Why??? Gaps Identified between: Program Director Expectations and Skills of Entering Residents What residents do without supervision and what they have been documented as competent to do without supervision Charge to Drafting Panel Develop a clear, concise list of what graduating medical students should be entrusted to do without direct supervision on DAY ONE of residency
Core Entrustable Professional Activities (EPAs) for Entering Residency (CEPAER): Report of the Drafting Panel AAMC Annual Meeting 2013
Specific units of professional work Tasks that trainees are entrusted to perform unsupervised After they’ve attained sufficient competence Olle ten Cate Acad Med 2007 Entrustable Professional Activity Ability to perform a task to a desired level of performance without direct supervision
Delineated a set of activities that entering residents should be expected (entrusted) to perform on day one of residency without direct supervision. 13 core EPAs for entering residency ranging from: - give patient handover to transition care - recognize patient requiring urgent care - to obtain informed consent EPA #7: Form clinical questions and retrieve evidence to advance patient care Drafting Panel Work http//:mededportal.com/icollaborative/resource/887
Core EPAs For Entering Residency EPAs For any Practicing Physician Expectations for the Medical School Graduate EPAs For Specialties
‘Entrustable’ Requires Direct Observation of: Level of K/S/A (Ability) Hard work & follow through (Conscientious) Absence of deception (Truthfulness) Knowing one’s limits (Discernment) Tara Kennedy Academic Medicine 2008
What does this have to do with teaching or EBM???
‘Background’ Questions About the disorder, test, treatment, etc. 2 components: a. Root* + Verb: “What causes …” b. Condition: “… cystic fibrosis?” * Who, What, Where, When, Why, How ‘RVC’ = Root, Verb, Condition
‘Foreground’ Questions About patient care decisions and actions 4 (or 3) components: a. patient, problem, or population b. intervention, exposure, or maneuver c. comparison (if relevant) d. clinical outcomes (including time horizon) ‘PICO’ = Patient, Intervention, Comparison, Outcomes
How does it feel … ? To know an answer? To NOT know an answer?
Emotions in Not Knowing Ready to …FeelingBehaviors FleeFearLeave Invisible FightAngerDisrupt Undermine Cry for helpDistressStop trying Body stress WithdrawSadnessInattention Detachment
Guiding or Coaching ‘Qs’? Try building up from ‘raw’ question to more complete anatomy (rather than tearing their efforts down) Consider 2 stages: “Sounds like you’re asking a question about … (therapy, prognosis, etc.)” “What would be the … (missing anatomy) you would want to know?”