Transcript Milestones and Entrustable Professional Activties (EPAs)

Help Us Spread the News
This presentation has been developed for
your use:
• Share and/or incorporate these slides as
needed, simply source the Royal College
• All text, images and logos contained herein
are the property of Royal College of
Physicians and Surgeons of Canada
• Questions? Email [email protected]
Milestones and EPAs
in the Royal College CBD Model
March 27, 2015
Hosted by: Dr. Jolanta Karpinski
Click to edit Master subtitle style
Objectives
At the end of this session you will be able to:
• Define the terms milestone and Entrustable
Professional Activity (EPA)
• Describe the application of these concepts
within the Competence by Design framework
• Describe the application of these concepts
within a residency program
• Identify some next steps in your use of
milestones and EPAs
What is Competency-Based
Medical Education?
A model to prepare physicians for practice that
is:
• oriented to outcomes desired in physician;
• based on patient needs;
• based on the needs of the learner, with more
accountability and flexibility; and
• focused on achieving skills and performance,
instead of time-spent in training.
Adapted from: Frank JR, Snell L, Dath, D, Sherbino, J, Holmboe ES, et
al. Competency-based medical education: theory to practice. Med
Teacher. 2010;32:638-45.
4
Outcomes Based Education
Julio Frenk et al, Lancet
2010; 376 :1923-58.
What is CBD?
How Does CanMEDS 2015 Fit?
Competence by Design (CBD) is
• Multi-year, transformational change initiative aimed
at introducing a competency-based medical
education (CBME) model to specialty education;
CanMEDS 2015 is
• Foundational project of CBD,
• Focused on updating the existing CanMEDS
Framework and introducing generic milestones across
the continuum
• Series IV of the Framework is now available
• The final version will be released at ICRE 2015 in
October 2015 along with an updated version of the
evergreen Milestones Guide
6
Key Concepts in CBD
• Stages of physician development
• Milestones
• Entrustable Professional Activities (EPAs)
Definitions
• What is a milestone?
• A defined, observable marker of an
individual's ability along a developmental
continuum
• What is an Entrustable Professional
Activity (EPA)?
• An essential task of a "discipline" that an
individual can be trusted to perform
independently in a given context
Milestones in CBD
A defined, observable marker of an
individual’s ability along a developmental
continuum.
• Generic from CanMEDS 2015.
• Abilities within a CanMEDS Role.
• Bound to a stage in the progression of
physician development.
Examples of Generic
Milestones: Medical Expert
EPAs in CBD
• In the setting of residency training.
• A Royal College Entrustable
Professional Activity (RCEPA) is a
responsibility or task in the clinical setting
that may be delegated to a resident by their
supervisor once sufficient competence has
been demonstrated.
• Linked to a specified stage of progression.
Examples of EPAs
In the real world
• Parallel park
In medicine
• Run a code
Images via: bing.com
Key Concept of EPAs:
Entrustment
“What can I safely delegate with
indirect supervision?”
14
Question Period
15
Using Milestones and EPAs
Click to edit Master subtitle style
Milestones and EPAs
Curriculum
Abilities expected of a
resident at a defined
stage of training
Assessment
Meaningful, measurable
markers of progression
of competence
Connecting Milestones
and EPAs
The key difference between EPAs and
milestones is that EPAs are the tasks or
activities that must be accomplished, whereas
milestones are the abilities of the
individual.
Examples of an EPA
from Medical Oncology
Medical Oncology EPA: the task that must
be accomplished
• Initial care for urgent and emergent
oncologic situations.
Examples of Milestones
from Medical Oncology
Medical Oncology Milestones: the abilities needed
to accomplish the task
• Recognize urgent and emergent oncologic issues,
including but not limited to, pain crisis, febrile
neutropenia, uncontrolled diarrhea, hypocalcemia,
epidural cord compression and malignant bowel
obstruction.
• Select and administer appropriate interventions for
urgent and emergent oncologic issues .
• Identify the limits of their own expertise and
appropriately seek assistance and supervision
Connection to CBD
Milestones
EPAs
Julio Frenk et al, Lancet 2010; 376 :1923-58.
Medical Oncology Example:
Milestones and EPA
Milestones which make up the Medical Oncology EPA
(abilities needed to accomplish the task)
• Recognize urgent and emergent oncologic issues, including
but not limited to, pain crisis, febrile neutropenia,
uncontrolled diarrhea, hypocalcemia, epidural cord
compression and malignant bowel obstruction.
• Select and administer appropriate interventions for urgent
and emergent oncologic issues.
• Identify the limits of their own expertise and appropriately
seek assistance and supervision.
Medical Oncology EPA
(the task that must be accomplished)
• Initial care for urgent and emergent oncologic situations.
What is a Milestone?
A milestone is an observable marker of an
individual's ability along a developmental
continuum.
• Milestones are used for planning and
teaching
23
What is an EPA?
An Entrustable Professional Activity (EPA)
is a task in the clinical setting that may be
delegated to a resident by their supervisor
once sufficient competence has been
demonstrated.
• EPAs are used for overall assessment
24
Benefits of Milestones
and EPAs
• Link clinical activities with learning and
assessment,
• Clearly defined targets for acquiring competency
and meeting standards throughout training,
• Better preparation to serve patients and
communities, and
• Strive towards mastery of skills and abilities
beyond training and throughout practice.
25
As a Teacher………
• Focus on specific clinical activities with
residents at different stages,
• Focus on teaching towards specific
milestones within a stage, and
• Conduct assessments of specific EPAs.
Question Period
27
Milestones within Each
Stage of Residency
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
Milestones within an EPA
Milestone
Milestone
Milestone
EPA
Typically, each
EPA integrates
multiple milestones.
Milestones and EPAs within
Four Stages of Residency
Problem with an EPA?
Unpack the Milestones
Progression of Competence
Question Period
33
Developing Milestones and EPAs
Click to edit Master subtitle style
Milestones and EPAs in CBD
• With CBD, specialty-specific milestones and
EPAs will become part of the standards of
training for each specialty and subspecialty
• Development of new standards of training
will be done by the Specialty Committee
including
• Determining stages of training for the
discipline (duration/focus),
• Crafting milestones, and
• Developing EPAs.
Milestones and EPAs in CBD…
• Milestones will make up a Pathway of
Competency requirements
• Map the expected progress of a resident’s
abilities
• Link to learning opportunities and
educational activities
• EPAs will link to required training
experiences and assessment strategies
CBD Discipline Rollout:
Proposed Implementation Plan
37
What Can Individual Programs
or Teachers Do Now?
• Ensure solid understanding of CBD
concepts
• Focus on progression of abilities
• What do you expect of the resident at
this point in training?
• Consider some EPAs in your clinical
environment
• Manage BP in clinic
Question Period
39
Your Input Matters
How can we improve the CBD Program?
Let us know at:
• [email protected]
• www.facebook.com/TheRoyalCollege
• https://twitter.com/Royal_College
• www.linkedin.com
For more information, visit our website:
• www.royalcollege.ca/cbd
40
Earn MOC Credits
with CBD Webinars
• Attend a CBD webinar and earn Section 1
MOC credits (Group Learning)
• View/listen to a webinar recording and earn
Section 2 MOC Credits (Self-Learning)
• Find webinar recordings at
www.royalcollege.ca/cbd/resources
(scroll to bottom of page)
• For more information about credit allocation,
please contact [email protected]
41