How can Entrustable Professional Activities serve the quality of health care provision through licensing and certification?
DOI:
https://doi.org/10.36834/cmej.73974Abstract
This paper about Entrustable Professional Activities (EPAs) was solicited to support the discussion about the future of licensing within the Medical Council of Canada. EPAs, units of professional practice to be entrusted to learners or professionals once they have shown to possess sufficient competence, were proposed in 2005 to operationalize competency-based postgraduate medical education and have become widely popular for various health professions education programs in many countries.
EPAs break the breadth of competence for license down to units of practice that can be overseen, assessed, monitored, documented, and entrusted. EPAs together may constitute an individual's portfolio of qualifications, and define a scope of practice. A medical license and a specialty certification can then be defined as the required combination of EPAs for which one is qualified at any specific moment in time. That 'snapshot' could change over time and reflect the professional development of the individual, both in their competence and in their privileges to practice. Micro-credentialing and digital badges might become an adequate option to show-case one's scope of practice at any time and operationalize the idea of a dynamic portfolio of EPAs.
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Shorey S, Lau TC, Lau ST, Ang E. Entrustable professional activities in health care education: a scoping review. Med Educ. 2019;53(8):766-777. https://doi.org/10.1111/medu.13879
O’Dowd E, Lydon S, O’Connor P, Madden C, Byrne D. A systematic review of 7 years of research on entrustable professional activities in graduate medical education, 2011–2018. Med Educ. 2019;53(3):234-249. https://doi.org/10.1111/medu.13792
Meyer EG, Chen HC, Uijtdehaage S, Durning SJ, Maggio LA. Scoping review of entrustable professional activities in undergraduate medical education. Acad Med. 2019;94(7):1040-1049. https://doi.org/10.1097/ACM.0000000000002735
Bramley A, McKenna L. Entrustable professional activities in entry-level health professional education: A scoping review. Med Educ. 2021;(Prepubl):0-3. https://doi.org/10.1111/medu.14539
ten Cate O. Entrustability of professional activities and competency-based training. Med Educ. 2005;39(12):1176-1177. https://doi.org/10.1111/j.1365-2929.2005.02341.x
Ten Cate O, Taylor DR. The recommended description of an entrustable professional activity: AMEE Guide No. 140. Med Teach. 2021;43(10):1106-1114. https://doi.org/10.1080/0142159X.2020.1838465
NN. Lexico. https://www.lexico.com/definition/Competence.
NN. Merriam-Webster Dictionary.
Oxford English Dictionary. Oxford University Press. https://www.oed.com.
ten Cate O. Medical Education, Competency-Based. In: Cockerham WC, Dingwall R, Quah SR, eds. The Wiley Blackwell Encyclopedia of health, illness, behavior, and society. Hoboken, NJ, USA: John Wiley & Sons, Ltd.; 2014:1329-1335. https://doi.org/10.1002/9781118410868.wbehibs331
ten Cate O, Scheele F. Viewpoint: competency-based postgraduate training: can we bridge the gap between theory and clinical practice? Acad Med. 2007;82(6):542-547. https://doi.org/10.1097/ACM.0b013e31805559c7
McGaghie WC, Miller GE, Sajid AW, Telder TW. Competency-Based Curriculum Development in Medical Education - an Introduction.; World Health Organization, 1978.
ten Cate O, Billett S. Competency-based medical education: origins, perspectives and potentialities. Med Educ. 2014;48(3):325-332. https://doi.org/10.1111/medu.12355
Teunissen PW, Watling C, Schrewe B, et al. Contextual Competence: how residents develop competent performance in new settings. Med Educ. 2021;55:1100-1109. https://doi.org/10.1111/medu.14517
ten Cate O. Entrustment as Assessment: Recognizing the Ability, the Right, and the Duty to Act. J Grad Med Educ. 2016;8(2):261-262. https://doi.org/10.4300/JGME-D-16-00097.1
Jonker G, Ochtman A, Marty AP, Kalkman CJ, Ten Cate O, Hoff RG. Would you trust your loved ones to this trainee? Certification decisions in postgraduate anaesthesia training. Br J Anaesth. 2020;125(5):E408-E410. https://doi.org/10.1016/j.bja.2020.07.009
Mattar SG, Alseidi AA, Jones DB, et al. General surgery residency inadequately prepares trainees for fellowship: Results of a survey of fellowship program directors. Ann Surg. 2013;258(3):440-447. https://doi.org/10.1097/SLA.0b013e3182a191ca
George BC, Bohnen JD, Williams RG, et al. Readiness of US General Surgery Residents for Independent Practice. Ann Surg. 2017;266(4):582-594. https://doi.org/10.1097/SLA.0000000000002414
Halpern SD, Detsky AS. Graded autonomy in medical education--managing things that go bump in the night. N Engl J Med. 2014;370(12):1086-1089. https://doi.org/10.1056/NEJMp1315408
ten Cate O, Hart D, Ankel F, et al. Entrustment decision making in clinical training. Acad Med. 2016;91(2):191-198. https://doi.org/10.1097/ACM.0000000000001044
ten Cate O, Schwartz A, Chen HC. Assessing trainees and making entrustment decisions. Vol Publish Ah.; 2020. https://doi.org/10.1097/acm.0000000000003427
Hauer KE, ten Cate O, Boscardin C, Irby DM, Iobst W, O’Sullivan PS. Understanding trust as an essential element of trainee supervision and learning in the workplace. Adv Heal Sci Educ. July 2013. https://doi.org/10.1007/s10459-013-9474-4
Norcini J, Blank L, Arnold G, Kimball H. The Mini-CEX (clinical evaluation exercise): a preliminary investigation. Ann Intern Med. 1995;123(10):795-799. https://doi.org/10.7326/0003-4819-123-10-199511150-00008
Norcini JJ, Blank LL, Duffy FD, Fortna GS. The Mini-CEX : a method for assessing clinical skills. Ann Intern Med. 2003;138:476-481. https://doi.org/10.7326/0003-4819-138-6-200303180-00012
Van Der Vleuten CPM, Schuwirth LWT, Driessen EW, et al. A model for programmatic assessment fit for purpose. Med Teach. 2012;34(3):205-214. https://doi.org/10.3109/0142159X.2012.652239
ten Cate O. entrustment decisions: bringing the patient into the assessment equation. Acad Med. 2017;92(6):736-738. https://doi.org/10.1097/ACM.0000000000001623
Ten Cate O, Carraccio C, Damodaran A, et al. Entrustment decision making: extending Miller’s Pyramid. Acad Med. 2021;96(2):199–204. https://doi.org/10.1097/ACM.0000000000003800
Ten Cate O, Chen HC, Hoff RG, Peters H, Bok H, Van Der Schaaf M. Curriculum development for the workplace using entrustable professional activities (EPAs): AMEE guide no. 99. Med Teach. 2015;37(11). https://doi.org/10.3109/0142159X.2015.1060308
Touchie C, Kinnear B, Schumacher D, et al. On the validity of summative entrustment decisions. Med Teach. 2021;(EarlyOnline). https://doi.org/10.1080/0142159X.2021.1925642
Hauer KE, Edgar L, Hogan SO, Kinnear B, Warm E. The science of effective group process: lessons for clinical competency committees. J Grad Med Educ. 2021;(April):S59-S64. https://doi.org/10.4300/JGME-D-20-00827.1
Smit MP, de Hoog M, Brackel HJL, ten Cate O, Gemke RJBJ. A national process to enhance the validity of entrustment decisions for Dutch pediatric residents. J Grad Med Educ. 2019;11(4s):158-164. https://doi.org/10.4300/jgme-d-18-01006
Kennedy TJT, Regehr G, Baker GR, Lingard L. Point-of-care assessment of medical trainee competence for independent clinical work. Acad Med. 2008;83(Supplement):S89-S92. https://doi.org/10.1097/ACM.0b013e318183c8b7
ten Cate O, Chen HC. The ingredients of a rich entrustment decision. Med Teach. 2020;42(12):1413-1420. https://doi.org/10.1080/0142159X.2020.1817348
de Graaf J, Bolk M, Dijkstra A, van der Horst M, Hoff RG, ten Cate O. The implementation of entrustable professional activities in postgraduate medical education in the Netherlands: rationale, process, and current status. Acad Med. 2021;96(7S):S29-S35. https://doi.org/10.1097/acm.0000000000004110
Wells K, Fleshman J. Screening Colonoscopy Should Be Available to All. JAMA Surg. 2019;154(7):636. https://doi.org/10.1136/jcp.2010.075507
ten Cate O, Carraccio C. Envisioning a true continuum of competency-based medical education, training and practice. Acad Med. 2019;94(9):1283-1288. https://doi.org/10.1097/ACM.0000000000002687
Englander R, Flynn T, Call S, et al. toward defining the foundation of the md degree: core entrustable professional activities for entering residency. Acad Med. 2016;91(10):1352-1358. https://doi.org/10.1097/ACM.0000000000001204
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):506-513. https://doi.org/10.1080/0142159X.2018.1435856
Ten Cate O. Trust, competence, and the supervisor’s role in postgraduate training. Br Med J. 2006;333(7571). https://doi.org/10.1136/bmj.38938.407569.94
Duijn C, Bok H, Ten Cate O, Kremer W. Qualified but not yet fully competent: Perceptions of recent veterinary graduates on their day-one skills. Vet Rec. 2020;186(7). https://doi.org/10.1136/vr.105329
de Raad T, Wiersma F, Kuilman L, ten Cate O. The fate of EPAs after graduation. A survey study among graduated physician assistants. (forthcoming).
Norcini J. Is it time for a new model of education in the health professions? Med Educ. 2020;54(8):687-690. https://doi.org/10.1111/medu.14036
ten Cate O, Pool IA. The viability of interprofessional entrustable professional activities. Adv Heal Sci Educ. 2020;25(5). https://doi.org/10.1007/s10459-019-09950-0
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