Entrustable Professional Activity 10: Case Simulation and Assessment-STEMI With Cardiac Arrest.

Area of Science:

• Medical Education
• Simulation-Based Assessment
• Entrustment Decisions

Background:

• Entrustable Professional Activities (EPAs) define units of professional practice for unsupervised trainee performance.
• AAMC Core EPA 10 focuses on recognizing emergent care needs and initiating evaluation/management.
• A simulation scenario was designed to assess EPA 10 behaviors and guide entrustment decisions.

Purpose of the Study:

• To design and implement a simulation scenario for evaluating medical trainees' competence in recognizing and managing emergent patient care.
• To assess the utility of the simulation in guiding entrustment decisions for AAMC Core EPA 10.

Main Methods:

• A simulation case involved a 61-year-old male presenting with symptoms leading to ST-elevation myocardial infarction and cardiac arrest.
• Trainees used a simulation manikin and were assessed via a checklist of critical actions based on EPA 10 functions.
• The assessment included recognizing unstable vital signs, requesting assistance, and determining appropriate patient disposition.

Main Results:

• The simulation was implemented in a mandatory fourth-year clerkship over 7 years.
• Approximately 14% of students failed to meet entrustment criteria in a recent institutional experience.
• Students highly valued the simulation, rating its usefulness for clinical performance improvement.

Conclusions:

• Faculty identified challenges in making entrustment decisions based on a single simulation experience.
• The influence of team roles (leader vs. supporter) on entrustment decisions requires further consideration.
• Simulation remains a valuable tool for assessing and guiding entrustment in medical education.