Development of Entrustable Professional Activities (EPAs) for Public
Health and Preventive Medicine (PHPM)
PHPM Program Directors April 13, 2015
Brent Moloughney, MD, MSc, FRCPC
Public Health Consultant
Webinar Goal
• Bring PHPM Program Directors up-to-date in preparation for an online survey to seek feedback on a draft, national core set of EPAs
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Overview
• EPAs – what and why
• PD working group and workshop
• Online survey and next steps
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Problem
• Challenges with the PHPM status quo:
– Long list of Objectives of Training:
• Provides detailed expectations
• But potentially overwhelming for residents and faculty
• Competence requires integration of competencies
– Final exam success rates
– All residents prepared for practice?
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Context
Historical • Training defined by specific amount of time in various rotations (‘dwell time’) • Exposure to situations & teaching within rotation (assume) uptake of necessary KSAs to produce professional • End-of-rotation ‘gestalt’ evaluation • Final exam as last hurdle to certification
CBME • Explicit competencies to be acquired • Stages of competence development defined by achievement of competency-based milestones (not time) • More frequent, direct observation to evaluate 5
• Shift in residency education – competence by design not opportunistic learning
Royal College
• Continuing evolution of CBME
• CanMEDS 2015:
– Competence continuum
• Transition to discipline
• Foundations of discipline
• Core of discipline
• Transition to practice
– Milestones
• Observable marker of an individual’s ability along a developmental continuum
– Earlier final examination (out-of-scope for this project)
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Entrustable Professional Activities (EPAs)
• Capture the work that is central/critical to a specialty
• Link competencies/milestones to practice in an integrated/holistic manner
• Be more explicit about assessing and documenting performance of specific activities/tasks
• Support graded supervision – entrust the activity to a trainee to execute once obtained adequate competence
• Being pursued by multiple disciplines around the world 8
Objectives of Training – Analytic Approach
ten Cate. ICRE 2013
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EPAs - Synthetic Approach
ten Cate. ICRE 2013
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EPAs and Milestones
• RC intends to use milestones and EPAs to redesign specialist training and assessment – Milestone is observable marker of an individual's
ability along a developmental continuum
– EPA is the task that must be accomplished - each EPA integrates multiple milestones
• Vision for application: – Use milestones to design educational activities and
teach specific abilities, skills and attitudes
– Assess overall achievement of various milestones using an EPA
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http://www.royalcollege.ca/portal/page/portal/rc/resources/publications/dialogue/vol15_2/epa_milestones
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EPAs are the tasks that must be accomplished, whereas milestones are the abilities of the individual
Example*
• EPA: Manage an infectious disease outbreak
• Milestones (examples) – Transition to discipline (post-MD clinical)
• Elicit relevant information for a suspect reportable disease
– Foundations (coursework) • Describe steps in an outbreak investigation
– Core (early rotations) • Assume under direct supervision a support role (e.g., case
finding plan; generate case definition; etc.)
– Transition to practice (late rotation) • Assume under minimal supervision the lead role (e.g.,
declare outbreak; organize team; plan/implement investigation; etc.)
13 *Calgary EPAs
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RC, PHPM & EPAs
• Number of broader issues that need to be explored with RC (note: opportunity to do so at March meeting): – Looking initially for PHPM EPAs to be a resource to
all programs and be non-prescriptive – issues?
– Looking forward, how might EPAs align with RC activities (e.g., accreditation, final examination)?
– Potential for RC support for future tasks? (e.g., packaging the EPAs, translation, learning & assessment tools, etc.)
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Check-In
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Path to PHPM EPAs
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Queen’s 2-Day Workshop (Mar 2015)
• Attendance: Queen’s, McMaster, Toronto, Ottawa, McGill, Calgary
• Inputs: – Calgary EPAs (with milestones) – 31 – Ontario EPAs (titles) – 27 (in 9 domains) – Experience in EPA development (e.g., Queen’s
pursuing across multiple disciplines)
• EPAs – Literature: 15-30 typically to describe a discipline;
fewer better than many – Focus is on ‘end of training’ EPAs – eventually may
have others for earlier stages of training
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Queen’s 2-Day Workshop (Mar 2015)
• Outputs:
– 20 end-of-training EPAs in 4 groups/domains
– Preliminary milestone work on 6 new EPAs
– Discussed issue of optional ‘clinical’ EPAs
– Discussed need for case-based learning & assessment
– Discussed need to seek feedback from other PDs
• Plan for online survey
• Need to bring other PDs up-to-speed
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End-of-Training EPAs (20) • Core/critical tasks for PHPM graduate – 4 groups:
– Monitor & assess the health of the public – Leadership and management – Protect the public’s health – Promote health and prevent diseases and injuries
• Reflect what was in Calgary and Ontario EPAs – For same concepts wording preference – For differences in scale went macro – Sought better language consistency:
• Verbs: ‘lead and manage’; manage ‘x’ = manage all aspects (reflected in EPA descriptions)
– Addressed balance of content areas: • Identified health promotion/disease prevention items
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Online Survey – Core EPAs
• 20 items are ‘draft’ – need feedback!
• Seek level of agreement and comments on each:
– EPA statement
– EPA brief description
• Plus, when view collectively, whether any suggested deletions or improvements
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Additional ‘Optional’ EPAs
• At the Queen’s workshop, it was noted that some residents pursue work in various clinical settings and in the broader health system; e.g.,:
– Community-oriented primary care practice
– Focussed clinical practice (TB clinic, STI clinic, addictions, travel medicine, etc.)
– Broader health system leadership and stewardship (e.g., RHA).
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Additional ‘Optional’ EPAs (cont’d)
• Challenge: – These career streams mentioned in introduction
of the Objectives of Training,
– But are not explicitly addressed in the competencies (or the draft core EPAs).
• Approach: – Workshop participants requested the survey ask
all PDs whether optional EPAs should be developed for one or more of these career streams.
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Case-Based Learning & Assessment
• EPAs’ focus on observable and measureable learning and assessment
• Considering the expected breadth of PHPM practice, there are intrinsic challenges:
– Training stages do not build seamlessly
– Limited overall field placement time
– Tasks: low volume and high duration
– Some scenarios rare – cannot expect residents to have universal opportunity to address
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Case-Based Learning & Assessment (cont’d)
• Implication is that cannot rely on placements alone for learning and assessment of EPAs
• Need a range of case-based learning and assessment scenarios and simulations
• Ideally, would enable roles for different levels of training
• Online survey will include questions: – To prioritize the EPAs that are most dependent on
scenarios and simulations
– To develop inventory of existing tools • inform future work…
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Survey Logistics
• Planning for distribution week of April 20th
• Provide 2.5-3 weeks to complete
• Have results summarized for end of May meeting with recommendations for next steps.
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Further Information
• PHPM EPA development resources: http://familymedicine.queensu.ca/education/phpm/competency_by_design_initiative/resources
• Brent Moloughney: [email protected]
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