Implementation and Use of Entrustable Professional Activities in the Internal Medicine Acting Internship

Area of Science:

• Medical Education
• Graduate Medical Education
• Internal Medicine Training

Background:

• The internal medicine acting internship (AI rotation) is crucial for residency readiness.
• Current grading and assessment methods in AI rotations lack transparency and consistency.
• The Association of American Medical Colleges' Core Entrustable Professional Activities for Entering Residency (EPAs) offer a standardized framework but their national implementation in AI rotations is not well-understood.

Purpose of the Study:

• To determine the national prevalence of EPA implementation in internal medicine AI rotations.
• To identify which specific EPAs are most frequently emphasized and assessed.
• To explore the relationship between EPA use and existing assessment and grading practices.

Main Methods:

• A cross-sectional electronic survey was distributed to internal medicine AI rotation course directors in January 2023.
• Data were collected from 71 out of 140 LCME-accredited US medical schools, yielding a 50.7% response rate.
• The survey assessed EPA-focused teaching, assessment, and their correlation with institutional grading and evaluation procedures.

Main Results:

• 57% of institutions reported incorporating EPAs into their AI rotations.
• Higher-level EPAs (e.g., EPA 4, 8, 10) were assessed more often in AI rotations than in core clerkships, but rates remained below 50%.
• EPA adoption correlated with workplace-based assessments and competency-based rubrics, but not with narrative comments, grading structures, or perceived grade inflation.

Conclusions:

• EPA implementation in internal medicine AI rotations is currently inconsistent nationwide.
• There is a significant opportunity to enhance the transition from undergraduate to graduate medical education by more intentionally integrating EPAs.
• Addressing gaps in instruction and formative assessment for key EPAs is essential for improving training.