1. INSTRUCTIONAL MATERIALS AND METHODS USED
A Psychiatric Specific EPA for Evaluation of the Prospective Psychiatric Resident: Towards a National Standard
Benjamin Griffeth1, William Brooks2, Adriana Foster3
¹University of South Carolina School of Medicine Greenville, ²University of South Alabama, ³Florida International University
OBJECTIVES
RESULTS
We tested the video and scoring rubric on 13 3rd and 4th year students from 3 schools:
minimal passes were given on 7 of 13 items
most minimal passes and the only failure were noted on the cognitive exam item
thought content item had >1 minimal pass
the students who go into psychiatry scored best
Discuss the evaluation of EPA 1 “Gather a history and perform a physical examination”.
Evaluate the proposed video against a cohort approved assessment tool.
PURPOSE OF INNOVATION
Medical education is increasingly competency-based. A competency-based curriculum organizes the educational experience around skill proficiency, underscores performance outcomes and ultimately promises greater accountability to patients and society (1). Graduate medical education accreditation agencies have historically required educational programs to implement competency-based evaluations. ACGME has developed a matrix of milestones which corresponds to each “developmental stage” in specialty training. IN 2014, AAMC followed suit with the development of Entrustable Professional Activities as a way to ensure adequate skills of the medical school graduate (2).
NEED FOR INNOVATION
While the twelve EPAs are applicable to all medical specialties, the competency to “Gather a History and Perform a Physical Examination” applies most explicitly to psychiatry through the performance of a mental status exam. Although proficiency in performing a psychiatric interview and mental status exam evolves throughout psychiatrists’ entire professional life, basic proficiency is essential in in order to function as an intern in a psychiatry residency program. Here we propose the development of an assessment tool for psychiatry specific EPA for future psychiatric residents.
INSTRUCTIONAL MATERIALS AND METHODS USED
We developed the Mental Status EPA assessment tool which includes a video recording of a psychiatric interview and a scoring rubric with anchors describing levels of competency in presenting a mental status exam. Together, these instruments form a tool that can be used to assess the “History and Examination” EPA, as applicable to psychiatry.
At all three sites, three M4 students who were choosing psychiatry as their intended residency and ten M3 students who had yet to make a choice of intended residency watched a standardized video of a psychiatrist performing a limited examination on a patient and wrote a complete Mental Status Examination which was compared to a rubric developed by the authors with input from ADMSEP faculty who watched the same video.
EDUCATIONAL OUTCOMES
We developed and utilized the video and the rubric at three institutions. We incorporated feedback from ADMSEP 2015 meeting, which led to a re-iteration of the rubric.
Lessons learned:
Fourth year medical students perform best due to :
Experience?
Specialty choice?
B. We must change how we teach the cognitive exam and thought content
C. The mental status exam appears to be an adequate choice for a psychiatry-specific EPA.
CONCLUSIONS
The Mental Status EPA assessment tool can be used at multiple programs and offers an opportunity to standardize mental status presentations by senior medical students who wish to specialize in psychiatry.
Future directions:
Comparisons between M3 and M4 who intend to enter psychiatry; comparisons between M4s choosing psychiatry versus other disciplines.
REFERENCES
1. Teherani, A and Chen HC, The Next Steps in Competency-Based Medical Education: Milestones, Entrustable Professional Activities and Observable Practice Activities, J Gen Intern Med Aug; 29(8): 1090–1092.
2. Core Entrustable Professional Activities for Entering Residency
AAMC, 2014.
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