M.G. Keeley is senior associate dean for education and professor, Office of Medical Education and Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia.
M.J. Bray is associate dean for curriculum and associate professor, Office of Medical Education and Department of Obstetrics and Gynecology, University of Virginia School of Medicine, Charlottesville, Virginia.
Acad Med. 2022 Nov 1;97(11):1637-1642. doi: 10.1097/ACM.0000000000004944. Epub 2022 Aug 16.
The rapid expansion of entrustable professional activity (EPA) assessment programs has led to calls to ensure fidelity in implementation and integrity in meeting the goals of competency-based medical education. Initiated in July 2017, in advance of the articulated core components of EPA implementation, this article describes the structure and outcomes of the University of Virginia (UVA) EPA Program and provides support for the identified essential components.
The UVA EPA Program includes workplace assessments by residents/fellows, attending faculty, and master assessors (MAs), experienced clinicians who assess students across disciplines and clinical settings. All assessors participate in formal professional development and provide verbal and written comments to support their supervision ratings. The Entrustment Committee, composed of 12 MAs, uses a shared mental model and aggregates all assessor data to make a high-stakes summative entrustment decision about students' readiness to assume the role of an acting intern.
Since 2017, over 2,000 assessors have completed 56,969 EPA assessments for 1,479 students. Ninety-four percent of assessments have been done during the clerkship phase. Residents/fellows have completed a mean of 18 assessments, attending faculty a mean of 27, and MAs a mean of 882. Seventy-four percent of observed encounters involved patients with acute concerns with or without a co-morbid condition. Fifty percent of assessments occurred in inpatient and 32% in ambulatory settings. Eighty-seven percent of assessments contained narrative comments with more than 100 characters.
Planned next steps will include earlier identification of students who require individualized learning to promote the development of skills related to EPAs, expansion of the remediation program to enable more students to engage in a clinical performance mastery elective, and creation of targeted professional development for assessors to reinforce the tenets of the EPA program.
可委托专业活动（EPA）评估计划的快速扩张导致人们呼吁确保实施的保真度，并确保基于能力的医学教育目标的完整性。本文于 2017 年 7 月启动，先于 EPA 实施的明确核心组成部分，描述了弗吉尼亚大学（UVA）EPA 计划的结构和结果，并为确定的基本组成部分提供了支持。
UVA EPA 计划包括住院医师/研究员、主治教员和主评估员（MA）对住院医师/研究员和研究员进行的工作场所评估，MA 是经验丰富的临床医生，他们评估跨学科和临床环境中的学生。所有评估员都参加正式的专业发展，并提供口头和书面评论，以支持他们的监督评级。由 12 名 MA 组成的委托委员会使用共享的心理模型并汇总所有评估员的数据，对学生承担代理实习医生角色的准备情况做出高风险的总结性委托决策。
自 2017 年以来，已有 2000 多名评估员为 1479 名学生完成了 56969 项 EPA 评估。评估的 94%是在实习阶段进行的。住院医师/研究员完成了平均 18 项评估，主治教员完成了平均 27 项评估，MA 完成了平均 882 项评估。74%的观察性接触涉及有急性问题的患者，无论是否有合并症。50%的评估发生在住院环境中，32%发生在门诊环境中。87%的评估包含超过 100 个字符的叙述性评论。
计划的下一步将包括更早地识别需要个性化学习的学生，以促进与 EPA 相关技能的发展，扩大辅导计划，使更多学生能够参加临床绩效掌握选修课，并为评估员制定有针对性的专业发展计划，以加强 EPA 计划的原则。
