Education Research: Entrustment and Simulated Performance of Neurocritical Care Advanced Practice Providers

Area of Science:

• Medical Education
• Neurocritical Care
• Advanced Practice Providers

Background:

• Entrustable professional activities (EPAs) are defined for neurocritical care (NCC) advanced practice providers (APPs).
• No validated assessment measure currently exists for APPs in neurology or NCC.
• This study aimed to validate assessment measures for NCC APPs.

Purpose of the Study:

• To assess the relationship between supervisor-assessed entrustment and performance in simulated emergencies.
• To evaluate the agreement between self-assessed and supervisor-assessed entrustment among NCC APPs.

Main Methods:

• A simulation quality improvement study was conducted with NCC APPs at 5 US academic medical centers.
• Participants completed 2 simulated scenarios assessing medical and neurologic emergency management.
• Outcomes included the relationship between performance and supervisor-assessed entrustment, and agreement between self- and supervisor-assessments.

Main Results:

• Physician supervisor-assessed entrustment positively correlated with performance (r_s = 0.57, p = 0.002).
• No significant correlation was found between APP supervisor-assessed entrustment and performance (r_s = -0.02, p = 0.952).
• Substantial agreement existed between physician supervisor and self-assessments (κ_w = 0.62), while fair agreement was noted between APP supervisor and self-assessments (κ_w = 0.38).

Conclusions:

• Physician supervisor EPA-based assessments correlate with NCC APP performance in simulations, offering validity evidence for competency-based medical education.
• The agreement between physician supervisors and APPs on self-assessment suggests potential for incorporating self-assessment into NCC APP training programs.