Development of EPAs for PHPM - Department of Family Medicine

Development of Entrustable
Professional Activities (EPAs) for Public
Health and Preventive Medicine (PHPM)
PHPM Program Directors
April 13, 2015
Brent Moloughney, MD, MSc, FRCPC
Public Health Consultant
Webinar Goal
• Bring PHPM Program Directors up-to-date in
preparation for an online survey to seek
feedback on a draft, national core set of EPAs
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Overview
• EPAs – what and why
• PD working group and workshop
• Online survey and next steps
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Problem
• Challenges with the PHPM status quo:
– Long list of Objectives of Training:
• Provides detailed expectations
• But potentially overwhelming for residents and faculty
• Competence requires integration of competencies
– Final exam success rates
– All residents prepared for practice?
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Context
• Shift in residency education – competence by
design not opportunistic learning
Historical • Training defined by specific amount of time in
various rotations (‘dwell time’)
• Exposure to situations & teaching within rotation
 (assume) uptake of necessary KSAs to produce
professional
• End-of-rotation ‘gestalt’ evaluation
• Final exam as last hurdle to certification
CBME
• Explicit competencies to be acquired
• Stages of competence development defined by
achievement of competency-based milestones (not
time)
• More frequent, direct observation to evaluate
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Royal College
• Continuing evolution of CBME
• CanMEDS 2015:
– Competence continuum
•
•
•
•
Transition to discipline
Foundations of discipline
Core of discipline
Transition to practice
– Milestones
• Observable marker of an individual’s ability along a
developmental continuum
– Earlier final examination (out-of-scope for this project)
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Entrustable Professional Activities
(EPAs)
• Capture the work that is central/critical to a
specialty
• Link competencies/milestones to practice in an
integrated/holistic manner
• Be more explicit about assessing and
documenting performance of specific
activities/tasks
• Support graded supervision – entrust the activity
to a trainee to execute once obtained adequate
competence
• Being pursued by multiple disciplines around the
world
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Objectives of Training –
Analytic Approach
ten Cate. ICRE 2013
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EPAs - Synthetic Approach
ten Cate. ICRE 2013
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EPAs and Milestones
• RC intends to use milestones and EPAs to
redesign specialist training and assessment
– Milestone is observable marker of an individual's
ability along a developmental continuum
– EPA is the task that must be accomplished - each EPA
integrates multiple milestones
• Vision for application:
– Use milestones to design educational activities and
teach specific abilities, skills and attitudes
– Assess overall achievement of various milestones
using an EPA
http://www.royalcollege.ca/portal/page/portal/rc/resources/
publications/dialogue/vol15_2/epa_milestones
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EPAs are the tasks
that must be
accomplished,
whereas milestones
are the abilities of
the individual
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Example*
• EPA: Manage an infectious disease outbreak
• Milestones (examples)
– Transition to discipline (post-MD clinical)
• Elicit relevant information for a suspect reportable disease
– Foundations (coursework)
• Describe steps in an outbreak investigation
– Core (early rotations)
• Assume under direct supervision a support role (e.g., case
finding plan; generate case definition; etc.)
– Transition to practice (late rotation)
• Assume under minimal supervision the lead role (e.g.,
declare outbreak; organize team; plan/implement
investigation; etc.)
*Calgary EPAs
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RC, PHPM & EPAs
• Number of broader issues that need to be
explored with RC (note: opportunity to do so
at March meeting):
– Looking initially for PHPM EPAs to be a resource to
all programs and be non-prescriptive – issues?
– Looking forward, how might EPAs align with RC
activities (e.g., accreditation, final examination)?
– Potential for RC support for future tasks? (e.g.,
packaging the EPAs, translation, learning &
assessment tools, etc.)
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Check-In
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Path to PHPM EPAs
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Queen’s 2-Day Workshop (Mar 2015)
• Attendance: Queen’s, McMaster, Toronto,
Ottawa, McGill, Calgary
• Inputs:
– Calgary EPAs (with milestones) – 31
– Ontario EPAs (titles) – 27 (in 9 domains)
– Experience in EPA development (e.g., Queen’s
pursuing across multiple disciplines)
• EPAs
– Literature: 15-30 typically to describe a discipline;
fewer better than many
– Focus is on ‘end of training’ EPAs – eventually may
have others for earlier stages of training
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Queen’s 2-Day Workshop (Mar 2015)
• Outputs:
– 20 end-of-training EPAs in 4 groups/domains
– Preliminary milestone work on 6 new EPAs
– Discussed issue of optional ‘clinical’ EPAs
– Discussed need for case-based learning &
assessment
– Discussed need to seek feedback from other PDs
• Plan for online survey
• Need to bring other PDs up-to-speed
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End-of-Training EPAs (20)
• Core/critical tasks for PHPM graduate – 4 groups:
–
–
–
–
Monitor & assess the health of the public
Leadership and management
Protect the public’s health
Promote health and prevent diseases and injuries
• Reflect what was in Calgary and Ontario EPAs
– For same concepts  wording preference
– For differences in scale  went macro
– Sought better language consistency:
• Verbs: ‘lead and manage’; manage ‘x’ = manage all aspects
(reflected in EPA descriptions)
– Addressed balance of content areas:
• Identified health promotion/disease prevention items
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Online Survey – Core EPAs
• 20 items are ‘draft’ – need feedback!
• Seek level of agreement and comments on
each:
– EPA statement
– EPA brief description
• Plus, when view collectively, whether any
suggested deletions or improvements
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Additional ‘Optional’ EPAs
• At the Queen’s workshop, it was noted that
some residents pursue work in various clinical
settings and in the broader health system;
e.g.,:
– Community-oriented primary care practice
– Focussed clinical practice (TB clinic, STI clinic,
addictions, travel medicine, etc.)
– Broader health system leadership and stewardship
(e.g., RHA).
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Additional ‘Optional’ EPAs (cont’d)
• Challenge:
– These career streams mentioned in introduction
of the Objectives of Training,
– But are not explicitly addressed in the
competencies (or the draft core EPAs).
• Approach:
– Workshop participants requested the survey ask
all PDs whether optional EPAs should be
developed for one or more of these career
streams.
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Case-Based Learning & Assessment
• EPAs’ focus on observable and measureable
learning and assessment
• Considering the expected breadth of PHPM
practice, there are intrinsic challenges:
– Training stages do not build seamlessly
– Limited overall field placement time
– Tasks: low volume and high duration
– Some scenarios rare – cannot expect residents to
have universal opportunity to address
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Case-Based Learning & Assessment
(cont’d)
• Implication is that cannot rely on placements
alone for learning and assessment of EPAs
• Need a range of case-based learning and
assessment scenarios and simulations
• Ideally, would enable roles for different levels of
training
• Online survey will include questions:
– To prioritize the EPAs that are most dependent on
scenarios and simulations
– To develop inventory of existing tools
•  inform future work…
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Survey Logistics
• Planning for distribution week of April 20th
• Provide 2.5-3 weeks to complete
• Have results summarized for end of May
meeting with recommendations for next
steps.
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Further Information
• PHPM EPA development resources:
http://familymedicine.queensu.ca/education/
phpm/competency_by_design_initiative/reso
urces
• Brent Moloughney:
brent.moloughney@rogers.com
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