Entrustable Professional Activities (EPAs)medinfo2.psu.ac.th/pg/file/upload_news/NEWS_20180531... · 2018. 5. 31. · 1 Entrustable Professional Activities (EPAs) Arnuparp Lekhakula

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Entrustable Professional Activities (EPAs)

Arnuparp LekhakulaM.D., M.S., MRCP, FACPFaculty of Medicine

Prince of Songkla University

Current Assessment SystemWhat are some limitations of current assessment systems?

Core competencies and sub‐competencies: long checklists of behavioral descriptors

Relies on traditional but limited assessment methods – knowledge exams, ward evaluations

Not a holistic summative view of the trainee

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What is the goal with assessment?

Integrated, longitudinal, learner‐centered assessment system

Promote skill acquisition in multiple domains concurrently

Assess what learners actually do in practice

Be able to conclude: this is a trustworthy trainee

Assessment Assessing competencies becomes central

Create assessments that reflects as closely as possible real life as professional

MCQs are often not sufficient to evaluate skills, attitudes, and behaviors

Workplace‐based assessment

Formative assessment mandatory

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Not observed

No assessment of competencies

No feed‐back

Problems of Workplace Training

Definitions Competency

Milestone

Entrustable professional activity (EPA)

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CompetencyAn observable ability integrating multiple components such as knowledge, skills, values and attitudes. They can be measured and assessed to ensure their acquisition.

Does the job

Learner-centered paradigm

what trainee can actually DO at the end of

LEARNING experiences/activities …

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Competency• Relevant to the practice• Related to an actual task in the field –

contextualised• Driven by professional practice and

values• Defines a level of ability for an

observable outcome

Knows

Knows how

Knows

Knows how

Shows how

Does

Pro

fess

iona

l aut

hent

icity

CLIMBING THE PYRAMID

In real situation orcontextualized

Competence

Performance

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Competency-Based Medical Education (CBME)

Philosophy Better, broader description of the physician

From assuming to assessing competence

Only graduate physicians meeting standards

Based on competence, not just time in training

Practice Detailed description of competencies

Struggle with teaching and assessment

Implications of CBME• Competency outcomes drive

curriculum

• Curriculum does NOT drive outcomes

• Fundamental shift from teacher‐centered to learner‐centered orientation

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Implications of CBME• Instruction is developed around stated

competencies that can be observed and measured

• Learning is measured according to how well the learner performs in relation to competencies

• Learning constant, time variable• Criterion‐based

Competencies of Residents in IM

Patient careMedical knowledge and skills

Practice‐based learning and improvement Interpersonal and communication skills Professionalism System‐based practice

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Patient Careก. มีทักษะในการซักประวัติ ตรวจรางกายผูปวย

ทําหัตถการ และการรวบรวมขอมูลข. วินิจฉัย บําบัดรักษาภาวะผิดปกติทาง

อายุรศาสตรท่ีพบพบโดยท่ัวไปในประเทศไทยได

ค. บันทึกรายงานผูปวยไดอยางสมบูรณและสมํ่าเสมอ

ง. ปองกันโรคและสรางเสริมสุขภาพ

Medical Knowledge and Skills

ก. เขาใจวิทยาศาสตรการแพทยพื้นฐานของรางกายและจิตใจ

ข. มีความรูความสามารถในวิชาชีพและเช่ียวชาญในสาขาอายุรศาสตร

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Practice-Based Learning and Improvement

ก. มีความคิดสรางสรรคตามหลักวิทยาศาสตรในการสรางความรูใหม และพัฒนาระบบบริการสุขภาพ

ข. ดําเนินการวิจัยทางการแพทยและสาธารณสุขได

ค. เรียนรูและเพิ่มประสบการณไดดวยตนเองจากการปฏิบัติ

Interpersonal and Communication Skills

ก. นําเสนอขอมูลผูปวย และอภิปรายปญหาอยางมีประสิทธิภาพ

ข. ถายทอดความรูและทักษะใหแกแพทย นักศึกษาแพทย และบุคลากรทางการแพทย

ค. สื่อสารใหขอมูลแกญาติและผูปวยไดอยางถูกตองและมีประสิทธิภาพโดยมีเมตตา เคารพการตัดสนิใจและศักดิ์ศรีของความเปนมนุษย

ง. มีมนุษยสัมพันธดี ทํางานกับผูรวมงานทุกระดบัอยางมีประสิทธิภาพ

จ. เปนท่ีปรึกษาและใหคาํแนะนําแกแพทยและบคุลากรอื่น โดยเฉพาะทางอายรุศาสตร

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Professionalismก. มีคุณธรรม จริยธรรม และเจตคติอันดีตอผูปวย

ญาติ ผูรวมงาน เพื่อรวมวิชาชีพ และชุมชนข. มีความสนใจใฝรู และสามารถพัฒนาไปสูความ

เปนผูเรียนรูตอเนื่องตลอดชีวิต (Continuous Professional Development)

ค. มีความรับผิดชอบตองานท่ีไดรับมอบหมายง. คํานึงถึงผลประโยชนสวนรวม

System-Based Practiceก. มีความรูความเขาใจเกี่ยวกับระบบสุขภาพและ

ระบบยาของประเทศ ข. มีความรูและมีสวนรวมในระบบพัฒนาคุณภาพ

การดูแลรักษาผูปวยค. มีความรูความเขาใจในเรื่องความปลอดภัยของ

ผูปวยง. มีความรูความเขาใจในเรื่องสิทธิของผูปวยจ. มีความรูความเขาใจในเรื่องการใชทรัพยากร

สุขภาพอยางเหมาะสม (Cost Consciousness Medicine) สามารถปรับเปลี่ยนการรักษาดูแลผูปวยใหเขากับบริบทของการบริการสาธารณสุขไดตามมาตรฐานวิชาชีพ

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Milestones• Developmental roadmap for the competencies and subcompetencies

• Observable developmental steps moving residents from novices to experts/masters

• A behavioral descriptor that marks a level of performance for a given competency

first day

final day

fromlearningcompetentperson

achievement of student…

Development

beginner

what we want to “CHANGE”…

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Example:Patient Care Domain

Make informed diagnostic and therapeutic decisions that result in optimal clinical judgment

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What criteria would you use to select your doctor?

Passed all tests and exams?

Grades and scores?

Years of training?

Follows protocols and guidelines?

Trust that s/he will manage a case in the best possible way?

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Can you trust the learner to function independently?

Entrustable professional Activity (EPA)

Units of professional practice, defined as tasks or responsibilities that trainees are entrusted to perform unsupervised once they have attained sufficient specific competence. EPAs are, therefore, suitable for entrustment decisions.

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EPA

“Patients’ and instructors’ … entrustment of responsibility to a trainee is an essential concept in this approach…”

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ten Cate et al. Acad Med 2007; 82: 542-47

EPA Define important clinical activities

Part of essential work for a qualified professional

Requires specific knowledge, skill, attitude

Acquired through training

Link to competencies / milestones

Reflect one or more competencies to be acquired

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EPA Leads to recognized outcome

Observable and measureable, leading to a conclusion

Include professional judgment of competence by clinicians

Make “decisions of entrustment” for “entrustable” activities

EPA’s together constitute the core of the profession


EPAs Entrustable: acts that require trust –by colleagues, patients, public

Professional: confined to occupations with extra‐ordinary qualification and right

Activities: tasks that must be done

EPAs ground competencies in daily practice


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EPAsDomains ofCompetency Milestones

Competencies versus EPAs

person-descriptors

knowledge, skills,attitudes, values

• content expertise• collaboration ability• communication ability• management ability• professional attitude• scholarly approach

work-descriptors

essential parts of professional practice

• discharge patient• counsel patient• lead family meeting• design treatment plan• perform paracentesis• resuscitate if needed

Competencies EPAs

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Competencies vs EPAs• Competencies – qualities of individuals• EPAs – units of work / tasks that must be

done• One can possess competencies, one

cannot possess EPAs

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The Matrix:EPAs require multiple competencies

EPA1 EPA2 EPA3 EPA4 EPA5

Competency1 ++ ++ + ++

Competency2 + + ++

Competency3 + ++ +

Competency4 + ++ ++

Competency5 + ++ +

Competency6 + + + ++

Core EPAs for Entering Residency: AAMC

EPA 1: Gather a history and perform a physical examination

EPA 2: Prioritize a differential diagnosis following a clinical encounter

EPA 3: Recommend and interpret common diagnostic and screening tests

EPA 4: Enter and discuss orders and prescriptions

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EPA 5: Document a clinical encounter in the patient record

EPA 6: Provide an oral presentation of a clinical encounter

EPA 7: Form clinical questions and retrieve evidence to advance patient care

EPA 8: Give or receive a patient handover to transition care responsibility


EPA 9: Collaborate as a member of an interprofessional team

EPA 10: Recognize a patient requiring urgent or emergent care and initiate evaluation and management

EPA 11: Obtain informed consent for tests and/or procedures

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EPA 12: Perform general procedures of a physician

EPA 13: Identify system failures and contribute to a culture of safety and improvement

EPAs of IM ResidencyEPA 1: Manage care of medical patients in the

ambulatory setting

EPA 2: Manage care of medical patients in the in‐patient setting

EPA 3: Manage care of medical patients in the emergency setting

EPA 4: Manage care of medical patients in the intensive/critically care setting

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EPAs of IM ResidencyEPA 5: Providing age‐appropriate screening

and preventive care

EPA 6: Providing general internal medicine consultation to non‐medical specialties

EPA 7: Providing palliative care

EPA 8: Demonstrating lifelong personal learning activities

EPAs of IM ResidencyEPA 9: Practicing patient safety

EPA 10: Working with interprofessional health care teams

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Implementation of EPAs1. The level of ‘entrustability’

2. The assessment

3. The training of faculties

Milestones EPA 5: Provide age-appropriate screening and preventive care

Yr 1 Yr 2 Yr 3การดแูลรกัษาผูปวย (Patient care)ก. มีทักษะในการซกัประวตั ิตรวจรางกายผูปวย ทําหตัถการ

และการรวบรวมขอมลู

ข. วินิจฉยั บําบดัรกัษาภาวะผดิปกตทิางอายรุศาสตรทีพ่บโดยทัว่ไปในประเทศไทยได

ค. บันทกึรายงานผูปวยไดอยางสมบรูณและสม่าํเสมอง. ปองกนัโรคและสรางเสรมิสขุภาพ

ความรู ความเชีย่วชาญ และความสามารถในการนาํไปใชแกปญหาและสงัคมรอบดาน (Medical knowledge and skills)ก. เขาใจวทิยาศาสตรการแพทยพืน้ฐานของรางกายและจติใจ

ข. มีความรูความสามารถในวชิาชพีและเชีย่วชาญในสาขาอายรุศาสตร

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Milestones EPA 5Yr 1 Yr 2 Yr 3

การเรยีนรูจากการปฏบิตั ิ(Practice-based learning) ก. ดําเนนิการวจิยัทางการแพทยและสาธารณสขุไดข. การใชยาและทรพัยากรอยางสมเหตผุล ค. เรียนรูและเพิม่ประสบการณไดดวยตนเองจากการปฏบิตัิ ทักษะปฏสิมัพนัธ และการสือ่สาร (Interpersonal and communication skills)ก. นําเสนอขอมลูผูปวย และอภปิรายปญหาอยางมปีระสทิธภิาพข. ถายทอดความรูและทกัษะใหแกแพทย นักศกึษาแพทย และ

บุคลากรทางการแพทย

ค. สื่อสารใหขอมลูแกญาตแิละผูปวยไดอยางถกูตองและมีประสทิธภิาพโดยมเีมตตา เคารพการตดัสนิใจและศกัดิศ์รีของความเปนมนษุย

ง. มีมนษุยสมัพนัธด ีทํางานกบัผูรวมงานทกุระดบัอยางมีประสทิธภิาพ

จ. เปนทีป่รกึษาและใหคาํแนะนาํแกแพทยและบคุลากรอืน่ โดยเฉพาะทางอายรศุาสตร

Milestones EPA 5Yr 1 Yr 2 Yr 3

ความเปนวชิาชพี (Professionalism)ก. มีคุณธรรม จริยธรรม และเจตคตอินัดตีอผูปวย ญาต ิ

ผูรวมงาน เพื่อนรวมวชิาชพี และชมุชน

ข. มีความสนใจใฝรู และสามารถพฒันาไปสูความเปนผูเรยีนรูตอเนือ่งตลอดชวีติ

ค. มีความรบัผดิชอบตองานทีไ่ดรบัมอบหมายง. คํานงึถงึผลประโยชนสวนรวม การปฏบิตังิานใหเขากบัระบบ (System-based practice)ก. มีความรูเกีย่วกบัระบบสขุภาพและระบบยาของประเทศ ข. มีความรู และมสีวนรวมในระบบพฒันาคณุภาพการดแูลรกัษา

ผูปวย

ค. มีความรูความเขาใจเรือ่งความปลอดภยัของผูปวย ง. มีความรูความเขาใจเกีย่วกบัสทิธขิองผูปวย จ. ใชทรพัยากรสขุภาพอยางเหมาะสม และสามารถปรบัเปลีย่น

การดแูลรกัษาผูปวยใหเขากบับรบิทของการบรกิารสาธารณสขุไดตามมาตรฐานวชิาชพี

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Entrustment in Residency Training

Attending physicians assess a multi‐dimensional construct of “trustworthiness” when deciding a level of supervision

Entrustment implies a level of competence

Kennedy, et. al.Acad Med 2008; 83(10 Suppl): S89-92

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When is “competence” reached?When do you trust the trainee?When a professional activity is mastered

• on a threshold level

• that permits unsupervised practice

• and full entrustment

It happens all the time: when trainees work without direct supervision

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Entrustment:Recognizing abilities + Right +

Duty to act Assessment of learners in regular education focuses on evaluation of abilities with no consequence other than individual progress

Entrustment of learners combines the evaluation of abilities with the permission to act and readiness to be scheduled for service

The Trust Concept in EPA-based Assessment

Trusting someone is making yourself vunerable

Calculated risk the adverse events are managable

Entrustment decisions require the adaptive competence to cope with unfamiliar situations

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Milestones + EPAsBoth are Critical for AssessmentCompetencies & Milestones: A Granular Approach (Telephoto)

• Assess how well a trainee can accomplish some small part of a professional activity

EPAs: A Holistic Approach (Panoramic)

• Integrate competencies within a clinical context and assess clusters of behavioursthat allow one to carry out a professional activity

What do humans value others who they must trust? Ability – Competence

Integrity – Honesty/truthfulness, benevolence

Reliability – Conscientious and consistent behavior

Humility – Discernment of limitations + willingness to ask for help

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Level of supervision Level 1: Not allowed to practice the EPA

Level 2: Practice with full supervision

Level 3: Practice with supervision on demand

Level 4: “Unsupervised” practice allowed

Level 5: Supervision task may be given

LEVEL OF SUPERVISION

Level of supervision Level 1: Not allowed to practice the EPA

Observe only

Level 2: Practice with full (direct) supervision

a. coactivity with supervisor

b. supervisor in room


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Level of supervision Level 3: Practice with supervision on demand

(indirect supervision)

a. supervisor in ward, all findings/decisions

double check

b. supervisor in ward, key findings/decisions

double check

c. supervisor in the house/key findings

decisions double check


Level of supervision

Level 4: “Unsupervised” practice alloweda. supervisor not in the house/key findings

decisions review

b. independent practice

Level 5: Supervision task may be given


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EPA Description1. Title

2. Specification

3. Context

4. Domains of competence

5. Required experience, knowledge, skills, attitude, and behavior for entrustment

EPA Description

6. Assessment information source to assess progress and ground a summative entrustment decision

7. Entrustment for which level of supervision is to be reached at which stage of training?

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ExampleTitle of the EPA Working with interprofessional health care teams

Specifications 1. Understands roles and responsibilities as a leader of health care teams

2. Understands roles of other professions to appropriately assess and address the health care needs of the patients and populations served and how the team works together to provide care

3. Works with individual of professions to maintain a climate of mutual respect and share values

4. Communicates with patients, families and other health professions in a responsive manner to support a team approach to maintenance of health and the treatment of disease

5. Listens actively, and encourages ideas and opinions of other team members

6. Applies relationship‐building values and the principle of team dynamics to perform effectively in different team roles to plan and deliver patient‐centered care

7. Applies leadership practices that support collaborative practice and team effectiveness

ExampleContext Ambulatory setting, emergency room, in‐

patient wardDomains of competence

Knowledge and skills/Practice‐based learning/Interpersonal and communication skills/ Professionalism/System‐based learning

Required experience, knowledge, skills, attitude, and behavior for entrustment

Knowledge: Principles of team dynamics and interpersonal communication Skills: Communication, consultation, active listening, management, working practice with other health professions, leadershipAttitude and behavior: Mutual respect, shared values, recognize one’s limitationsExperience: Demonstrate experience in leading the health care team during primary physician or chief ward rotation within 3 years of training

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ExampleAssessment informationsource to assess progress and ground a summative entrustment decision

Direct observation Mini‐Peer Assessment Team / Multisource feedback (MSF)Self evaluation – E portfolio

Entrustment for which level of supervision is to be reached at which stage of training?

- Execution with reactive supervision (on

request) by the end of first year – level 3 (2

inpatient ward rotation)

- Unsupervised at the end of third year –

level 4 (2 chief ward rotation)

Competency-Based Assessment Requirement

In CBME, certification, diploma should not be granted primarily because of completion of rotation and training

An EPA‐based CBME program focuses on gradual but deliberate increased of clinical responsibilities for separate units of practice

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That can only be done if entrustment decisions for transfer of EPA responsibilities are valid.

Validity of entrustment decisions can be supported by multiple sources of information, and by sharing the decision among multiple clinicians.


Remember: summative entrustment decisions to decrease default supervision are serious, formal decisions with consequences.

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Moving from Just Assessment of Ability to Entrustment Decision-Making

Traditional psychometrics do not work well in the workplace

Variance caused by raters and context is larger than variance caused by trainee qualities

Worsen by lack of supervision, fragmented care, short patient stays, little observation

A move from traditional assessment to entrustment decisions for EPAs may increase validity

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Modes of TrustPresumptive trust

Prior credentials withoutobservation

Guides ad‐hoc entrustment decision

Initial trust First impression

Grounded trust More or less systematic data collection

Guides summative entrustment decision

Entrustment Decisions: Two Modes

Ad‐hoc entrustment decisions:Happen every day; situationally determined;based on presumptive trust and initial trust.Formative nature.Assessment retrospectively

Summative entrustment decisions:Serve as certification/ license to act.Summative nature; based on grounded trust. Assessment with prospective purposes

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Factors Determining an Entrustment Decision (ED)

Trainee factors (‘trustworthiness – ability, integrity, reliability and humility)

Supervisor factors (‘propensity to trust’ and acquaintance with learner)

Perceived benefits (educational & contextual)

Perceived risks (for patients, self)

ED = ƒ T*S*benefitsrisks

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Training Deliberate professional practice

EPA1EPA4

EPA2EPA3

EPA5

Competence

Threshold

Justified entrustment decisions

Sample Competency Curve

Summative Entrustment DecisionsEPA PGY1 PGY2 PGY3

EPA1 1 2 2 2 3 4EPA2 1 1 2 2 3 4EPA3 2 2 3 4 4 5EPA4 1 2 2 3 4 4EPAx 2 3 4 4 4 5

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Information Sources to Support Summative Entrustment Decisions1. [Prior credentials

2. Knowledge and skill tests]

3. Short practice observation

4. Case‐based/entrustment‐based discussion

5. Longitudinal practice observations

6. Product evaluation

7. [Self‐report]

Short Practice Observation Direct observation bedsides/ in consultation room, consult or procedure (MiniCEX, DOPS)

Video‐observation

Patient presentations at morning rounds and handovers

Any other situation in clinical practice

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Case or Entrustment based Discussion (CbD/EbD)

10‐15 minutes oral discussion

Agenda:

1. What was done?

2. Demonstrate background knowledge

3. Demonstrate awareness of risks and possible complications

4. What if the patient had been different for any reason?

Longitudinal Practice Observation

Multi‐source feedback / observation

Evaluation of a shift

Observers can be asked to evaluate Integrity, Reliability, Humility

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When does EPA entrustment require simulation training and

assessment only? When skills cannot be performed in practice while entrustment is needed

‐ Basic life support skills at graduation from medical school

When situations are rare or unpredicted but require essential skills

‐ Rare diseases

‐ Resolving collaboration conflicts

Issues in Workplace-based Assessment

Generosity error (too high score – failure to fail)

Halo (generalizing from observing one feature)

Unreliable (not producible)

Unclear standards (often no standards)

Observer/rater variation

Rating unclear to profiency, to personal development, to effort, etc.

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Work-Based Assessment MethodsMini‐Clinical Evaluation Exercise (mini‐CEX) Direct Observation of Procedural Skills (DOPS) Case‐Based Discussions (CbD)Mini‐Peer Assessment tool (Mini‐PAT) Multi‐Source Feedback (MSF) Portfolios

Workplace-based Assessment

Workplace-based AssessmentWBA Competencies Examples of Assessors Setting

Mini-CEX

Communication with patient, physical

examination, diagnosis, treatment plan

Educational/ Clinical Supervisors, senior

trainee

Clinic, A&E, ward, community

CBDClinical judgement, clinical

management, reflective practice


trainee

Multiple areas covered by a

challenging case

DOPs Technical skills, procedures and protocols.


traineeMulti-professional team

(MPT)

Clinic, A&E, ward, theatre

Mini-PATMSFTAB

Team-working, professional behaviour Trainee’s MPT Multiple areas

covered by MPT

PBA/OSATTechnical skills, procedures

and protocols, theatre team-working

Consultant or ST5 + trainee

Clinic, A&E, ward, theatre

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Mini-CEX Faculty member observes a trainee interacting with a patient in a clinical setting

15 minutes (+5 minutes for feedback)

Interviewing skills, physical exam, professionalism, communication skills

Formative feedback


Mini-CEXMedical Interviewing Skills

Physical Examination Skills

Humanistic Qualities/Professionalism

Clinical Judgment

Counseling Skills Organization/Efficiency Overall Clinical Competence


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Mini-CEXMedical interviewing skillsfacilitates patient’s telling of story; effectively use questions to obtain accurate, adequate information needed; responds appropriately to affect, non-verbal cues

Physical Examination Skills

Follow efficient, logical sequence; balances screening/

diagnostic steps for problem; informs patient; sensitive

to patient’s comfort, modesty

Humanistic Qualities/ Professionalism

Shows respect, compassion, empathy, establishes trust;

attends to patient’s needs of comfort, modesty,

confidentiality, information

Mini-CEXClinical JudgmentSelectively orders/ performs appropriate diagnostic

studies, consider risks, benefitsCounseling Skills

Explains rationale for test/ treatment, obtains patient’s

consent educates/ counsels regarding management

Organization/ Efficiency

Prioritize; is timely; succinct

Overall clinical competence

Demonstrates judgment, synthesis, caring, effectiveness, efficiency

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MiniCEX – Rating Form

MiniCEX Not for high stakes exams

Not to rank trainees Not to compare training programmes

4‐6 times in the year

Different assessor each time

Encounter chosen by the trainee, confirmed by the assessor


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DOPS Direct observation of procedural skillsWhole procedure observed from start to finish

Real patients, workplace, not OSCE 15 minutes (+ 5 minutes feedback)

Trainees select from an approved list of procedures

Indications, communication, technique, analgesia, asepsis


DOPS Understanding of indications, relevant anatomy, technique of procedure

Obtains informed consent

Preparation pre‐procedure Analgesia or safe sedation Technical ability as applicable to procedure Aseptic technique


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DOPS Seeks help where appropriate Post‐procedure management

Communication skills

Consideration of patient and professionalism

Overall ability to perform procedure


DOPS – Rating Form

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Four real patients

The whole encounter is observed

Focused history & examination

Clinical reasoning & decision‐making

Communication skills

20‐30 minutes

Summative / formatives

Direct Observation Clinical Encounter Examination “DOCE”


A structured interview designed to explore professional judgement in clinical cases

Professional Judgement:

The ability to make holistic, balanced, and justifiable decisions in situations of complexity and uncertainty


Case-based Discusssion(CbD)

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CbD Trainee selects case studies, and present to the trainer one week before the meeting

Selection of cases needs careful consideration – a balance of cases and contexts is required

Assessor chooses two of these Assessor should ask why this selection


CbD The discussion will be centred on the trainee’s record to assess clinical decision‐making and the application of medical knowledge

Assessor will use structured question guidance to seek evidence indicating a level of performance

20 minutes (5 minutes for feedback)

Judge the level of performance

Repeat in each four months


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CbD - Types Short case/long case/viva Knowledge‐basedManagement of patient

Multi‐disciplinary team

Decision making

Ethical Reflection Developmental change


CbD - AreasMedical record keeping

Clinical assessment/Diagnosis

Decision making

Investigation and referrals Treatment

Management of medical complexity

Follow‐up and future planning Professionalism Overall clinical care/Fitness to practice


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CbD• Summative and formative components

• Based on what has happened not what would happen

• Explores reasoning

• Questioning to ‘dig deep’

• Promotes learning and new insights if used well

• Just ticks the boxes if done badly


CbD – Rating Form

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MiniPAT Peer assessment tool

8 assessors Including senior colleagues, nurses, AHPs Including self assessment

Routine performance

Feedback reviewed with trainee and supervisor

Agreed action plan


Multi-source Feedback (MSF) 360 Degree Assessment

Provides performance data from multiple points of reference

Like a compass, it is a navigational tool

More powerful, reliable and accurate as compared to traditional, single source feedback processes


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Information provided by a co‐worker on the aspects of performing and understanding

Multiple sampling

Team approach

Assessors include peers, supervisors, nurses, secretary, lab technicians, and

patients

MSF


Large sample of raters (10‐30) is often clusters in groups e.g. 3 nurses, 4 patients, 3 peers, + self

Focus on medical knowledge, clinical care, communication skills, management and administrative skills, interpersonal skills, professionalism

Different categories of different raters

Proper and timely feedback is critical

MSF


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Wrap-Up CBME is a movement to stay

EPAs have become popular worldwide as framework to connect competencies to clinical practice

Make sense to faculty, trainees and the public

Make assessment more practical and meaningful

Wrap-Up Add meaning to assessment by focusing on integration of competencies in the context of card delivery

Align what we assess with what we do

Entrustment decision making is recent but quickly emerging approach to assessment

Simulation and skills training is important but not enough for entrustmen6

Documents

Entrustable Professional Activities (EPAs)medinfo2.psu.ac.th/pg/file/upload_news/NEWS_20180531... · 2018. 5. 31. · 1 Entrustable Professional Activities (EPAs) Arnuparp Lekhakula