The Use of Entrustable Professional Activities in Pediatric Postgraduate Medical Education: A Systematic Review.

BACKGROUND: Entrustable Professional Activities (EPAs) provide a framework to make judgments of trainees' abilities in several settings including postgraduate medical education. No systematic review of the role of EPAs in pediatrics has yet been performed. OBJECTIVES: In our systematic review, we sought to determine the use of EPAs in pediatrics to identify research gaps, summarize and discuss evidence relating to the development, implementation, and assessment. DATA SOURCES: Medline, Scopus, PsycINFO, MedEdPortal, and Web of Science. STUDY ELIGIBILITY CRITERIA: Two independent reviewers used a structured screening protocol in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and Association for Medical Education in Europe's guide for systematic reviews to include all articles reporting on EPAs in postgraduate medical education and pediatrics in particular. There were no restrictions due to language, study design, or participants. STUDY APPRAISAL AND SYNTHESIS METHODS: Data on development, implementation, feasibility, acceptance, and assessment of EPAs were extracted and analyzed by the 2 independent researchers. RESULTS: Twenty-eight articles published between 2014 and 2020 were included in the review. We found an increase in publications and a notable shift from descriptions of development processes toward aspects beyond development, ie, implementation, feasibility, acceptance/perception, and assessment. LIMITATIONS: Studies from non-English-speaking countries are scarce which might lead to an inaccurate representation of actual international practice. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: We provide a comprehensive overview of EPAs in pediatrics to guide future curriculum developers in collaborative development, implementation and assessment of EPAs in pediatric postgraduate medical education.

A systematic review of how patients value COPD outcomes.

Our objective was to summarise systematically all research evidence related to how patients value outcomes in chronic obstructive pulmonary disease (COPD).We conducted a systematic review (systematic review registration number CRD42015015206) by searching PubMed, Embase, PsycInfo and CINAHL, and included reports that assessed the relative importance of outcomes from COPD patients' perspective. Two authors independently determined the eligibility of studies, abstracted the eligible studies and assessed risk of bias. We narratively summarised eligible studies, meta-analysed utilities for individual outcomes and assessed the certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluations approach.We included 217 quantitative studies. Investigators most commonly used utility measurements of outcomes (n=136), discrete choice exercises (n=13), probability trade-off (n=4) and forced choice techniques (n=46). Patients rated adverse events as important but on average, less so than symptom relief. Exacerbation and hospitalisation due to exacerbation are the outcomes that COPD patients rate as most important. This systematic review provides a comprehensive registry of related studies.