Identifying Entrustable Professional Activities for Internal Medicine Residents in Ambulatory Continuity Practice
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Division of General Internal Medicine, Zuckerberg San Francisco General Hospital , University of California San Francisco , San Francisco , CA , USA; Division of General Internal Medicine , University of California San Francisco , San Francisco , CA , USA; 3Internal Medicine Residency Program , University of California San Francisco , San Francisco , CA , USA; 4Division of General Internal Medicine, San Francisco Veterans Affairs Medical Center , University of California San Francisco , San Francisco , CA , USA; 5Department of Medicine , University of California San Francisco , San Francisco , CA , USA; 6Department of Surgery , University of California San Francisco , San Francisco , CA , USA; 7Research and Development in Medical Education , University of California San Francisco , San Francisco , CA , USA.
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J Gen Intern Med DOI: 10.1007/s11606-019-05430-8 © Society of General Internal Medicine 2019
INTRODUCTION
Medical care is increasingly provided in the ambulatory setting. Internal medicine (IM) residency training programs must assess residents’ trajectory to independently provide quality care in ambulatory continuity practice. Entrustable professional activities (EPAs) are measurable, discrete tasks used for competency-based assessment. This study aimed to identify EPAs for IM residents applicable to the ambulatory continuity setting overcoming others’ failure to achieve consensus.1–3
METHODS
Three authors (C.S., K.J., R.L.) compiled a list of 177 potential EPAs from a literature review.1, 3–5 The study team eliminated EPAs irrelevant to ambulatory IM, reducing the list to 50 EPAs. A group of medical educators combined redundant EPAs and identified gaps finalizing 20 candidate EPAs. Two study authors (C.S., R.L.) graded each EPA using the EQual rubric, an instrument with 14 categories scored on a scale of 1– 5 to evaluate EPA consistency.6 The team re-evaluated EPAs scoring less than 4 in any category. Through the revision process, the team eliminated four EPAs and revised five, resulting in sixteen EPAs. Participants in the study were IM physician educators from one of three settings: a university-based clinic, a VA clinic, or a safety net clinic. Using a Delphi technique, participants could Preliminary findings from this paper were presented in a poster session at the Society of General Internal Medicine Annual Conference in Denver, Colorado, in April 2018. Received August 16, 2019 Revised August 27, 2019 Accepted September 24, 2019
complete two rounds of surveys via email. In the first round, participants rated level of importance of each EPA on a 5-point Likert scale (1 = not at all important, 5 = very important) and in which year of training a resident is expected to be independent (PGY1–PGY3). Respondents could submit additional EPAs. In round 2, respondents received their response from
Table 1 Delphi Participant Characteristics N (%) Title Professor 8 (50) Associate professor 4 (25) Assistant professor 3 (19) Other 1 (6) Practice site VA clinic 5 (31) University clinic 8 (50) County clinic 3 (19)
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