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2. Click to edit Master subtitle style Milestones and Entrustable Professional Activities (EPAs)

3. What is CBD? How Does CanMEDS 2015 Fit? 3 Competence by Design (CBD) is Multi-year, transformational change initiative aimed at introducing a competency-based medical education (CBME) model to specialty education; CanMEDS 2015 is Foundational project of CBD, Focused on updating the existing CanMEDS Framework and introducing generic milestones across the continuum Series IV of the Framework is now available Series IV A final version will be released at ICRE 2015 in October 2015

5. CanMEDS 2015: Milestones and EPAs 5 Using the updated CanMEDS Framework and the Milestones Guide as a program scaffolding, each CBD adopting discipline will: Milestones Guide Separate their specialty into stages of training; Integrate new themes like patient safety and handovers into their programs; and Develop specialty-specific milestones and Entrustable Professional Activities (EPAs) for each stage of training.

6. Milestones and EPAs 6 Milestones: for teaching The abilities expected of a health professional at a stage of development Demonstrate a commitment to patient safety and quality improvement through adherence to institutional policies and procedures Entrustable Professional Activities (EPAs): for assessment The key tasks of a discipline that a practitioner needs to be able to perform, Recognize and manage conflicts of interest in independent practice

7. Milestones and EPAs con’t The key difference between EPAs and milestones is that EPAs are the tasks or activities that must be accomplished, whereas milestones are the abilities of the individual.

8. Key Concept of EPAs: Entrustment 8 “What can I safely delegate with indirect supervision?”

9. Medical Oncology Example: Milestones and EPA Milestones which make up the Medical Oncology EPA (abilities needed to accomplish the task) Recognize urgent and emergent oncologic issues, including but not limited to, pain crisis, febrile neutropenia, uncontrolled diarrhea, hypocalcemia, epidural cord compression and malignant bowel obstruction. Select and administer appropriate interventions for urgent and emergent oncologic issues. Identify the limits of their own expertise and appropriately seek assistance and supervision. Medical Oncology EPA (the task that must be accomplished) Initial care for urgent and emergent oncologic situations.

11. Four Stages of Residency Transition to Practice Core of Discipline Foundations of Discipline Transition to Discipline

12. Milestones within Each Stage of Residency M M M M MM MM M M M M M M M M M M M M M M M M M M M M M

13. Milestones within each EPA EPA Milestone Typically, each EPA integrates multiple milestones.

14. Milestones and EPAs within Each Stage of Residency

15. Benefits of Milestones and EPAs 15 Link clinical activities with learning and assessment, Clearly defined targets for acquiring competency and meeting standards throughout training, Better preparation to serve patients and communities, and Strive towards mastery of skills and abilities beyond training and throughout practice.

16. As a Teacher……… Focus on specific clinical activities with residents at different stages, Focus on teaching towards specific milestones within a stage, and Conduct assessments of specific EPAs.

17. Milestones and EPAs Milestones for teaching Abilities expected of a resident at a defined stage of training EPAs for Assessment Meaningful, measurable markers of progression of competence

18. Teaching and Assessing with Milestones and EPAs Educators will use milestones to design educational activities and teach specific abilities. Once the skills/attitudes required to meet the milestones have been taught, educators can assess achievement using an EPA. If the EPA is successfully performed, then all the skills which make up the various milestones within the EPA have been learned and competence has been demonstrated.

19. Unpack Milestones If a trainee is struggling with an EPA, the teacher can break the EPA down into its component abilities (milestones) to help determine where further guidance or teaching is needed.

20. A Balanced View of Performance 20 The combination of milestones and EPAs will allow educators to examine performance at both the micro (when needed) and macro levels – providing a truly balanced view of a trainee’s abilities.

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