An entrustable professional activity descriptor for medical aid in dying: a mixed-methods study

Area of Science:

• Medical Education
• Healthcare Competency Assessment
• End-of-Life Care

Background:

• Medical Aid in Dying (MAiD) is legally available in many jurisdictions, necessitating standardized competence assessment for providers.
• Entrustable Professional Activities (EPAs) offer a framework for competency-based training and workplace assessment.
• Experienced MAiD providers were convened to develop an EPA descriptor for MAiD.

Purpose of the Study:

• To develop a consensus-based EPA descriptor for medical aid in dying (MAiD).
• To establish a standardized framework for assessing and ensuring the competence of MAiD providers.

Main Methods:

• A mixed-methods sequential study combining qualitative (focus group) and quantitative (survey) approaches.
• Focus groups with experienced MAiD assessors and providers to identify key competencies.
• Modified Delphi approach with surveys to refine and achieve consensus on the EPA descriptor.

Main Results:

• The focus group identified key knowledge, skills, and attitudes for MAiD assessment, preparation, and provision.
• Participants suggested teaching approaches and methods for evaluating progress and entrustment.
• A high degree of agreement was achieved on the EPA descriptor after two rounds of Delphi surveys, with modifications based on feedback regarding entrustment conditions.

Conclusions:

• A competency-based EPA descriptor for MAiD was successfully developed with a high level of agreement.
• This EPA descriptor can guide the development of practice standards, curricula, and competence assessments for MAiD providers.
• The framework supports consistent and high-quality care in medical aid in dying.