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Building Assessments for an EPA in Three Steps
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One key aspect of competency-based medical education is the ability to capture meaningful and authentic work-based assessments of a trainee’s performance.  To assist program directors in developing these work-based assessments, the AAIM Education Redesign Committee has mapped the internal medicine curricular milestones to a set of EPAs that trainees should be expected to demonstrate before entering into unsupervised practice. 

When building assessments for a particular EPA, the committee recommends following a three-step process using the EPA mapping document (MS Word).

Step 1: Describe the activity and the tasks required of the resident for a faculty member / program director to entrust this activity to a trainee.  This step is crucial at helping faculty and trainees understand the context of what is expected of the trainee.  It begins the conversation about expectations and helps all parties to develop a “shared mental model” of the desired performance.  Ideally, the description and tasks will be evidence-based and informed by the knowledge, skills, and attitudes required of physicians to meet the outcomes expected of the future health care system.  Without this step, faculty may agree upon or state understanding of common words on a page but still have differing ideas of expected performance from a trainee.  Examples of step 1 have been provided for EPA #1, EPA #8, and EPA #10.

Step 2: Using the abbreviated list of curricular milestones (i.e. list of 142) provided in the table, the faculty / program director are encouraged to identify those milestones that best inform assessment of the description and tasks identified in step 1.  (The mapping document contains agreed-upon abbreviations for the curricular milestones presented at the 2012 APDIM Spring Conference.)  Remember, there is typically overlap in many of the curricular milestones, therefore, it is not necessary to choose every potential milestone when building an assessment for an EPA.  The milestones chosen should be tailored to a specific residency program based upon the local resources, rotation structure, and existing culture.  Choose those milestones that will help faculty assess for competence in a trainee and make a decision regarding entrustment for the chosen activity.  While there are not necessarily right or wrong milestones, it remains important to make decisions based upon the knowledge, skills, and attitudes required of physicians to meet the outcomes expected of the future health care system.

Step 3: Apply the curricular milestones identified in step 2 to a particular assessment method or assessment tool.  The preferred assessment methods provided by ACGME include direct observation, multisource feedback, and chart audit.  Some program directors will choose to develop and implement new assessment tools while others may choose to overlay the milestones on existing tools and assessment structures.  Refer to previous APDIM workshops, posters, and forums for examples on how to develop these assessments.  Examples of step 3 have been provided for EPA #1, EPA #8, and EPA #10.

 

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