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Narrative Performance Level Assignments at Initial Entrustment and Graduation: Integrating EPAs and Milestones to
Daniel J Schumacher1, Alan Schwartz2, Joseph A Zenel3
1D.J. Schumacher is associate professor of pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio.
Summary
Clinical competency committees determined the minimum performance levels for graduating pediatric residents. Discrepancies between expected and actual performance levels were noted in several key entrustable professional activities (EPAs).
Area of Science:
- Medical Education
- Pediatrics
- Competency-Based Assessment
Background:
- The assessment of resident competency is crucial for patient safety and effective healthcare delivery.
- Entrustable Professional Activities (EPAs) provide a framework for defining and evaluating clinical skills.
- Standardizing performance expectations across different training programs is an ongoing challenge.
Purpose of the Study:
- To identify the minimum narrative performance levels for general pediatrics entrustable professional activities (EPAs) that clinical competency committees (CCCs) deem necessary for resident graduation and initial entrustment.
- To compare the expected narrative performance levels (ENPLs) with the actual narrative performance levels (ANPLs) assigned to residents at the point of initial entrustment.
Main Methods:
- Developed a 5-level narrative performance scale for each of the 17 general pediatrics EPAs.
- Collected ENPLs for initial entrustment and graduation from CCCs at 22 pediatric training sites.
- Collected ANPLs for initial entrustment decisions from AY 2015-2016 to 2017-2018.
- Utilized a logistic mixed-effects model to compare ENPLs and ANPLs.
Main Results:
- The most frequent ENPLs for graduation and entrustment were level 3 (competent) and level 4 (proficient).
- For 9 EPAs, ENPLs for graduation and entrustment differed, suggesting variations in program timelines for entrustment versus graduation.
- Actual narrative performance levels (ANPLs) were significantly lower than ENPLs for several EPAs, including medical home-well child, transition to adult care, behavioral/mental health, referrals, team leadership, and handovers.
Conclusions:
- Clinical competency committees often set the same performance expectations for graduation and initial entrustment.
- Differences in ENPLs for graduation versus entrustment for some EPAs may highlight curricular gaps.
- Lower ANPLs compared to ENPLs in specific EPAs warrant further investigation to ensure resident preparedness.
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