Core Entrustable Professional Activities (EP As) and Librarian Involvement in Competency-based Medical Education Canadian Health Libraries Association / Association des bibliothèques de la santé du Canada 2018 Association of Academic Health Sciences Libraries - Competency-Based Medical Education Task Force CC BY-NC
What is Competency-Based Medical Education? CBME is a learner-centered, time-agnostic, outcomes-based approach to the design, implementation, assessment and evaluation of medical education using an organizing framework of competencies (Frank et al. 2010, Boyd et al. 2017). Competencies are predominantly in the literature as understood as observable and measurable abilities that, when actively integrated in practice, constitute physician competence. (Frank et al. 2010, Boyd et al. 2017).
What are Entrustable Professional Activities (EP As)? Developed by AAMC in 2014 A core group of 13 activities that all residents entering their first year of residency should be able to complete without supervision regardless of specialty. Based on a documented performance gap EP As are “ units of professional practice, defined as tasks or responsibilities that trainees are entrusted to perform unsupervised once they have attained sufficient specific competence. EP As are independent ly execut able, observable, and measurable in their process and outcome, and, therefore, suitable for entrustment decisions.” (EP A Curriculum Designer Toolkit) Being piloted by 10 medical schools
• Gather a history and perform a physical examination. 1 • Prioritize a differential diagnosis following a clinical encounter. 2 • Recommend and interpret common diagnostic and screening tests. 3 • Enter and discuss orders and prescriptions. 4 • Document a clinical encounter in the patient record. 5 • Provide an oral presentation of a clinical encounter. 6 • Form clinical questions and retrieve evidence to advance patient care. 7 • Give or receive a patient handover to transition care responsibility. 8 • Collaborate as a member of an interprofessional team. 9 • Recognize a patient requiring urgent or emergent care and initiate evaluation and management. 10 • Obtain informed consent for tests and/ or procedures. 11 • Perform general procedures of a physician. 12 • Identify system failures and contribute to a culture of safety and improvement. 13
AAHS L CBME Taskforce Activities to Date 12 member task force formed S pring 2016 to evaluate how the entrustable professional activity competency framework was being implemented and potential areas of engagement for librarians in clinical competency entrustment. Core tasks: identify how libraries were participating in Core EP A activities and develop a methodology to characterize the nature of their participation; map EP As to ACRL framework
S urvey Results & Analysis
S urvey A survey was developed in Qualtrics and sent to medical schools via the AAHS L listserv in fall of 2016. The survey was distributed to all 164 AAHS L member libraries in S eptember 2016, garnering a 52% response rate or 85 members. Results were analyzed using S PS S and with the expertise of a statistician.
Is your library involved in implementing Core EPAs in the undergraduate medical curriculum at your medical school? I am unsure whether Core EP As are being implemented at our Y es, librarians are working institution. with individuals in the medical school to implement one or more 23% Core EP As. No, Core EP As are not being implemented at our institution. 39% Y es, the library is working on its 15% own proj ect to implement one or No, the library is not more Core EP As, without others at involved in the institution. implementing Core EP As 22% although Core EP As are 1% being implemented at the institution.
Which Core EPAs are being planned and/or implemented in the undergraduate medical curriculum at your medical school? 100% 18% 90% 20% 20% 20% 22% 22% 22% 24% 24% 24% 24% 25% 29% 2% 80% 2% 0% 4% 4% 2% 4% 2% 2% 2% 4% 4% 18% 70% 2% 60% 37% 50% 55% 67% 67% 65% 71% 67% 73% 40% 71% 59% 69% 67% 63% 30% 20% 37% 22% 10% 12% 12% 10% 10% 8% 6% 4% 4% 4% 4% 0% EPA 1 EPA 2 EPA 3 EPA 4 EPA 5 EPA 6 EPA 7 EPA 8 EPA 9 EPA 10 EPA 11 EPA 12 EPA 13 Insufficient information to answer Not being implemented or planned at t he instit ution Implemented or planned but library is not involved Library is involved
EP A 7 Description On day 1 of residency, it is crucial that residents be able to identify key clinical questions in caring for patients, identify information resources, and retrieve information and evidence that will be used to address those questions. Day 1 residents should have basic skill in critiquing the quality of the evidence and assessing applicability to their patients and the clinical context. Underlying the skill set of practicing evidence-based medicine is the foundational knowledge an individual has and the self-awareness to identify gaps and fill them.
EP A 7 Functions Develop a well-formed, focused, pertinent clinical question based on clinical scenarios or real-time patient care. Demonstrate basic awareness and early skills in appraisal of both the sources and content of medical information using accepted criteria. Identify and demonstrate the use of information technology to access accurate and reliable online medical information. Demonstrate basic awareness and early skills in assessing applicability/ generalizability of evidence and published studies to specific patients. Demonstrate curiosity, obj ectivity, and the use of scientific reasoning in acquisition of knowledge and application to patient care. Apply the primary findings of one’s information search to an individual patient or panel of patients. Communicate one’s findings to the health care team (including the patient/ family). Close the loop through reflection on the process and the outcome for the patient.
What Functions of EP A 7 Are Being Taught or Assessed? 80 70 60 50 40 30 20 10 0 Teach in the Assess in the Teach In the Clinical Assess In the Clinical Teach In Both Assess In Both Do not Teach at all Do not Assess at all Preclinical Preclinical Curriculum Curriculum Preclinical and Preclinical and Curriculum Curriculum Clinical Curriculum Clinical Curriculum Develop a well-formed, focused, pertinent clinical question Demonstrate basic awareness and early skills in appraisal of both the sources and content of medical information using accepted criteria Identify and demonstrate the use of information technology to access accurate and reliable online medical information Demonstrate basic awareness and early skills in assessing applicability/generalizability of evidence and published studies to specific patients Demonstrate curiosity, objectivity, and the use of scientific reasoning in acquisition of knowledge and application to patient care Apply the primary findings of one’s information search to an individual patient(s) Communicate one’s findings to the health care team (including the patient/family) Close the loop through reflection on the process and the outcome for the patient
Challenges and Barriers - The Librarian Perspective 100 90 80 70 60 50 40 30 20 10 0 No orientation Lack of time in Institution not No Lack of models Lack of Difficulty Difficulty Lack of S tudent or to Core EPAs the curriculum currently librarian/ staff from other resources (i.e. integrating integrating evidence of the faculty push- for librarians implementing training or libraries on time, funding) Core EPA- Core EPA- value of Core back regarding and/ or staff Core EPAs expertise in implementing in the library to related content related content EPAs the importance content related Core EPAs implement Core into the into the clinical of Core EPAs to Core EPAs EPAs preclinical phase of the vs. traditional phase of the curriculum basic science or curriculum clinical content Extremely S ignificant More S ignificant Less S ignificant Not Significant
Challenges Teaching and Assessing EP A 7 Not much research out there about EP A 7 and what there is demonstrates challenges. Program Directors do not think that residents can proficiently form or answer clinical questions using the biomedical literature. (Pearlman 2017 and Lindeman 2015) UGME and GME literature does confirm what librarians have long known. This is a hard skill to teach, assess, and promote across learner contexts. Key takeaway: this is a skill being discussed within clinical frameworks outside of our profession.
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