Post on 30-Jun-2020
Entrustable Professional Activities (EPAs) in Residency Training in Anesthesiology
Suwannee Suraseranivongse, MD
Professor in Anesthesiology
Deputy Dean & Director of Siriraj Medical School
Faculty of Medicine Siriraj Hospital, Mahidol University
Outline
•Rationale of change
•Competency, EPAs, Milestones
•How to develop EPAs
Medical Council of Thailand
Royal College of Anesthesiologists of Thailand
Board Committee of Residency training in Anesthesiology
14 Training institutes n =140 / year
Previous curriculum • Traditional time-based curriculum • Summative evaluation • Informal formative evaluation & development • Suitable for small training center with few trainers & trainees
Current curriculum • Competency-based curriculum
• Formal formative evaluation & development
Increased number of trainee
History of EPAs in residency training in Anesthesiology
Policy 2017
Pilot model
Sharing
Brainstorming 2015
Competency based curriculum Entrustable professional activity (EPAs)
Milestones
Competency
•An observable ability of a health professional integrating multiple components such as knowledge, skills, values, and attitudes. •Observable & measurable, they can be assessed to
ensure their acquisition
Competency
• Patient care
• Medical knowledge & skills
• Practice-based learning & improvement
• Interpersonal & communication skills
• Professionalism
• System-based practice
Competency Definition Learning process Assessment
Patient care Clinical skills Authentic learning,
simulation
Workplace-based
assessment, Mini-CEX,
DOPS, PBA,
Medical knowledge &
skills
Basic Science & Clinical
knowledge
Lecture, SDL, Seminar MCQ, Essay, MEQ, SAQ,
CRQ, WBA, etc
Practice base learning
& improvement
Research skills, IT skills
Procedural skills, etc
Research project, authentic
practice, simulation
Research progress
DOPS, PBA, OSCE
Interpersonal &
communication skills
Presentation skills
Communication skills
Presentation, workshop,
authentic practice
Multisource feedback (360
degree assessment)
Professionalism Ethics, non-technical
skills
Workshop, authentic
practice
WBA, MSF
System based practice Patient safety, Rational
drug use, Quality
development, Risk
Seminar, workshop,
simulation, authentic
practice
WBA, project-based
assessment
Competency / Outcome based training
Entrustable professional activities (EPA) Prof. Olle ten Cate
•A unit of professional practice that can be fully entrusted to a trainee, as soon as he or she has demonstrated the necessary competence to execute this activity unsupervised”
Benefit of EPAs
• Trust • Guide learning, teaching & coaching • Assessment • Specific feedback
Milestone: A behavioral descriptor that marks a level of performance for a given competency L1 not allowed to practice the EPA
L2 practice the EPA with full supervision
L3 practice the EPA with supervision on demand
L4 unsupervised” practice allowed
L5 supervision task may be given
EPAs in Anesthesiology…trainee should be able to provide… 1. proper perioperative care including complication management for
patients undergoing general anesthesia (WPBA)
2. proper perioperative care including complication management for patients undergoing regional anesthesia (WPBA)
3. appropriate airway management (WPBA)
4. cardiopulmonary resuscitation (simulation)
5. respiratory care and crisis management (simulation, WPBA)
6. pain management (WPBA)
Overview of EPAs –Competency matrix Competency EPA1 EPA2 EPA3 EPA4 EPA5 EPA6
Patient care
Medical knowledge
Practice based learning & improvement
Interpersonal & Communication skills
Professionalism
System based practice
Workplace based assessment
Clinical skills
X Perioperative care in general( non subspecialty), simple patients, simple procedure
Y Perioperative care in complicated patients, complicated procedures
Milestones: entrustment level
Level of
resident
Type of clinical
skills (MUST)
Milestone: level
6 mo 12 mo
1 X 2 3
2 X
Y
3-4
2
4
3
3 X
Y
4-5
3-4
4-5
4
EPA 1: Perioperative care including complication management for patients undergoing general anesthesia Title of the EPA Perioperative care including complication management for
patients undergoing general anesthesia Specifications 1.Providing preop. evaluation & preparation
2.Providing plan & conduct 3.Use and interpretation of monitoring and equipment 4.Providing intra and post anesthetic care 5.Managing airway 6.Providing technical skills 7.Manage crisis 8.Manage peri-anesthetic /peri-procedural complications 9.Communicating & team working 10.Demonstrate professionalism & non-technical skills
EPA 1: Perioperative care including complication management for patients undergoing general anesthesia Title of the EPA Perioperative care including complication management for
patients undergoing general anesthesia
Context Operating theater setting
Domains of competence Patient care / Medical knowledge and skills / Practice-based learning / Interpersonal and communication skills / Professionalism / System-based practice
EPA 1: Perioperative care including complication management for patients undergoing general anesthesia Title of the EPA Perioperative care including complication management for
patients undergoing general anesthesia
Knowledge, skills, attitude and behavior and required experience for entrustment
Knowledge: preop.evaluation & preparation, choice of anesthesia, intraoperative and postoperative care, potential complications & management Skills: clinical reasoning and decision making, communication with patients and family, IV access, airway management, fluid & ventilator management, pain management Attitude and behavior: professionalism. Experience:
- Demonstrate experience coping with 2 simple patients undergoing general
anesthesia for uncomplicated surgery within 1st year of training
- Demonstrate experience coping with 2 complicated patients undergoing general
anesthesia for complicated surgery within 2nd year of training
EPA 1: Perioperative care including complication management for patients undergoing general anesthesia Title of the EPA Perioperative care including complication management for patients
undergoing general anesthesia
Assessment information source to assess progress and ground for a summative entrustment decision
- Direct observation, Anes-CEX
- Information from colleagues (multisource feedback)
- Medical records
Check list EPA Item correct Partial
correct incorrect Note for
feedback
1.Providing preop. evaluation & preparation
2.Providing plan & conduct
3.Use and interpretation of monitoring and equipment
4.Providing intra and post anesthetic care
5.Managing airway
6.Providing technical skills
7.Manage crisis
8.Manage peri-anesthetic /peri-procedural complications
9.Communicating & team working
10.Demonstrate professionalism & non-technical skills (responsibility, situation awareness)
Global assessment L1not allowed to practice the EPA L2practice the EPA with full supervision L3 practice the EPA with supervision on demand L4 unsupervised” practice allowed L5 supervision task may be given
Feedback…………………………………………………………………………………
E- Anes CEX for EPAs assessment in Mobile phone
ANESLOG
Global entrustment level
Comment
Self reflection
Brainstorming: selection of mandatory neonatal cases & procedures Co-morbidity/ Congenital anomalies Must Should May
Common congenital heart diseases:
ASD, VSD, PDA, TOF
Complicated congenital heart
diseases: TGA, Single ventricle
Common congenital anomalies:
Down syndrome
Rare/Complicated congenital
anomalies
URI
Laryngospasm
Airway obstruction
Laryngeal edema
Emergence delirium
Neonates
Premature babies
Difficult airway
Hypothermia
Malignant hyperthermia
Muscular dystrophy
Glucose, fluid, electrolyte
management
Massive bleeding
Postoperative pain management
Chronic/cancer pain management
Anesthetic procedures Must Should May
Inhalation induction
Mask ventilation
Under mask technique
Endotracheal intubation in
infant and children
Endotracheal intubation in
neonate
LMA in pediatric patients
Fiberoptic intubation in
pediatric patients
Ventilator setting in
neonate and infant
Peripheral nerve block
- Ilioinguinal,
iliohypogastic nerve
block
- Penile block
- Brachial block
- TAP block
Caudal block
Lumbar epidural block
Diagnosis/type of operation Must Should May
Gastroschisis/omphalocele
Congenital diaphragmatic hernia
Tracheoesophageal fiatula
Pyloric stenosis
Necrotizing enterocolitis
Retinopathy of prematurity
Strabismus & muscle correction
Adenotonsillectomy
Tympanoplasty
Craniotomy
Craniofacial reconstruction
Thoracotomy
Endoscopic surgery
Frenulotomy (tongue tie)
Muscle biopsy
Upper abdominal surgery
Lower abdominal surgery
Groin, perineal and anorectal
surgery
R1 R2 R3
Asse
ssm
en
t fo
r E
ntr
usta
ble
pro
fessio
na
l a
cti
vit
y
(EP
A)
1 Basic RA L4 #1
2 Basic GA ETT L4 #2
3 Basic GA under mask L4 #1
4 Complicated surgery L4 #1
5 Basic OB GA L4 #1
6 Basic OB RA L4 #1
7 Complicated OB L4 #1
8 GA supraglotic device L4 #1
9 Pediatrics L4 #1
10 Intracranial surgery L4 #1
11 Airway procedure L4 #1
12 Painless labor L4 #1
13 Neonate/infant L4 #1
14 Simple open cardiac surgery L4 #1
15 Thoracic surgery L4 #1
16 Acute pain L4 #1
17 Cancer/neuropathic pain L3 #1
Selection of Clinical skills, EPA & Milestones
Questions
• Minimum number of EPAs to assess for competency achievement
• Practicality
Thank you