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A model for EPA development
An Entrustable Professional Activity (EPA) for Handoffs as a Model for EPA Assessment Development. Aylward M et al.  Academic Medicine 2014; Published ahead of print
Reviewed by Gary Beck


What was the study question?
Can an assessment tool for the evaluation of resident handoffs, a sample Entrustable Professional Activity (EPA), be developed as a model for the creation of other EPA assessments?

How was the study done?
The authors focused on one EPA, resident handoffs, chosen because of their importance in patient safety, hoping to learn from the experience and refine the process to develop other EPA assessments.  Steps taken to develop the EPA were:  1) Evaluate the current environment for learning, practicing, and assessing skills related to the EPA; 2) Identify and address systemic factors and faculty effort that may facilitate/impede assessments; 3) Determine components of the EPA to be assessed 4) Determine criteria for advancement; and 5) Faculty development. 

A pilot study was conducted with 25 of 32 interns receiving an average of 4 assessments over a 6 month period. 

What were the results?
Of the 19 interns observed more than once, 13 demonstrated improvement over multiple observations.  Faculty observers provided feedback on the tool; an iterative process critical in refining it.  Faculty felt entrustment was achieved at level 4.

What are the implications of these findings?
A model for planning and developing an EPA that offers a stepwise approach to conducting the needs assessment for the competency to measure, challenges observing identified activities, how it should be assessed, benchmarks of successful completion, and faculty development needs that could be adapted by any educational program is presented in Table 1 of the paper. 

Editor’s note: Now I finally understand what an Entrustable Professional Activity or EPA is. This study can provide guidance for others asked to assess educational outcomes with students and residents (RR).
It’s ok to help

Effects of free, cued and modeled reflection on medical students’ diagnostic competence.  Ibiapina C et al.  Medical Education 2014;48:796-805

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