century. Approximately 30 years ago, George Miller wrote about the assessment of competence in medical education and challenged faculty to reach for higher levels of assessment than knowledge or skill.2 Acknowledging that no one assessment method can result in a valid assessment of competence, Miller proposed a four-level framework for assessment. The lowest level involves measuring what students know ("knows"), followed by assessment of the skill with which knowledge is applied in relevant tasks or problems ("knows how"). Next is an assessment of task performance in standardized settings ("shows how"), and finally, the highest level assesses the student's performance in the unstandardized clinical workplace ("does"). The 2019 assessment workshop focused on advances in the assessment of learners in the unstandardized workplace-the highest level of Miller's assessment pyramid ("does"). Research has shown that dental education has struggled to implement assessment strategies that meet this level.3 The workshop brought together individuals from around the world, with an interest in assessment in dental education, to consider how assessment in the "does" level, specifically EPAs and WBA, factors into competence assessment in dentistry/dental education.

The Power of Subjectivity in the Assessment of Medical Trainees.

Objectivity in the assessment of students and trainees has been a hallmark of quality since the introduction of multiple-choice items in the 1960s. In medical education, this has extended to the structured examination of clinical skills and workplace-based assessment. Competency-based medical education, a pervasive movement that started roughly around the turn of the century, similarly calls for rigorous, objective assessment to ensure that all medical trainees meet standards to assure quality of health care. At the same time, measures of objectivity, such as reliability, have consistently shown disappointing results. This raises questions about the extent to which objectivity in such assessments can be ensured.In fact, the legitimacy of "objective" assessment of individual trainees, particularly in the clinical workplace, may be questioned. Workplaces are highly dynamic and ratings by observers are inherently subjective, as they are based on expert judgment, and experts do not always agree-for good, idiosyncratic, reasons. Thus, efforts to "objectify" these assessments may be problematically distorting the assessment process itself. In addition, "competence" must meet standards, but it is also context dependent.Educators are now arriving at the insight that subjective expert judgments by medical professionals are not only unavoidable but actually should be embraced as the core of assessment of medical trainees. This paper elaborates on the case for subjectivity in assessment.

Strategies for continuing professional development among younger, middle-aged, and older nurses: a biographical approach.

BACKGROUND: A nursing career can last for more than 40 years, during which continuing professional development is essential. Nurses participate in a variety of learning activities that correspond with their developmental motives. Lifespan psychology shows that work-related motives change with age, leading to the expectation that motives for continuing professional development also change. Nevertheless, little is known about nurses' continuing professional development strategies in different age groups. OBJECTIVES: To explore continuing professional development strategies among younger, middle-aged, and older nurses. METHODS: A qualitative study using semi-structured interviews, from a biographical perspective. Data were analysed using a vertical process aimed at creating individual learning biographies, and a horizontal process directed at discovering differences and similarities between age groups. PARTICIPANTS: Twenty-one nurses in three age groups from general and academic hospitals in the Netherlands. RESULTS: In all age groups, daily work was an important trigger for professional development on the ward. Performing extra or new tasks appeared to be an additional trigger for undertaking learning activities external to the ward. Learning experiences in nurses' private lives also contributed to their continuing professional development. Besides these similarities, the data revealed differences in career stages and private lives, which appeared to be related to differences in continuing professional development strategy; 'gaining experience and building a career' held particularly true among younger nurses, 'work-life balance' and 'keeping work interesting and varied' to middle-aged nurses, and 'consistency at work' to older nurses. CONCLUSIONS: Professional development strategies can aim at performing daily patient care, extra tasks and other roles. Age differences in these strategies appear to relate to tenure, perspectives on the future, and situations at home. These insights could help hospitals to orientate continuing professional development approaches toward the needs of all age groups. This should be particularly relevant in the face of present demographic changes in the nursing workforce.

Essential facets of competence that enable trust in medical graduates: a ranking study among physician educators in two countries.

One way to operationalize the assessment of trainees in a competency-based context is to determine whether they can be entrusted with critical activities. To determine which facets of competence (FOCs) are most informative for such decisions, we performed a Delphi study among Dutch educators. In the current study, the resulting list of facets of competence was evaluated among experienced Dutch and German clinical educators to determine which facets appear most relevant and to evaluate the agreement among experts in different countries as a support for their external validity. Eight Dutch and eight German experts scored each FOC on a five-point scale for relevance. A rank-order comparison showed that there was almost full agreement about the top 10 FOCs, among which 'Scientific and empirical grounded method of working', 'Knowing and maintaining own personal bounds and possibilities', 'Active professional development', 'Teamwork and collegiality', 'Active listening to patients', and 'Verbal communication with colleagues and supervisors'. We conclude that these facets of competence may be used in a training for educators who need to make entrustment decisions about trainees.

Essential facets of competence that enable trust in graduates: a delphi study among physician educators in the Netherlands.

BACKGROUND: There is a need for valid methods to assess the readiness for clinical practice of recently graduated physicians. To develop these methods, it is relevant to know the general features of trainees' performance that facilitate supervisors' trust in their ability to perform critical clinical tasks. OBJECTIVE: To discover such essential facets of competence (FOCs), based on the opinion of experienced physician educators. METHODS: We conducted a Delphi study, consisting of 2 rounds, among 18 experienced physician educators in the Netherlands. Mean, standard deviation, level of agreement, and skewness were calculated for the importance of FOCs for making entrustment decisions. The study yielded a list of 25 FOCs. RESULTS: In the first round, means were between 6.50 and 7.00 on a 7-point Likert scale (SD, 0.42-2.18); in the second round, means ranged from 5.45 to 6.90 (SD, 0.3-2.02). The level of agreement was high for 92% of the FOCs in the first round and 100% of the FOCs in the second round. CONCLUSIONS: Our Delphi study found consensus among experts about FOCs that are important for clinical entrustment decisions.