Comparing Entrustment Decision-Making Outcomes of the Core Entrustable Professional Activities Pilot, 2019-2020

Importance Gaps in readiness for indirect supervision have been identified for essential responsibilities encountered early in residency, presenting risks to patient safety. Core Entrustable Professional Activities (EPAs) for entering residency have been proposed as a framework to address these gaps...

Full description

Saved in:
Bibliographic Details
Published in:JAMA network open 2022-09, Vol.5 (9), p.e2233342-e2233342
Main Authors: Brown, David R., Moeller, Jeremy J., Grbic, Douglas, Andriole, Dorothy A., Cutrer, William B., Obeso, Vivian T., Hormann, Mark D., Amiel, Jonathan M., Amiel, Jonathan, Barron, Beth, Catallozzi, Marina, Obeso, Vivian, Biehler, Jefry, Brown, David R, Hormann, Mark, Adams, Sasha, Ownby, Allison R, Swails, Jennifer, Wagner, Dianne, Emery, Matthew, Sousa, Aron, Thompson-Busch, Angela, Cocks, Patrick M., Gillespie, Colleen C., Rosenfeld, Melvin, Tewksbury, Linda, Mejicano, George, Bumsted, Tracy, Phillipi, Carrie A., Warren, Jamie, Yingling, Sandra, Aiyer, Meenakshy, Jokela, Janet, Khan, Asra R., Chastain, Cody, Parekh, Kendra, Vasilevskis, Eduard, Ryan, Michael S., Biskobing, Diane M., Deiorio, Nicole, Trimble, Gregory, Green, Michael, Gielissen, Katherine, Wu, Barry, Whelan, Alison J.
Format: Article
Language:English
Subjects:
Decision making
Patient safety
Schools
Students
Supervision
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Importance Gaps in readiness for indirect supervision have been identified for essential responsibilities encountered early in residency, presenting risks to patient safety. Core Entrustable Professional Activities (EPAs) for entering residency have been proposed as a framework to address these gaps and strengthen the transition from medical school to residency. Objective To assess progress in developing an entrustment process in the Core EPAs framework. Design, Setting, and Participants In this quality improvement study in the Core EPAs for Entering Residency Pilot, trained faculty made theoretical entrustment determinations and recorded the number of workplace-based assessments (WBAs) available for each determination in 2019 and 2020. Four participating schools attempted entrustment decision-making for all graduating students or a randomly selected subset of students. Deidentified, individual-level data were merged into a multischool database. Interventions Schools implemented EPA-related curriculum, WBAs, and faculty development; developed systems to compile and display data; and convened groups to make theoretical summative entrustment determinations. Main Outcomes and Measures On an EPA-specific basis, the percentage of students for whom an entrustment determination could be made, the percentage of students ready for indirect supervision, and the volume of WBAs available were recorded. Results Four participating schools made 4525 EPA-specific readiness determinations (2296 determinations in 2019 and 2229 determinations in 2020) for 732 graduating students (349 students in 2019 and 383 students in 2020). Across all EPAs, the proportion of determinations of “ready for indirect supervision” increased from 2019 to 2020 (997 determinations [43.4%] vs 1340 determinations [60.1%]; 16.7 percentage point increase; 95% CI, 13.8-19.6 percentage points; P  < .001), as did the proportion of determinations for which there were 4 or more WBAs (456 of 2295 determinations with WBA data [19.9%] vs 938 [42.1%]; 22.2 percentage point increase; 95% CI, 19.6-24.8 percentage points; P  < .001). The proportion of EPA-specific data sets considered for which an entrustment determination could be made increased from 1731 determinations (75.4%) in 2019 to 2010 determinations (90.2%) in 2020 (14.8 percentage point increase; 95% CI, 12.6-16.9 percentage points; P  < .001). On an EPA-specific basis, there were 5 EPAs (EPA 4 [orders], EPA 8 [handovers], EPA 10 [urgent care]
ISSN:2574-3805
2574-3805
DOI:10.1001/jamanetworkopen.2022.33342