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Patients, Nurses, and Physicians Working Together to Develop a Discharge Entrustable Professional Activity Assessment
Lauren B Meade1, Kathleen Heist Suddarth, Ronald R Jones
1L.B. Meade is Macy Faculty Scholar, Baystate Medical Center, Springfield, and associate professor of medicine, Tufts University School of Medicine, Boston, Massachusetts.K.H. Suddarth is associate program director for internal medicine and assistant professor of medicine, University of Colorado Denver School of Medicine, Denver, Colorado.R.R. Jones is associate program director in internal medicine, Summa Health Systems, Akron, and associate professor of medicine, Department of Medicine, Northeast Ohio Medical University, Rootstown, Ohio.A.K. Zaas is program director for internal medicine and associate professor, Duke University School of Medicine, Durham, North Carolina.T. Albanese is formerly manager of medical education, Summa Health System, Akron, Ohio.K. Yamazaki is outcome assessment research associate, Accreditation Council for Graduate Medical Education, Chicago, Illinois.C.W. O'Malley is program director in internal medicine and assistant professor of medicine, University of Arizona College of Medicine, Phoenix, Arizona.
Physician training milestones need enhancement to include interprofessional team behaviors for safe hospital discharges. New assessment tools are being developed to improve physician performance in team-based care.
Area of Science:
- Medical Education
- Interprofessional Healthcare
- Patient Safety
Background:
- Accreditation Council for Graduate Medical Education milestones, designed by physicians, may not fully encompass essential interprofessional team competencies.
- Optimizing physician performance within interprofessional teams requires a comprehensive understanding of team-based behaviors.
Purpose of the Study:
- To identify and prioritize physician behaviors crucial for safe and effective hospital discharge within an interprofessional team context.
- To develop an assessment tool for observing physician performance related to the discharge entrustable professional activity (EPA).
Main Methods:
- Interprofessional discussion groups, including patients, nurses, and physicians, were convened across 11 internal medicine programs.
- Groups generated and prioritized physician behaviors associated with the discharge EPA, focusing on key components like medication reconciliation and communication.
Main Results:
- A total of 182 physician behaviors were identified and batched into six core components of a safe discharge.
- High-priority behaviors were specified, and an observational assessment tool for the discharge EPA was created.
- Participants gained a deeper appreciation for the complexities of training physicians for discharge responsibilities.
Conclusions:
- An assessment tool for the discharge EPA is currently undergoing evaluation in 15 internal medicine programs.
- Future work includes developing assessment tools for other EPAs and evaluating patient outcomes in milestone-based education.
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