U N I V E R S I T Ä T S M E D I Z I N B E R L I NU N I V E R S I T Ä T S M E D I Z I N B E R L I N

Identifying EPAs for

Undergraduate Medical

Education

Y Holzhausen, A Maaz, A Degel, H Peters

Charité Universitätsmedizin BerlinDieter Scheffner Center for Medical

Teaching and Educational Research

AMEE 2014

U N I V E R S I T Ä T S M E D I Z I N B E R L I N 2

1995

Traditional curriculum

2000 2005 2010 2015

Modular curriculumReformed curriculum

Change of legal frame work

Main characteristics:

• Integrated, modular structure

• Competency‐based

• Learner‐based

• Patient‐based

Background

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• EPAs (ten Cate, 2005)

• Widely applied in postgraduate medical education

• Trend to apply it in undergraduate medical education

AAMC: 13 Core Entrustable Professional Activities for Entering Residency (2014)

Background

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Goal of Delphi Study

• Define Core EPAs for Entering Residency Outcomes for the modular curriculum Charité

Objectives

(Association of American Medical Colleges, 2013)

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Participants (n= 46)• Physicians of varying medical specialties (25)

• Experts in curricular planning

Round 1 (August 2014)

Sample

n 17 ( 37%)

Gender ♂ = 65%

Age M = 45.47 (SD = 8.19)

Work Experience (Years) M = 18.56 (SD =7.6)

Teaching Experience (Years) M = 14.29 (SD = 6.2)

Medical Specialties 12

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1. Gather a history and perform a physical examination and generate a list of problems

2. Develop and implement a diagnostic plan

3. Interpret diagnostic results and act on them

4. Develop and implement a treatment plan

5. Provide an oral presentation of a clinical encounter

6. Retrieve best evidence for distinct clinical question and the individual patient

7. Obtain informed consent for tests and/or procedures

8. Perform general procedures of a physician

9. Inform, advise and instruct a patient

10. Give or receive a patient handover

11. Document a clinical encounter in the patient record

12. Recognize an emergency situation and act on it

List of EPAs

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Item Response

Relevance of EPA

Clarity of title

Completeness of description

4-point likert scale (disagree- agree)

Acceptance of title

Acceptance of description

Accept / Change / Complement

Difficulty of EPA High / Appropriate / Low

Additional EPAs  Free text

Questionnaire

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Results: Relevance of EPAs

  EPA CVI Rating(Relevance)

Mean (SD)

1 Gather a history and perform a physical examination and generate a list of problems

94.1  3.59(.8)

2 Develop and implement a diagnostic plan 88.2  3.29(.85)

3 Interpret diagnostic results and act on them 82.4  3.29(.92)

4 Develop and implement a treatment plan 76.5  3.12(.93)

5 Provide an oral presentation of a clinical encounter 94.1  3.63(.72)

6 Retrieve best evidence for distinct clinical question and the individual patient

58.8  2.82(.81)

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  EPA CVI Rating(Relevance)

Mean(SD)

7 Obtain informed consent for tests and/or procedures

88.2  3.59(.71)

8 Perform general procedures of a physician 88.2  3.41(.71)

9 Inform, advise and instruct a patient 62.5  2.81(1.05)

10 Give or receive a patient handover 88.2  3.59(.71)

11 Document a clinical encounter in the patient record 76.5  3.18(.95)

12 Recognize an emergency situation and act on it 70.6  3.24(.90)

Results: Relevance of EPAs

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Results: Difficulty of EPAs

EPA12

EPA11

EPA10

EPA9

EPA8

EPA7

EPA6

EPA5

EPA4

EPA3

EPA2

EPA1

0 10 20 30 40 50 60 70 80 90 100

easyappropriatedifficult

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  EPA CVI Rating(Relevance)

Difficulty

6 Retrieve best evidence for distinct clinical question and the individual patient

58.8 70.629.4

9 Inform, advise and instruct a patient 62.5 58.841.2

12 Recognize an emergency situation and act on it 70.6 70.629.4

Results: Content Validity Index

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• Interaction between curriculum experts and faculty members

• Consequences for the modular curriculum at the Charité

• Overlap with other EPAs

• Validation of international EPAs for undergraduate medical education

Key Points

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Thank you for your attention

Ylva Holzhausen

Charité - Universitätsmedizin Berlin

Dieter Scheffner Center for Medical Teaching and Educational Research

Charitéplatz 1

10117 Berlin

Tel. +49 30 450 576 457

ylva.holzhausen@charite.de

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References

1. ten Cate, O. (2005). Entrustability of professional activities and competency-based training. Medical Education, 39(12), 1176-1177.

2. Core entrustable professional´activities for entering residency (CEPAER).

Available at https://www.mededportal.org/icollaborative/resource/887

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Neurology Intensive Care

Psychiatry Audiology

Psychosomatic Medicine Dermatology

Cardiology Otolaryngology

Endocrinology General Medicine

Geriatric Medicine Surgery

Nephrology Oncology

Rheumatology Obstetrics

Urology Pediatrics

Anesthesiology Neonatology

Policlinic Gynecology

Emergency Medical Aid

List of Medical Specialties

U N I V E R S I T Ä T S M E D I Z I N B E R L I N 16

Title Gather a history and perform a physical examination and generate a list of problems

Description In the first days of residency, the resident is able to gather a history and to perform a physical examination of an adult patient with a typical presentation and/or a common disease. Following the encounter, the resident is able to generate a structured list of problems.

This applies for both the inpatient and outpatient sector. It is expected that the professional activity is executed in a complete and focused fashion and is adapted to the situational requirements. This also includes the searching for typical complaints and signs of relevant illnesses and health problems (differential diagnosis on a patient). The results are expected to be presented by means of a structured summary and list of problems to the supervising physician (main complaints, additional complaints diagnosis and problems).

This EPA applies to common diseases/health problems and their typical presentations.

This EPA does not apply to:1)Newborns, babies, children, adolescents and pregnant women;2) No interdisciplinary diseases/health problems

Example of EPA