Entrustment Decision Making in the Core Entrustable Professional Activities: Results of a Multi-Institutional Study

Affiliations

¹ D.R. Brown is professor, chief, Division of Family and Community Medicine, and interim chair, Department of Humanities, Health, and Society, Florida International University Herbert Wertheim College of Medicine, Miami, Florida; ORCID: http://orcid.org/0000-0002-5361-6664 .
² J.J. Moeller is associate professor and residency program director, Department of Neurology, Yale University School of Medicine, New Haven, Connecticut; ORCID: https://orcid.org/0000-0002-6135-5572 .
³ D. Grbic is lead research analyst, Medical Education Research, Association of American Medical Colleges, Washington, DC.
⁴ D.M. Biskobing is professor of medicine and associate dean of medical education, Virginia Commonwealth University School of Medicine, Richmond, Virginia.
⁵ R. Crowe is director of integrated clinical skills, director of practice of medicine, Office of Medical Education, and associate professor of medicine, New York University Grossman School of Medicine, New York, New York.
⁶ W.B. Cutrer is associate dean for undergraduate medical education and associate professor of pediatrics (critical care medicine), Vanderbilt University School of Medicine, Nashville, Tennessee; ORCID: https://orcid.org/0000-0003-1538-9779 .
⁷ M.L. Green is professor of medicine and director of student assessment, Teaching and Learning Center, Yale University School of Medicine, New Haven, Connecticut.
⁸ V.T. Obeso is associate dean for curriculum and medical education and associate professor, Division of Internal Medicine, Department of Translational Medicine, Florida International University Herbert Wertheim College of Medicine, Miami, Florida.
⁹ D.P. Wagner is associate dean for undergraduate medical education and professor of medicine, Michigan State University College of Human Medicine, East Lansing, Michigan.
¹⁰ J.B. Warren is associate professor, Division of Neonatology, and clinical vice chair, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon; ORCID: https://orcid.org/0000-0003-4422-1502 .
¹¹ S.L. Yingling is associate dean for educational planning and quality improvement, University of Illinois College of Medicine (Chicago, Peoria, Rockford, and Urbana), Chicago, Illinois.
¹² D.A. Andriole is senior director, Medical Education Research, Association of American Medical Colleges, Washington, DC; ORCID: https://orcid.org/0000-0001-8902-1227 .

PMID: 34261864
DOI: 10.1097/ACM.0000000000004242

Multicenter Study

Entrustment Decision Making in the Core Entrustable Professional Activities: Results of a Multi-Institutional Study

David R Brown et al. Acad Med. 2022.

. 2022 Apr 1;97(4):536-543.

doi: 10.1097/ACM.0000000000004242.

Affiliations

¹ D.R. Brown is professor, chief, Division of Family and Community Medicine, and interim chair, Department of Humanities, Health, and Society, Florida International University Herbert Wertheim College of Medicine, Miami, Florida; ORCID: http://orcid.org/0000-0002-5361-6664 .
² J.J. Moeller is associate professor and residency program director, Department of Neurology, Yale University School of Medicine, New Haven, Connecticut; ORCID: https://orcid.org/0000-0002-6135-5572 .
³ D. Grbic is lead research analyst, Medical Education Research, Association of American Medical Colleges, Washington, DC.
⁴ D.M. Biskobing is professor of medicine and associate dean of medical education, Virginia Commonwealth University School of Medicine, Richmond, Virginia.
⁵ R. Crowe is director of integrated clinical skills, director of practice of medicine, Office of Medical Education, and associate professor of medicine, New York University Grossman School of Medicine, New York, New York.
⁶ W.B. Cutrer is associate dean for undergraduate medical education and associate professor of pediatrics (critical care medicine), Vanderbilt University School of Medicine, Nashville, Tennessee; ORCID: https://orcid.org/0000-0003-1538-9779 .
⁷ M.L. Green is professor of medicine and director of student assessment, Teaching and Learning Center, Yale University School of Medicine, New Haven, Connecticut.
⁸ V.T. Obeso is associate dean for curriculum and medical education and associate professor, Division of Internal Medicine, Department of Translational Medicine, Florida International University Herbert Wertheim College of Medicine, Miami, Florida.
⁹ D.P. Wagner is associate dean for undergraduate medical education and professor of medicine, Michigan State University College of Human Medicine, East Lansing, Michigan.
¹⁰ J.B. Warren is associate professor, Division of Neonatology, and clinical vice chair, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon; ORCID: https://orcid.org/0000-0003-4422-1502 .
¹¹ S.L. Yingling is associate dean for educational planning and quality improvement, University of Illinois College of Medicine (Chicago, Peoria, Rockford, and Urbana), Chicago, Illinois.
¹² D.A. Andriole is senior director, Medical Education Research, Association of American Medical Colleges, Washington, DC; ORCID: https://orcid.org/0000-0001-8902-1227 .

PMID: 34261864
DOI: 10.1097/ACM.0000000000004242

Abstract

Purpose: In 2014, the Association of American Medical Colleges defined 13 Core Entrustable Professional Activities (EPAs) that all graduating students should be ready to do with indirect supervision upon entering residency and commissioned a 10-school, 5-year pilot to test implementing the Core EPAs framework. In 2019, pilot schools convened trained entrustment groups (TEGs) to review assessment data and render theoretical summative entrustment decisions for class of 2019 graduates. Results were examined to determine the extent to which entrustment decisions could be made and the nature of these decisions.

Method: For each EPA considered (4-13 per student), TEGs recorded an entrustment determination (ready, progressing but not yet ready, evidence against student progressing, could not make a decision); confidence in that determination (none, low, moderate, high); and the number of workplace-based assessments (WBAs) considered (0->15) per determination. These individual student-level data were de-identified and merged into a multischool database; chi-square analysis tested the significance of associations between variables.

Results: The 2,415 EPA-specific determinations (for 349 students by 4 participating schools) resulted in a decision of ready (n = 997/2,415; 41.3%), progressing but not yet ready (n = 558/2,415; 23.1%), or evidence against student progression (n = 175/2,415; 7.2%). No decision could be made for the remaining 28.4% (685/2,415), generally for lack of data. Entrustment determinations' distribution varied across EPAs (chi-square P < .001) and, for 10/13 EPAs, WBA availability was associated with making (vs not making) entrustment decisions (each chi-square P < .05).

Conclusions: TEGs were able to make many decisions about readiness for indirect supervision; yet less than half of determinations resulted in a decision of readiness to perform this EPA with indirect supervision. More work is needed at the 10 schools to enable authentic summative entrustment in the Core EPAs framework.

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References

1. Hall AK, Rich J, Dagnone JD, et al. It’s a marathon, not a sprint: Rapid evaluation of competency-based medical education program implementation. Acad Med. 2020;95:786–793.
1. Hauer KE. Seeking trust in entrustment: Shifting from the planning of entrustable professional activities to implementation. Med Educ. 2019;53:752–754.
1. ten Cate O. Entrustability of professional activities and competency-based training. Med Educ. 2005;39:1176–1177.
1. Chen HC, van den Broek WE, ten Cate O. The case for use of entrustable professional activities in undergraduate medical education. Acad Med. 2015;90:431–436.
1. 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;91:1352–1358.

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Entrustment Decision Making in the Core Entrustable Professional Activities: Results of a Multi-Institutional Study

Affiliations

Entrustment Decision Making in the Core Entrustable Professional Activities: Results of a Multi-Institutional Study

Authors

Affiliations

Abstract

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Research Materials