1/31/2017 Presenter Overview of Entrustable Professional Activities for New Pharm acy Graduates Cynthia J. Boyle, Pharm.D., FAPhA 2016-2017 AACP Immediate Past President JCPP Meeting cjboyle@umes.edu February 2 , 2 0 1 7 American Association of Colleges of Pharmacy 2015-2016 Academic Affairs Committee 2016-2017 Academic Affairs Committee The Context Joint Commission for Pharmacy Practitioners – Pharmacists Care Process CAPE 2013 – 15 Competencies in 4 Domains NABP NAPLEX Blueprint – 47 Competencies in 8 W HAT I S THE Domains in 2 Areas I MPORTANCE OF EPA S ? ACPE Standards 2016 – “Practice-Ready” and “Team-Ready” Association of American Medical Colleges (AAMC) released a set of EPAs to guide medical education 3 3 1
1/31/2017 The 2015-2016 Academic Affairs The Charge, The Challenge Committee Identify the EPAs for pharmacy graduates Stuart T. Haines (University of Mississippi), Chair as they transition from completion of Amy Pittenger (University of Minnesota) Advanced Pharmacy Practice Experiences Alexander Kantorovich (Chicago State University) Brenda L. Gleason (St. Louis College of Pharmacy) into practice and post-graduate Jennifer M. Trujillo (University of Colorado) opportunities such as residency training. Marianne McCollum (Regis University) Scott K. Stolte (Roseman University) Cecilia M. Plaza (AACP staff liaison) Boyle CJ. Capitalizing on Foundations in Citizenship. Am J Pharm Educ. 2015; 4 5 70(6). Article S5. What are EPAs? EPAs are units of professional practice or descriptors of work, defined as specific tasks or responsibilities that trainees are entrusted to perform without direct supervision once they have attained sufficient competence EPAs are independently executable, observable, and measurable in W HAT ARE EPA S ? their process and outcome EPAs for New Pharmacy Graduates are discrete, essential activities and tasks that all new pharmacy graduates must be able to perform without direct supervision upon entering practice or postgraduate training 7 Association of American Medical Colleges (AAMC). Core Entrustable Professional 6 Activities (EPAs) for Entering Residency. 2014 2
1/31/2017 EPAs vs. Competencies vs. Example Learning Objectives EPA—Patient Care Provider Domain EPAs Com petencies/ Outcom es Learning Objectives Establish patient-centered goals and create a care plan for a patient in • • • Activities/ tasks that An observable ability of a A description of collaboration with the patient, caregiver(s), and other health professionals that is evidence-based and cost-effective. represent the day- pharmacist, integrating knowledge, skills, or to-day work of a multiple behaviors that you pharmacist components/ learning want learners to objectives such as exhibit at the end of Competencies/ Outcomes—CAPE 2013 • Specific tasks that knowledge, skills, the learning ● Learner ● Caregiver ● Problem Solver trainees that are attitudes/ values/ habits experience ● Collaborator ● Communicator ● Advocate entrusted to perform • • In aggregate, define the Atomistic, discrete • Descriptors of work “good pharmacist” Learning Objectives • Descriptors of Knowledge Skill Attitude/ Behavior pharmacists • • • Explain medication Efficiently use appropriate Demonstrate confidence selection based on the tertiary references to while interacting with EPAs, Competencies and Learning Objectives are not mutually exclusive. appropriate clinical check for interactions the healthcare team EPAs require integration of competencies which require integration of learning practice guideline objectives. 8 9 Advantages of EPAs Competency-Based Education Backward milestones In theory … – Roadmap for learners from program entry Move from fixed-time, variable to practice – Direct observation assessment strategy outcome to a across curriculum fixed-outcome, variable time model Designation of trust level without judgmental That is … description Learners only progress once competencies have Allow for direct observation assessment 10 11 been demonstrated 3
1/31/2017 Audiences for EPAs Internal Stakeholders – Colleges/ Schools – Students W HO ARE THE AUDI ENCES FOR EPA S ? – Pharmacy Organizations – Practicing Pharmacists 13 12 Audiences for EPAs External Stakeholders – Other healthcare professionals – Prospective students W HEN, W HERE, AND HOW – Patients – Media MI GHT EPA S BE USED I N – Public PHARMACY EDUCATI ON? – Payers 14 15 4
1/31/2017 EPAs in the Didactic Curriculum EPAs in the Didactic Curriculum Operationalize competencies into discrete, Curricular Development measurable activities that pharmacists perform – Start with the end in mind Require students to demonstrate the necessary – Map competencies and content to EPAs combination of knowledge, skills, attitudes to be effective clinicians. Curricular Delivery – Course design, course activity design – Link multiple competencies into discrete activities – Determine expected level of trust at different points in the curriculum 16 17 EPAs in the Didactic Curriculum EPAs in the Didactic Curriculum Assessment/ Evaluation – Operationalize multiple competencies into EPAs Communication Strategy that are observable and can be practiced and – Help articulate what the curriculum is trying to assessed achieve – May require multi-step process with repeated low – Provide students, faculty, and preceptors with stakes assessments leading to summative a clear understanding of program outcomes evaluation – Consider strategies such as Objective Structured Clinical Examinations (OSCEs) or similar 19 18 observable, skill-based assessments 5
1/31/2017 EPAs in the Experiential Curriculum An Example Throughout the Curriculum IPPE and APPE activity development “ Collect information to identify a patient’s medication-related problems and health-related Multiple and repeated opportunities to practice EPAs with formative feedback needs. ” – Introduced in a pharmacotherapeutics didactic course Assessment/ Evaluation – Reinforced in a skills lab with simulated practice – From low to higher levels of entrustable performance opportunities and assessment – Practiced in a community-based IPPE Preceptor Development – Repeatedly performed during APPEs, moving from lower to higher levels of entrustability at specified milestones 20 21 EPA use in Pharmacy Education Represent the minimum baseline set of activities THE EPA S FOR NEW They are not meant to represent the ceiling. PHARMACY They are not meant to be GRADUATES limiting. Colleges and schools of pharmacy are encouraged to expand the list to meet their own institutional missions. 23 22 6
1/31/2017 EPA Development Methods EPA Development Methods Statement development occurred in four rounds Round 3 Round 1 generated 151 statements – 111 statements met criteria and retained – Committee members brainstormed 151 draft – Statements were then grouped by theme statements based on CAPE 2013, JCPP Pharmacists’ – Further review combined, parsed statements for clarity Care Process, and NABP NAPLEX Blueprint • 51 draft EPAs moved forward Round 2 Round 4 – Draft statements were further categorized – Each statement was reviewed to determine if • The statement was a discrete task or activity • Essential EPA Statements • That task or activity could be assigned and observed – All pharmacists must be able to carry out the function/ activity • Supporting EPA/ Task – Statements were retained or deleted after agreement – A task or activity that is done in order to accomplish an essential EPA by 75% of committee members 25 24 EPA Development Methods EPA Development Methods Influence of Context EPAs were further classified – Activities and tasks might be entrustable in – Context independent some settings and not others – Entrustable only with further training or experience • Environment/ Setting: volume, pace, access to Statements were deleted if: resources, staffing, technology, scope of practice – The EPA was a specialized activity • Patient/ Population: acuity/ stability, urgency, – The task could not be entrusted to a new graduate number of medications, health literacy, comorbid without direct supervision conditions The initial draft EPAs (“the list”) – 28 Essential EPA Statements 26 – 18 Supporting Task Statements 28 7
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