Summative Entrustment Decision-Making in a National Entrustable Professional Activity-Based Residency Training Programme: Where theory meets practice

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Published Jun 26, 2023
DOI: https://doi.org/10.18103/mra.v11i6.3863

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Main Article Content

Maaike P. Smit, MD, PhD-Student
Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
Reinoud J.B.J. Gemke, MD, PhD
Consultant Paediatrician, Professor of Paediatrician and Child Health, Amsterdam University Medical Centre, The Netherlands
Karsten A. van Loon, PhD
Department for Postgraduate Medical Training, Amsterdam University Medical Centre, The Netherlands
Marieke de Visser, PhD
Department for Research in Learning and Education, Radboudumc Health Academy, Radboud University Medical Centre, Nijmegen, The Netherlands
Matthijs de Hoog, MD, PhD
Paediatrician Intensivist, Professor of Postgraduate Medical Education, Director of the PICU, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
Janiëlle van der Velden, MD, PhD
Paediatrician Endocrinologist, Director of Paediatric Residency Training, Radboudumc Amalia Children’s Hospital, Nijmegen, The Netherlands

Abstract

Introduction: The Entrustable Professional Activity (EPA) framework was introduced to operationalise and translate competency-based medical education into daily practice. Adoption of EPAs is recommended and supported in guidelines by educational research on trust and entrustment decision-making. However, systematic field studies evaluating the experiences of medical professionals (residents and supervisors) working with an EPA framework in daily practice are lacking. Still these evaluations are necessary to support the design and implementation of new EPA-based residency training programmes. This study provides an in-depth insight and a more comprehensive understanding of the experiences of professionals working in an EPA-based residency training programme.


Methods: We conducted a qualitative study using a constructivist approach. Focus groups were used for separate interviews with residents and supervisors assessing their experiences with the first national EPA-based residency training programme in the Netherlands. Thematic analysis was used to analyse the results of the focus groups and to define relevant themes.


Results: The EPA framework enabled residents to enhance and individualise their training programme. Personal leadership proved to be essential for finding a balance between the requirements of the national training programme and exploration of residents’ individual talents, experience and learning curve. Supervisors’ supportive and guiding role is crucial throughout the process of EPA acquirement. Independent from each other, supervisors and residents indicated that trust (and not exhaustive testing) is essential in the summative assessment by a Clinical Competence Committee (CCC). Supervisors see added value in the mandatory portfolio that residents compile to help them prepare for the CCC meeting. Starting to work without supervision is an important but challenging goal once an EPA has been acquired. The ability to further individualise the training programme after an EPA has been acquired, varies among residents.


Discussion: We found that residents and supervisors see added value in working and learning in an EPA-based residency training programme. Awareness and encouragement of self-regulated learning skills could potentially help create a balance between programme requirements and individualisation. When discussing a portfolio, trust and gut-feelings during CCC meetings is fundamental and helpful for supervisors to get a comprehensive view of the resident’s performance. An autonomy-supportive supervision strategy could encourage and improve residents’ autonomy and practice of working without direct supervision after acquiring an EPA.

Keywords: Entrustment decision-making, EPA-based training programme, innovation of resident training, evaluation of resident training individualised residency training programme

Article Details

How to Cite
SMIT, Maaike P. et al. Summative Entrustment Decision-Making in a National Entrustable Professional Activity-Based Residency Training Programme: Where theory meets practice. Medical Research Archives, [S.l.], v. 11, n. 6, june 2023. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/3863>. Date accessed: 21 nov. 2024. doi: https://doi.org/10.18103/mra.v11i6.3863.
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Issue
Vol 11 No 6 (2023): June Issue, Vol.11, Issue 6
Section
Research Articles

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References

1. El‐Haddad C, Damodaran A, McNeil HP, Hu W. The ABCs of entrustable professional activities: an overview of ‘entrustable professional activities’ in medical education. Internal medicine journal. 2016;46(9):1006-1010.

2. Smit MP, de Hoog M, Brackel HJ, Ten Cate O, Gemke RJ. A national process to enhance the validity of entrustment decisions for Dutch pediatric residents. Journal of graduate medical education. 2019;11(4s):158-164.

3. Duitsman ME, Fluit CR, van Alfen-van der Velden J, et al. Design and evaluation of a clinical competency committee. Perspectives on medical education. 2019;8(1):1-8.

4. Ten Cate O. Entrustability of professional activities and competency-bases training. Medical education. 2005;39:1176-1177.

5. ten Cate O, Chen HC, Hoff RG, Peters H, Bok H, van der Schaaf M. Curriculum development for the workplace using entrustable professional activities (EPAs): AMEE guide no. 99. Medical teacher. 2015;37(11):983-1002.

6. ten Cate O, Scheele F. Competency-based postgraduate training: can we bridge the gap between theory and clinical practice? Academic Medicine. 2007;82(6):542-547.

7. ten Cate O. Nuts and bolts of entrustable professional activities. Journal of graduate medical education. 2013;5(1):157-158.

8. Peters H, Holzhausen Y, Boscardin C, ten Cate O, Chen HC. Twelve tips for the implementation of EPAs for assessment and entrustment decisions. Medical teacher. 2017;39(8):802-807.

9. ten Cate O, Hart D, Ankel F, et al. Entrustment Decision Making in Clinical Training. Academic Medicine. 2016;91(2):191-198. doi:10.1097/acm.0000000000001044

10. Choo KJ, Arora VM, Barach P, Johnson JK, Farnan JM. How do supervising physicians decide to entrust residents with unsupervised tasks? A qualitative analysis. Journal of hospital medicine. 2014;9(3):169-175.

11. TOP2020 part 1. Dutch Association for Pediatricians. Accessed May 2022, https://assets.nvk.nl/p/491522//files/TOP2020%20deel%20I%20definitief_maart%202017.pdf

12. van Rossum TR, Scheele F, Sluiter HE, Bosman PJ, Rijksen L, Heyligers IC. Flexible competency based medical education: more time efficient, higher costs. Medical teacher. 2018;40(3):315-317.

13. Dreyfus SE, Dreyfus HL. A five-stage model of the mental activities involved in directed skill acquisition. 1980.

14. Tavakol M, Sandars J. Quantitative and qualitative methods in medical education research: AMEE Guide No 90: Part I. Medical Teacher. 2014;36(9):746-756.

15. Mann K, MacLeod A. Constructivism: learning theories and approaches to research. In: Durning SJ, Cleland J, eds. Researching medical education. Wiley Blackwell; 2015:49-66.

16. Stalmeijer RE, McNaughton N, Van Mook WN. Using focus groups in medical education research: AMEE Guide No. 91. Medical teacher. 2014;36(11):923-939.

17. Frambach JM, van der Vleuten CP, Durning SJ. AM last page: Quality criteria in qualitative and quantitative research. Academic Medicine. 2013;88(4):552.

18. Barry CA, Britten N, Barber N, Bradley C, Stevenson F. Using reflexivity to optimize teamwork in qualitative research. Qualitative health research. 1999;9(1):26-44.

19. Tavakol M, Sandars J. Quantitative and qualitative methods in medical education research: AMEE Guide No 90: Part II. Medical teacher. 2014;36(10):838-848.

20. Braun V, Clarke V. Using thematic analysis in psychology. Qualitative research in psychology. 2006;3(2):77-101.

21. Williams GC, Saizow RB, Ryan RM. The importance of self-determination theory for medical education. Academic Medicine. 1999;74(9):992-5.

22. Zimmerman BJ. Investigating Self-Regulation and Motivation: Historical Background, Methodological Developments, and Future Prospects. American Educational Research Journal. 2008;45(1):166-183. doi:10.3102/0002831207312909

23. Siddaiah-Subramanya M, Nyandowe M, Zubair O. Self-regulated learning: why is it important compared to traditional learning in medical education? Advances in medical education and practice. 2017:243-246.

24. van Houten-Schat MA, Berkhout JJ, van Dijk N, Endedijk MD, Jaarsma ADC, Diemers AD. medical education in review. Medical Education. 2018;52:1008-1015.

25. Pacifico JL, Villanueva JAS, Heeneman S, van der Vleuten C. How perceptions of residents toward assessment influence learning: a qualitative study. Asia Pac Scholar. 2020;5(1):46-53.

26. Lu L, Yuan YC, McLeod PL. Twenty-five years of hidden profiles in group decision making: A meta-analysis. Personality and Social Psychology Review. 2012;16(1):54-75.

27. Janis IL. Groupthink. IEEE Engineering Management Review. 2008;36(1):36.

28. Hauer KE, Cate Ot, Boscardin CK, et al. Ensuring resident competence: a narrative review of the literature on group decision making to inform the work of clinical competency committees. Journal of graduate medical education. 2016;8(2):156-164.

29. Stasser G, Titus W. Pooling of unshared information in group decision making: Biased information sampling during discussion. Journal of personality and social psychology. 1985;48(6):1467.

30. Stasser G, Titus W. Effects of information load and percentage of shared information on the dissemination of unshared information during group discussion. Journal of personality and social psychology. 1987;53(1):81.

31. Van Der Gulden R, Heeneman S, Kramer A, Laan R, Scherpbier-de Haan N, Thoonen B. How is self-regulated learning documented in e-portfolios of trainees? A content analysis. BMC medical education. 2020;20(1):1-13.

32. van der Gulden R, Timmerman AA, Sagasser MH, et al. How does portfolio use support self-regulated learning during general practitioner specialty training? A qualitative focus group study. BMJ open. 2023;13(2):e066879.

33. Ramani S, Könings KD, Ginsburg S, van der Vleuten CP. Twelve tips to promote a feedback culture with a growth mind-set: Swinging the feedback pendulum from recipes to relationships. Medical teacher. 2019;41(6):625-631.

34. Sargeant JM, Mann KV, Van der Vleuten CP, Metsemakers JF. Reflection: a link between receiving and using assessment feedback. Advances in health sciences education. 2009;14(3):399-410.

35. Biondi EA, Varade WS, Garfunkel LC, et al. Discordance between resident and faculty perceptions of resident autonomy: can self-determination theory help interpret differences and guide strategies for bridging the divide? Academic Medicine. 2015; 90(4):462-471.

36. Baldwin CD, Craig MS, Garfunkel LC, et al. Autonomy-Supportive Medical Education: Let the Force Be: Within: You! Academic Medicine. 2012;87(11):1468-1469.

37. Schneider EC, Shah A, Doty MM, Tikkanen R, Fields K, Williams II RD. Reflecting Poorly: Health Care in the US Compared to Other High-Income Countries. 2021