ABSTRACT
Background: It is essential that medical education (MedEd) fellows achieve desired outcomes prior to graduation. Despite the increase in postgraduate MedEd fellowships in emergency medicine (EM), there is no consistently applied competency framework. We sought to develop entrustable professional activities (EPAs) for EM MedEd fellows. Methods: From 2021 to 2022, we used a modified Delphi method to achieve consensus for EPAs. EM education experts generated an initial list of 173 EPAs after literature review. In each Delphi round, panelists were asked to make a binary choice of whether to include the EPA. We determined an inclusion threshold of 70% agreement a priori. After the first round, given the large number of EPAs meeting inclusion threshold, panelists were instructed to vote whether each EPA should be included in the "20 most important" EPAs for a MedEd fellowship. Modifications were made between rounds based on expert feedback. We calculated descriptive statistics. Results: Seventeen experts completed four Delphi rounds each with 100% response. After Round 1, 87 EPAs were eliminated and two were combined. Following Round 2, 46 EPAs were eliminated, seven were combined, and three were included in the final list. After the third round, one EPA was eliminated and 13 were included. After the fourth round, 11 EPAs were eliminated. The final list consisted of 16 EPAs in domains of career development, education theory and methods, research and scholarship, and educational program administration. Conclusions: We developed a list of 16 EPAs for EM MedEd fellowships, the first step in implementing competency-based MedEd.
ABSTRACT
Objectives: The recent outbreak of the COVID-19 altered the traditional paradigm of clinical medical education. While individual clerkships have shared their curricular adaptations via social and academic networking media, there is currently no organizational standard in establishing a nonclinical, emergency medicine (EM) virtual rotation (VR). The primary objective of this study was to describe EM clerkship directors' (CDs) perspectives on their experience adapting an EM VR curriculum during the onset of the COVID-19 pandemic. Methods: A 21-item survey with quantitative and qualitative questions was disseminated between June and August 2020 to EM CDs via the Clerkship Director of Emergency Medicine Listserv to describe their experience and perspectives in adapting a VR during spring 2020. Results: We analyzed 59 of 77 EM clerkship survey responses. Among respondents, 52% adapted a VR while 47.5% did not. Of those who adapted a VR, 71% of CDs had 2 weeks or less to develop the new curriculum, with 84% reporting usual or increased clinical load during that time. Clerkships significantly diversified their asynchronous educational content and utilized several instructional models to substitute the loss of clinical experience. Reflecting on the experience, 71% of CDs did not feel comfortable writing a standardized letter of evaluation for students based on the VR, with the majority citing inability to evaluate students' competencies in a clinical context. Conclusion: A crisis such as COVID-19 necessitates change in all facets of medical education. While EM educators demonstrated the ability to create emergency remote learning with limited time, this was not equivalent to the formal development of preplanned VR experiences. Future faculty development and curriculum innovation are required to fully transition an in-person immersive experience to a noninferior virtual experience.
