A Checklist for Entrustment for EPA- 10 Laura Thompson, Cynthia Leung, Brad Green, Jonathan Lipps, Troy Schaffernocker, Cynthia Ledford, John Davis, David Way, Nicholas Kman The Ohio State University College of Medicine Recognize a patient who requires emergent care and initiate evaluation and management • Vital signs • Severity of illness • Apply BLS/ ACLS • Start initial care for decompensating patient • Engage and communicate with team members and ancillary staff or consultants • Update family and document/ report status N= 114 students Fifteen students did not attain entrustment (14%) Definition: EPA 10 Results - Reliability • It is possible to determine a single point of entrustment for EPA 10 in a simulated setting • Not all students meet expectations for EPA10 during their fourth year of medical school • Inter-rater reliability was moderate to high, but varies across cases and between assessors from different specialties (anesthesia vs. EM) • Some assessment item reliability is case specific, and cases must be evaluated individually. Purpose Current Questions Approach High fidelity simulation, 4 students per case: • Leader • Procedures • Consent • Sign out/ communication • Checklist developed by faculty experts using AAMC EPA guidebook • Critical actions • Ad hoc/ global entrustment assessment • Assessed leader for each case • 1-2 faculty raters per student • Electronic checklist Assessment Unstable Atrial Fibrillation Hypotension, tachycardia, arrhythmia Motor Vehicle Accident with Tension Pneumothorax Dyspnea, hypoxia, hypotension Sepsis Oliguria, fever, altered mental status, hypotension GI Bleed Tachycardia, hypotension, altered mental status Ruptured Ectopic Tachycardia, hypotension, abdominal pain • Is a single observation appropriate? • Why do students fail to attain entrustment? • Can we separate individual performance from team performance? • Does EPA-10 need to be assessed differently in different specialty settings? Different years of Medical School? • Can this process by formalized across institutions? • How can EPA 10 be remediated? Cases Met entrustment 86% Global Critical Actions % met Recognizing unstable vital signs 97% Engaging ancillary staff and asking for help/ consult as appropriate 93% Appropriate disposition 92% TASK Interjudge Reliability Item Status Obtains & recognizes patient status - unstable vital signs High Asks for help when needed Low Needs Improvement Determines patient disposition Moderate Case specific Provides stabilizing treatment Moderate Case specific Global EPA- Meets Entrustment Moderate Case and rater specific Interrater reliability was evaluated through Krippendorf Alpha Statistic and percent agreement. To determine rates of entrustment of EPA-10 using a novel checklist to assess student performance using high fidelity simulation, and to assess inter-rater reliability of the checklist among faculty raters. Results – Rates of Entrustment References & Acknowledgments • Thompson LR, Leung CG, Green B, Lipps J, Schaffernocker T, Ledford C, Davis J, Way DP, Kman NE. Development of an assessment for Entrustable Professional Activity (EPA) 10: Emergent patient management. West J Emerg Med. (In press). • Thank you to Ms. Sharon Pfeil, Ms. Victoria Cannon, and to The Ohio State University College of Medicine Clinical Skills Education and Assessment Center.

EPA 10 Approach to Emergent Patient Poster

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Page 1: EPA 10 Approach to Emergent Patient Poster

Recognize a patient who requires emergent care and initiate evaluation and management

• Vital signs• Severity of illness• Apply BLS/ ACLS• Start initial care for decompensating patient• Engage and communicate with team members and

ancillary staff or consultants• Update family and document/ report status

N= 114 students Fifteen students did not attain entrustment (14%)

Definition: EPA 10 Results - Reliability

• It is possible to determine a single point of entrustment for EPA 10 in a simulated setting

• Not all students meet expectations for EPA10 during their fourth year of medical school

• Inter-rater reliability was moderate to high, but varies across cases and between assessors from different specialties (anesthesia vs. EM)

• Some assessment item reliability is case specific, and cases must be evaluated individually.

PurposeSignificance

Current QuestionsApproach

High fidelity simulation, 4 students per case:• Leader• Procedures• Consent• Sign out/ communication

• Checklist developed by faculty experts using AAMC EPA guidebook

• Critical actions• Ad hoc/ global entrustment

assessment• Assessed leader for each

case• 1-2 faculty raters per student

• Electronic checklist

Assessment

Unstable Atrial Fibrillation Hypotension, tachycardia, arrhythmia

Motor Vehicle Accident with Tension Pneumothorax Dyspnea, hypoxia, hypotension

Sepsis Oliguria, fever, altered mental status, hypotension

GI Bleed Tachycardia, hypotension, altered mental status

Ruptured Ectopic Tachycardia, hypotension, abdominal pain

• Is a single observation appropriate?• Why do students fail to attain entrustment?• Can we separate individual performance from team

performance?• Does EPA-10 need to be assessed differently in different

specialty settings? Different years of Medical School? • Can this process by formalized across institutions?• How can EPA 10 be remediated?

Cases

Met entrustment86%

Global Critical Actions % met

Recognizing unstable vital signs 97%

Engaging ancillary staff and asking for help/ consult as appropriate 93%

Appropriate disposition 92%

TASK Interjudge Reliability

Item Status

Obtains & recognizes patient status - unstable vital signs

High

Asks for help when needed Low Needs ImprovementDetermines patient disposition Moderate Case specificProvides stabilizing treatment Moderate Case specificGlobal EPA- Meets Entrustment Moderate Case and rater specific

Interrater reliability was evaluated through Krippendorf Alpha Statistic and percent agreement.

To determine rates of entrustment of EPA-10 using a novel checklist to assess student performance using high fidelity simulation, and to assess inter-rater reliability of the checklist among faculty raters.

Results – Rates of Entrustment

References & Acknowledgments• Thompson LR, Leung CG, Green B, Lipps J, Schaffernocker T, Ledford C, Davis J, Way DP, Kman

NE. Development of an assessment for Entrustable Professional Activity (EPA) 10: Emergent patient management. West J Emerg Med. (In press).

• Thank you to Ms. Sharon Pfeil, Ms. Victoria Cannon, and to The Ohio State University College of Medicine Clinical Skills Education and Assessment Center.