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Sunday, February 26 • 1:45pm - 2:30pm
ARCHES - [Oral Presentation] 1. Entrustable professional activities (EPAs) in undergraduate medical education (UME): How supervisors make entrustment decisions about medical students

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1:45 PM - 2:00 PM

Entrustable professional activities (EPAs) in undergraduate medical education (UME): How supervisors make entrustment decisions about medical students 

C. Boscardin, K.E. Hauer, A. Teherani, Medicine, University of California, San Francisco
S. Oza, Albert Einstein College of Medicine, New York
P. Walstock, University of Groningen and University Medical Center Groningen
Abstract Body: Introduction Trust is at the nexus of EPAs as an assessment tool. Work to date on EPAs in undergraduate medical education (UME) has defined and provided content validity evidence for EPAs. Little is known about how entrustment decisions are made for UME EPAs. Research Questions We investigated what levels of entrustment are typical for clinical year students at different levels, how supervisors make entrustment decisions, and how EPA ratings relate to other performance measures. Methods We implemented two institutionally-defined EPAs in the longitudinal integrated clerkships at the mid- and end-of third year (MS3) and end-of sub-internship in the fourth year (MS4). The two EPAs were: (1) Evaluate and care for a patient with an acute complaint and (2) Evaluate and care for a patient with a chronic medical problem. Supervising clinicians rated students on a 5-point scale developed by ten Cate and colleagues in which level 4 indicates the ability of the student to act independently. Results MS3s and MS4s were both predominantly rated at level 3 (may act under reactive supervision). As a group, MS4s were rated slightly higher than MS3s. The primary means by which clinical supervisors gathered information to judge students’ readiness for independent work was through direct observation of a range of activities. Although clinical supervisors saw the EPAs as representative of the activities students’ partake in, some felt that ratings of entrustment were less relevant, particularly in the third-year, when students would not be able to achieve independence. We found low to moderate correlations between EPA scores and overall ratings by clerkship directors and comprehensive standardized patient examination scores for both MS3s and MS4s. All students scored between 3 (good) and 4 (outstanding) on clerkship director ratings, and no scores below 3 were recorded. In contrast, supervisors used the full 5-point EPA scale, resulting in greater performance differentiation across learners. Discussion MS3s and MS4s are trusted to complete an activity with supervision readily available upon request. Supervisors’ reliance on direct observation indicates that EPAs may help facilitate high quality assessment. EPAs might be used to diversify the information on which to base consequential summative decisions. Our recommendations for how EPAs can be structured to improve judgments of trust include focus on scale use, EPA details, and faculty development. Advancing the conversation on EPAs entails inquiry into how trust forms across the continuum of medical school education starting in early clinical education.  

Sunday February 26, 2017 1:45pm - 2:30pm

Attendees (22)