Entrustment and mapping of observable practice activities for resident assessment

Abstract

Entrustable Professional Activities (EPAs) and the Next Accreditation System reporting milestones reduce general competencies into smaller evaluable parts. However, some EPAs and reporting milestones may be too broad to use as direct assessment tools. We describe our internal medicine residency curriculum and assessment system, which uses entrustment and mapping of observable practice activities (OPAs) for resident assessment. We created discrete OPAs for each resident rotation and learning experience. In combination, these serve as curricular foundation and tools for assessment. OPA performance is measured via a 5-point entrustment scale, and mapped to milestones and EPAs. Entrustment ratings of OPAs provide an opportunity for immediate structured feedback of specific clinical skills, and mapping OPAs to milestones and EPAs can be used for longitudinal assessment, promotion decisions, and reporting. Direct assessment and demonstration of progressive entrustment of trainee skill over time are important goals for all training programs. Systems that use OPAs mapped to milestones and EPAs provide the opportunity for achieving both, but require validation.

Figure 1

Observable practice activities (OPAs).

Figure 2

a: NAS reporting milestone entrustment scores for a single PGY-3 resident for the 6-month periods of 7/1/12 to 12/31/12 (total of 495 assessments, average of 22.5 assessments per NAS milestone) and 1/1/13 to 6/30/13 (total of 927 assessments, average of 42.1 assessments per milestone). Entrustment scores are derived from entrustment decisions made by assessors for Observable Practice Activities over the course of the year. b, c, and d: comparison of entrustment curves for three PGY-1/2 residents (dark lines with circles) plotted against the entire class (grey line with diamonds) for the first five quarters of residency for a single NAS milestone (PC-2: develops and achieves comprehensive management plan for each patient). Curves such as these can be generated for every internal medicine NAS reporting milestone, curricular milestone, and end-of-training EPA. MedHub, Inc. P.O. Box 4148 Ann Arbor, Michigan 48106-4148.