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Do summative entrustment decisions actually lead to entrustment?

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Entrustable professional activities (EPAs) generally increased resident autonomy in Dutch dermatology programs. However, some residents still required supervision, especially in academic medical centers.

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Area of Science:

  • Medical Education
  • Professional Development
  • Healthcare Systems

Background:

  • Entrustable Professional Activities (EPAs) were implemented in Dutch postgraduate programs from 2017-2019.
  • The study investigates whether residents gained increased clinical responsibility after summative entrustment for an EPA.

Purpose of the Study:

  • To assess the impact of EPAs on resident autonomy in dermatology.
  • To determine the extent of increased clinical responsibility granted to residents upon EPA entrustment.

Main Methods:

  • A survey study involving Dutch dermatology residents and program directors (PDs).
  • Utilized hypothetical clinical cases aligned with an early-stage EPA (simple dermatological problems).
  • Assessed resident and PD perspectives on supervision requirements.

Main Results:

  • Most residents (65%) and PDs (63%) agreed that competent residents could perform the EPA unsupervised, particularly for GP referrals.
  • A significant minority of level 4 residents in University Medical Centers (36%) reported needing supervision.
  • Supervision requirements for second opinions showed contrasting trends.

Conclusions:

  • The introduction of EPAs and entrustment procedures generally facilitated intended resident autonomy in Dutch dermatology.
  • Findings suggest successful implementation of EPAs in fostering independence, with nuances in academic settings.