Entrustable Professional Activities

Rationale and Objectives

Learner assessment in medical education has undergone tremendous change over the past two decades. During this time frame, the concept of Entrustable Professional Activities (EPAs) was introduced to guide the faculty when making competency-based decisions on the level of supervision required by trainees. EPAs are gaining momentum in medical education as a basis for decisions related to transitioning from residency training to clinical practice. The purpose of this article is twofold: (1) define EPAs for radiology (EPA-R) and (2) illustrate radiology-specific examples of these EPAs.

Materials and Methods

A multi-institutional work group composed of members of the Alliance of Directors and Vice Chairs of Education in Radiology convened at the 2015 Association of University Radiologists annual meeting to discuss radiology EPAs. The EPAs initially developed by the Accreditation Council for Graduate Medical Education (ACGME) Radiology milestone work group and the resultant ACGME Radiology milestones formed the basis for this discussion.

Results

A total of 10 radiology EPAs and illustrative vignettes were developed to help radiology educators and trainees better understand milestone assessment and how this translates to the necessary skills and responsibilities of practicing radiologists. Examples of EPA mapping to the ACGME subcompetencies and methods of assessment were included.

Conclusions

EPAs offer an opportunity to improve our approach to training by increasing our focus on how we provide appropriate supervision to our residents and assess their progress. In this work, through suggested lists and vignettes, we have attempted to establish the framework for further discussion and development of EPA-Rs.

Introduction

Learner assessment in medical education has undergone tremendous change over the past two decades. In 2002, the Accreditation Council for Graduate Medical Education (ACGME) introduced the concept of six specific areas of performance that can be measured, the competencies, through the Outcomes Project . This was followed by the introduction of the milestones with the ACGME Next Accreditation System, implemented in July 2013 . Ten Cate introduced the concept of Entrustable Professional Activity (EPA) to allow the faculty to make competency-based decisions on the level of supervision required by trainees during this same time frame .

EPAs are gaining momentum in medical education as a basis for decisions related to transitioning from residency training to clinical practice . The number of specialties reporting EPAs continues to increase and includes internal medicine , pediatrics , family medicine , critical care medicine , as well as emergency medicine , but, to the best of our knowledge, not radiology. The purpose of this article is twofold: (1) define EPAs for Radiology (EPA-R) and (2) illustrate radiology-specific examples of these EPAs.

What Is an Entrustable Professional Activity?

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ACGME Competencies, Subcompetencies, and Milestones

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Clinical Activities and Responsibilities of Radiologists: Defining EPAs

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EPA-R 1: Collaborates as a Member of an Interprofessional Team

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EPA-R 1 Vignette

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EPA-R 2: Triages and Protocols Exams

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EPA-R 2 Vignette

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EPA-R 3: Interprets Examinations and Prioritizes a Differential Diagnosis

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EPA-R 3 Vignette

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EPA-R 4: Communicates Diagnostic Imaging Findings

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EPA-R 4 Vignette

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EPA-R 5: Recommends Appropriate Next Steps

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EPA-R 5 Vignette

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EPA-R 6 Vignette

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EPA-R 7: Manages Patient after Imaging and Procedures

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EPA-R 7 Vignette

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EPA-R 8: Formulates Clinical Questions and Retrieves Evidence to Advance Patient Care

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EPA-R 8 Vignette

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EPA-R 9: Behaves Professionally

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EPA-R 9 Vignette

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EPA-R 10: Identifies System Failures and Contributes to a Culture of Safety and Improvement

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EPA-R 10 Vignette

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Conclusion

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References

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2. Nasca T.J., Philibert I., Brigham T., et. al.: The next GME accreditation system—rationale and benefits. N Engl J Med 2012; 366: pp. 1051-1056.
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4. Englander R., Carraccio C.: From theory to practice: making entrustable activities come to life in the context of the milestones. Acad Med 2014; 89: pp. 1321-1323.
5. Hauer K.E., Kohlwes J., Cornett P., et. al.: Identifying entrustable professional activities in internal medicine training. J Grad Med Educ 2013; pp. 54-59.
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7. Chan B., Englander H., Desai S., et. al.: Transitioning toward competency: a resident-faculty collaborative approach to developing a transitions of Care EPA in an internal medicine program. J Grad Med Educ 2014; 6: pp. 760-764.
8. American Board of Pediatrics. Available at https://www.abp.org/subspecialty-epas Accessed July 12, 2015
9. Shaughnessy A.F., Sparks J., Cohen-Osher M., et. al.: Entrustable professional activities in family medicine. J Grad Med Educ 2013; 5: pp. 112-118.
10. Fessler H.E., Addrizzo-Harris D., Beck J.M., et. al.: Entrustable professional activities and curricular milestones for fellowship training in pulmonary and critical care medicine: executive summary from the Multi-society Working Group. Crit Care Med 2014; 42: pp. 2290-2291.
11. Beeson M., Warrington S., Bradford-Saffles A., et. al.: Entrustable professional activities: making sense of the emergency medicine milestones. J Emerg Med 2014; 47: pp. 441-472.
12. Ten Cate O.: AM last page: what entrustable professional activities add to a competency-based curriculum. Acad Med 2014; 89: pp. 691.
13. The Diagnostic Radiology Milestone Project A Joint Initiative of The Accreditation Council for Graduate Medical Education and The American Board of Radiology. Available at https://www.acgme.org/acgmeweb/Portals/0/PDFs/Milestones/DiagnosticRadiologyMilestones.pdf Accessed August 8, 2015
14. Ten Cate O., Scheele F.: Competency-based postgraduate training: can we bridge the gap between theory and practice?. Acad Med 2007; 82: pp. 542-547.
15. Ten Cate O.: Nuts and bolts of entrustable professional activities. J Grad Med Educ 2013; 1: pp. 157-158.
16. The Core Entrustable Professional Activities for Entering Residency Curriculum Developer’s Guide. Available at www.afmrd.org/i4a/doclibrary/getfile.cfm?doc_id=156 Accessed August 24, 2015
17. Crossing the Quality Chasm: A New Health System for the 21st Century—Institute of Medicine. Available at https://iom.nationalacademies.org/~/media/Files/Report%20Files/2001/Crossing-the-Quality-Chasm/Quality%20Chasm%202001%20%20report%20brief.pdf Accessed September 1, 2015
18. Lingard L., McDougall A., Levstik M., et. al.: Representing complexity well: a story about teamwork, with implications for how we teach collaboration. Med Educ 2012; 46: pp. 869-877.
19. ACR Appropriateness Criteria. Available at http://www.acr.org/Quality-Safety/Appropriateness-Criteria Accessed August 26, 2015
20. ACR Practice Parameter for Communication of Diagnostic Imaging findings. Available at http://www.acr.org/~/media/C5D1443C9EA4424AA12477D1AD1D927D.pdf Accessed August 26, 2015

Entrustable Professional Activities

Rationale and Objectives

Materials and Methods

Results

Conclusions

Introduction

What Is an Entrustable Professional Activity?

ACGME Competencies, Subcompetencies, and Milestones

Clinical Activities and Responsibilities of Radiologists: Defining EPAs

EPA-R 1: Collaborates as a Member of an Interprofessional Team

EPA-R 1 Vignette

EPA-R 2: Triages and Protocols Exams

EPA-R 2 Vignette

EPA-R 3: Interprets Examinations and Prioritizes a Differential Diagnosis

EPA-R 3 Vignette

EPA-R 4: Communicates Diagnostic Imaging Findings

EPA-R 4 Vignette

EPA-R 5: Recommends Appropriate Next Steps

EPA-R 5 Vignette

EPA-R 6: Obtains Informed Consent and Performs Diagnostic/Interventional Procedures

EPA-R 6 Vignette

EPA-R 7: Manages Patient after Imaging and Procedures

EPA-R 7 Vignette

EPA-R 8: Formulates Clinical Questions and Retrieves Evidence to Advance Patient Care

EPA-R 8 Vignette

EPA-R 9: Behaves Professionally

EPA-R 9 Vignette

EPA-R 10: Identifies System Failures and Contributes to a Culture of Safety and Improvement

EPA-R 10 Vignette

Conclusion

References

Further Reading

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