EPAs? Entrustable Professional Activities! Rikke Ogawa, MLIS, AHIP (D) - PowerPoint Presentation

EPAs?Entrustable Professional Activities! Rikke Ogawa, MLIS, AHIP (D) Midday at the OASIS July 20, 2016

Outline Background What are EPAs? Why now? How are they different from Competencies? Elements of the EPA framework Implications for Education AAMC pilot program Effect on & Opportunities for Libraries How does this relate to ACRL’s framework? AAHSL Task Force

Background on EPAs

What are EPAS? EPA = Entrustable Professional Activity “… units of professional practice, defined as tasks or responsibilities to be entrusted to the unsupervised execution by a trainee once he or she has attained sufficient specific competence ” Ten Cate O. “ Nuts and bolts of entrustable professional activities.” J Grad Med Educ. 2013 Mar;5(1):157-8. PMCID: PMC3613304

Why now? Graduation competencies/objectives are unique to each school Many based on recommendations of educational or medical specialty organizations No agreement on common set of behaviors that should be expected of all medical school graduates ACGME/ABMS Milestone Project

Competency-Based Medical Education “An observable ability of a health professional, integrating multiple components such as knowledge, skills, values, and attitudes. Since competencies are observable, they can be measured and assessed to ensure their acquisition.” Frank JR, Snell LS, Cate OT, et al. Competency-based medical education: Theory to practice. Med Teach. 2010;32:638–645. PMID: 20662574

EPAs, Competencies, Milestones EPA = larger unit of professional practice made up of competencies Competency = observable ability integrating multiple components (knowledge, skills, values, attitudes) Milestone = behavior that show performance AAMC Core Entrustable Professional Activities for Entering Residency: www.aamc.org/cepaer

Existing Competencies & Objectives ACGME (graduate medical education; residency) Medical School Objectives Project (AAMC) (1998) CanMEDS American Association of Colleges of Nursing Specialty boards (family med, peds , etc.)

Reference List of General Physician Competencies Patient Care Knowledge for practice Interpersonal and Communication Skills Professionalism Practice-Based Learning and Improvement Systems-Based Practice Interprofessional Collaboration Personal and Professional Development Englander R, et al. Toward a common taxonomy of competency domains for the health professions and competencies for physicians . Acad Med. 2013 Aug;88(8):1088-94. PMID: 23807109

Competencies related to information Patient care : 1.5: Make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment Practice-based learning & improvement: 3.6 : Locate, appraise, and assimilate evidence from scientific studies related to patients’ health problems 3.7 : Use information technology to optimize learning

EPAs Gather a history and perform a physical examination Prioritize a differential diagnosis following a clinical encounter Recommend and interpret common diagnostic and screening tests Enter and discuss orders and prescriptions Document a clinical encounter in the patient record Provide an oral presentation of an encounter Form clinical questions and retrieve evidence to advance patient care

EPAs (cont’d) Give or receive a patient handover to transition care responsibility Collaborate as a member of an interprofessional team Recognize a patient requiring urgent or emergent care and initiate evaluation and management Obtain informed consent for tests and/or procedures Perform general procedures of a physician Identify system failures and contribute to a culture of safety and improvement

What does entrustable look like? EPA 7 – form clinical questions and retrieve evidence to advance patient care Routinely identifies knowledge gaps Mantains sufficient knowledge base that can be translate to patient care Asks relevant clinical questions Retrieve and assess evidence Reports/applies evidence to effect change AAMC. “Core Entrustable Professional Activities for Entering Residency: Faculty and Learner’s Guide” p.53. Available online at : www.aamc.org/cepaer

What are the implications for the educational process?

Competency model of health professions education From To Teaching Learning Content Performance Measuring inputs Measuring outputs Time-based training Individualized pace

Some Questions EPAs Prompt Does the process need to be a linear progression? What if someone can demonstrate competence before year 4? Are our (libraries’ & med schools’) curricula relevant? If knowledge alone doesn’t equal competence, how does our test centric model of medical education need to change? How do we shift our emphasis toward outcomes and away from process (instructional modalities)?

AAMC 5 year Pilot Implementation program Columbia University College of Physicians and Surgeons Florida International University Herbert Wertheim College of Medicine Michigan State University College of Human Medicine New York University School of Medicine Oregon Health & Science University School of Medicine University of Illinois College of Medicine University of Texas Health Science Center at Houston Vanderbilt University School of Medicine Virginia Commonwealth University School of Medicine Yale University School of Medicine

Effect on & Opportunities for Libraries

Academic & Hospital Libraries Progress towards information literate MDs from day 1 Engagement in Curricula – UME, GME Design next generation of services & tools

How does this fit with ACRL framework? ACRL Framework for Information Literacy for Higher Education available online at: http :// www.ala.org/acrl/standards/ilframework Foundational ideas related to information literacy rather than competencies Previous Competencies: “ Information   Literacy Competency Standards for Higher Education” Rescinded by ACRL Board of Directors June 2016, see http:// www.acrl.ala.org/acrlinsider/archives/12126

AAHSL Task Force Identify AAHSL libraries that are participating to a significant degree in incorporating Core EPAs Develop a methodology to characterize the nature and depth of the participation . Map, cross-reference & identify gaps in existing medical organizations’ EBM competencies Compose a white paper or similar work for publication on the state of the art of librarians’ roles and involvement in all phases of competency-based medical education.

AAHSL Task Force Members Nancy Adams, Penn State Emily Brennan, MUSC Heather Collins, Kansas (Chair) Megan von Isenburg, Duke Iris Kovar-Gough, Michigan State Elizabeth R Lorbeer , Western Michigan University Joey Nicholson, NYU Rikke Ogawa, UCLA Judy Spak , Yale Kelly Thormodson, North Dakota

Questions