Abstract
One of the main goals of the CoreEPA pilot has been to determine the feasibility of developing a process to make summative entrustment decisions regarding entrustable professional activities (EPAs). Five years into the pilot, we report results of a research study we conducted to explore approaches to the entrustment process undertaken by our ten participating schools. We sought to identify the choices that participating schools made regarding the entrustment process and why these decisions were made. We are sharing these results, highlighting ongoing challenges that were identified with the intent of helping other medical schools that are moving toward EPA-based assessment. We conducted semi-structured interviews with representatives of all 10 medical schools in the CoreEPA pilot to understand their choices in designing the entrustment process. Additional information was obtained through follow-up communication to ensure completeness and accuracy of the findings. Several common themes are described. Our results indicate that, while approaches to the entrustment process vary considerably, all schools demonstrated consistent adherence to the guiding principles of the pilot. Several common barriers to the entrustment process emerged, and there was a consensus that more experience is needed with the process before consequential entrustment decisions can be made. The CoreEPA pilot schools continue to address challenges identified in implementing entrustment processes and making entrustment decisions for our students graduating in the Class of 2020.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
ten Cate O. Entrustability of professional activities and competency-based training. Med Educ. 2005;39(12):1176–7. https://doi.org/10.1111/j.1365-2929.2005.02341.x.
Englander R, Flynn T, Call S, Carraccio C, Cleary L, Fulton TB, et al. Toward defining the foundation of the MD degree: Core Entrustable professional activities for entering residency. Acad Med. 2016;91(10):1352–8. https://doi.org/10.1097/ACM.0000000000001204.
Lomis K, Amiel JM, Ryan MS, Esposito K, Green M, Stagnaro-Green A, et al. Implementing an Entrustable professional activities framework in undergraduate medical education: early lessons from the AAMC Core Entrustable professional activities for entering residency pilot. Acad Med. 2017;92(6):765–70. https://doi.org/10.1097/ACM.0000000000001543.
Brown DR, Warren JB, Hyderi A, Drusin RE, Moeller J, Rosenfeld M, et al. Finding a path to entrustment in undergraduate medical education: a Progress report from the AAMC Core Entrustable professional activities for entering residency entrustment concept group. Acad Med. 2017;92(6):774–9. https://doi.org/10.1097/ACM.0000000000001544.
Kennedy TJ, Regehr G, Baker GR, Lingard L. Point-of-care assessment of medical trainee competence for independent clinical work. Acad Med. 2008;83(10 Suppl):S89–92. https://doi.org/10.1097/ACM.0b013e318183c8b7.
Bunniss S, Kelly DR. Research paradigms in medical education research. Med Educ. 2010;44(4):358–66. https://doi.org/10.1111/j.1365-2923.2009.03611.x.
Obeso VPC, Degnon C, Carter T. A. a systems-based approach to curriculum development and assessment of Core Entrustable professional activities in undergraduate medical education. Med Sci Educ. 2018;28(2):406–16. https://doi.org/10.1007/s40670-018-0540-7.
Hauer KE, Chesluk B, Iobst W, Holmboe E, Baron RB, Boscardin CK, et al. Reviewing Residents' competence: a qualitative study of the role of clinical competency committees in performance assessment. Acad Med. 2015;90(8):1084–92. https://doi.org/10.1097/Acm.0000000000000736.
Brokaw JJ, Torbeck LJ, Bell MA, Deal DW. Impact of a competency-based curriculum on medical student advancement: a ten-year analysis. Teach Learn Med. 2011;23(3):207–14. https://doi.org/10.1080/10401334.2011.586910.
Andrews JS, Bale JF Jr, Soep JB, Long M, Carraccio C, Englander R, et al. Education in pediatrics across the continuum (EPAC): first steps toward realizing the dream of competency-based education. Acad Med. 2018;93(3):414–20. https://doi.org/10.1097/ACM.0000000000002020.
Ten Cate O, Graafmans L, Posthumus I, Welink L, van Dijk M. The EPA-based Utrecht undergraduate clinical curriculum: development and implementation. Med Teach. 2018;40(5):506–13. https://doi.org/10.1080/0142159X.2018.1435856.
Green EP, Gruppuso PA. Justice and care: decision making by medical school student promotions committees. Med Educ. 2017;51(6):621–32. https://doi.org/10.1111/medu.13280.
Cavalcanti RB, Detsky AS. The education and training of future physicians: why coaches can't be judges. JAMA. 2011;306(9):993–4. https://doi.org/10.1001/jama.2011.1232.
Acknowledgments
The authors wish to thank the Association of American Medical Colleges, Alison Whelan MD, Chris Hanley and Beatrice Schmider, and all of the members of the Core Entrustable Professional Activities for Entering Residency pilot for their support, inspiration, and contributions to this report. John Encandela, PhD, provided invaluable guidance on analysis and interpretation of the data. All participating CoreEPA pilot institutions and individuals can be found at https://www.aamc.org/initiatives/coreepas/pilotparticipants/.
Funding
This work was supported by the Association of American Medical Colleges and by the medical schools participating in the Core Entrustable Professional Activities for Entering Residency pilot.
Author information
Authors and Affiliations
Consortia
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare that they have no conflict of interest.
Ethical Approval
The protocol for this report was reviewed by Yale Human Subjects Research Protection Program and was deemed not to be human subject research.
Informed Consent
N/A
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
ESM 1
(DOCX 16 kb)
Rights and permissions
About this article
Cite this article
Moeller, J.J., Warren, J.B., Crowe, R.M. et al. Developing an Entrustment Process: Insights from the AAMC CoreEPA Pilot. Med.Sci.Educ. 30, 395–401 (2020). https://doi.org/10.1007/s40670-020-00918-z
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40670-020-00918-z