Benefits of EPAs at risk? The influence of the workplace environment on the uptake of EPAs in EPA-based curricula
Tóm tắt
Introduction Entrustable Professional Activities (EPAs) have been applied differently in many postgraduate medical education (PGME) programmes, but the reasons for and the consequences of this variation are not well known. Our objective was to investigate how the uptake of EPAs is influenced by the workplace environment and to what extent the benefits of working with EPAs are at risk when the uptake of EPAs is influenced. This knowledge can be used by curriculum developers who intend to apply EPAs in their curricula. Method For this qualitative study, we selected four PGME programmes: General Practice, Clinical Geriatrics, Obstetrics & Gynaecology, and Radiology & Nuclear Medicine. A document analysis was performed on the national training plans, supported by the AMEE Guide for developing EPA-based curricula and relevant EPA-based literature. Interviews were undertaken with medical specialists who had specific involvement in the development of the curricula. Content analysis was employed and illuminated the possible reasons for variation in the uptake of EPAs. Results An important part of the variation in the uptake of EPAs can be explained by environmental factors, such as patient population, the role of the physician in the health-care system, and the setup of local medical care institutions where the training programme takes place. The variation in uptake of EPAs is specifically reflected in the number and breadth of the EPAs, and in the way the entrustment decision is executed within the PGME programme.
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Tài liệu tham khảo
Frank J. The CanMEDS 2005 physician competency framework: better standards, better physicians, better care. Ottawa: Royal College of Physicians and Surgeons of Canada; 2005.
Ten Cate O, Scheele F. Viewpoint: competency-based postgraduate training: can we bridge the gap between theory and clinical practice? Acad Med. 2007;82:542–7.
Prescott LE, Norcini JJ, McKinlay P, Rennie JS. Facing the challanges of competency-based assessment of postgraduate dental training: Longitudinal Evaluation of Performance (LEP). Med Educ. 2002;36:92–7.
Lurie SJ, Mooney CJ, Lyness JM. Measurement of the general competencies of the accreditation council for graduate medical education: a systematic review. Acad Med. 2009;84:301–9.
Ten Cate O. Entrustability of professional activities and competency-based training. Med Educ. 2005;39:1176–7.
Ten Cate O, Chen HC, Hoff RG, Peters H, Bok H, van der Schaaf M. Curriculum development for the workplace using Entrustable Professional Activities (EPAs): AMEE Guide No. 99. Med Teach. 2015;37:983–1002.
Ten Cate O. Entrustment as assessment: recognizing the ability, the right, and the duty to act. J Grad Med Educ. 2016;8:261–2.
Specialisten FM. Opleidingsakkoord. http://www.demedischspecialist.nl/onderwerp/opleidingsakkoord. Accessed 3 Dec 2019.
Specialisten FM. Individualisering van de opleidingsduur.. http://www.demedischspecialist.nl/onderwerp/individualisering-van-de-opleidingsduur. Accessed 3 Dec 2019.
Specialisten DAoMSFM. Guide for a Training plan based on EPAs. 2015. Handreiking Opleidingsplan gebaseerd op EPA’s.
BOEG. Landelijk opleidingsplan voor de opleiding Obstetrie en Gynaecologie. Nederlandse Vereniging van Obstetrie & Gynaecologie. https://www.nvog.nl/wp-content/uploads/2017/12/BOEG-opleidingsplan-Obstetrie-en-Gynaecologie-1-12.pdf (Created 28 Feb 2013). Accessed 10 Oct 2019.
College voor Sociale Geneeskunde. Handboek Modernisering Medische Vervolgopleidingen Sociale Geneeskunde. 2007.
Nederlandse Vereniging voor Radiologie, Nederlandse Vereniging voor Nucleaire Geneeskunde. CORONA: Opleidingsplan Radiologie (Gefuseerde opleiding Radiologie en Nucleaire geneeskunde). 2015.
Anesthesiologie WMC. Project Modernisering: Opleidingsplan Anesthesiologie. 2008.
Buurma H. Opleidingsplan Specialisme Openbare Farmacie. Den Haag: Koninklijke Netderlandse Maatschappij ter bevordering der Pharmacie (KNMP); 2015.
Nederland H. Landelijk Opleidingsplan voor de opleiding tot huisarts. Utrecht: Huisartsopleiding Nederland; 2017.
Nederlandse Vereniging Klinische Geriatrie. Geriatrie CoK. EIK: Eindtermen en Individualisering Klinische Geriatrie. 2017.
O’Dowd E, Lydon S, O’Connor P, Madden C, Byrne D. A systematic review of 7 years of research on entrustable professional activities in graduate medical education, 2011–2018. Med Educ. 2019;53:234–49.
Ten Cate O, Graafmans L, Posthumus I, Welink L, van Dijk M. The EPA-based Utrecht undergraduate clinical curriculum: development and implementation. Med Teach. 2018;40:506–13.
Shorey S, Lau TC, Lau LST, Ang E. Entrustable professional activities in health care education: a scoping review. Med Educ. 2019;53:766–77.
Van Rossum TR, Scheele F, Sluiter HE, Bosman PJ, Rijksen L, Heyligers IC. Flexible competency based medical education: more time efficient, higher costs. Med Teach. 2018;40:315–7.
Specialisten FM. EPA’s: bouwstenen voor nieuw opleidingsplan.. http://www.demedischspecialist.nl/nieuws/epa%E2%80%99s-bouwstenen-voor-nieuw-opleidingsplan. Accessed 10 Jan 2020.
MAXQDA, software for qualitative data analysis. Berlin, Germany: VERBI Software–Consult–Socialforschung GmbH; 2016; pp. 1989–2016.
van Loon KA, Driessen EW, Teunissen PW, Scheele F. Experiences with EPAs, potential benefits and pitfalls. Med Teach. 2014;36:698–702.
Sterkenburg A, Barach P, Kalkman C, Gielen M, ten Cate O. When do supervising physicians decide to entrust residents with unsupervised tasks? Acad Med. 2010;85:1408–17.
Pope C, Ziebland S, Mays N. Qualitative research in health care. Analysing qualitative data. BMJ. 2000;320:114–6.
Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15:1277–88.
de la Croix A, Veen M. The reflective zombie: problematizing the conceptual framework of reflection in medical education. Perspect Med Educ. 2018;7:394–400.
Varpio L, Bell R, Hollingworth G, et al. Is transferring an educational innovation actually a process of transformation? Adv Health Sci Educ. 2012;17:357–67.
Caverzagie KJ, Cooney TG, Hemmer PA, Berkowitz L. The development of entrustable professional activities for internal medicine residency training: a report from the Education Redesign Committee of the Alliance for Academic Internal Medicine. Acad Med. 2015;90:479–84.
Rogers EM. Diffusion of innovations. New York: Simon & Schuster; 2010.
Ten Cate O. An updated primer on Entrustable Professional Activities (EPAs). Rev Bras Educ Med. 2019;43:712–20.
Shaughnessy AF, Sparks J, Cohen-Osher M, Goodell KH, Sawin GL, Gravel J Jr.. Entrustable professional activities in family medicine. J Grad Med Educ. 2013;5:112–8.
Landzaat LH, Barnett MD, Buckholz GT, et al. Development of entrustable professional activities for hospice and palliative medicine fellowship training in the United States. J Pain Symptom Manage. 2017;54:609–16.
Chang A, Bowen JL, Buranosky RA, et al. Transforming primary care training—patient-centered medical home entrustable professional activities for internal medicine residents. J Gen Intern Med. 2013;28:801–9.
Westein MPD, de Vries H, Floor A, Koster AS, Buurma H. Development of a postgraduate community pharacist specialization program using CanMEDS competencies, and Entrustable Professional Activities. Am J Pharm Educ. 2019;83:1354–65.
Taylor DR, Park YS, Egan R, et al. EQual, a novel rubric to evaluate entrustabel professional activities for quality and structure. Acad Med. 2017;92:S110–S7. 11S Association of American Medical Colleges Learn Serve Lead: Proceedings of the 56th Annual Research in Medical Education Sessions.
Bonnie LHA, Visser MRM, Bont J, Kramer AWM, van Dijk N. Trainers’ and trainees’ expectations of entrustable professional activities (EPAs) in a primary care training programme. Educ Prim Care. 2019;30:13–21.
Post JA, Wittich CM, Thomas KG, et al. Rating the quality of entrustable professional activities: content validation and associations with the clinical context. J Gen Intern Med. 2016;31:518–23.