Development of Entrustable
Professional Activities (EPAs) for Public
Health and Preventive Medicine (PHPM)
PHPM Program Directors
April 13, 2015
Brent Moloughney, MD, MSc, FRCPC
Public Health Consultant
Webinar Goal
• Bring PHPM Program Directors up-to-date in
preparation for an online survey to seek
feedback on a draft, national core set of EPAs
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Overview
• EPAs – what and why
• PD working group and workshop
• Online survey and next steps
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Problem
• Challenges with the PHPM status quo:
– Long list of Objectives of Training:
• Provides detailed expectations
• But potentially overwhelming for residents and faculty
• Competence requires integration of competencies
– Final exam success rates
– All residents prepared for practice?
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Context
• Shift in residency education – competence by
design not opportunistic learning
Historical • Training defined by specific amount of time in
various rotations (‘dwell time’)
• Exposure to situations & teaching within rotation
 (assume) uptake of necessary KSAs to produce
professional
• End-of-rotation ‘gestalt’ evaluation
• Final exam as last hurdle to certification
CBME
• Explicit competencies to be acquired
• Stages of competence development defined by
achievement of competency-based milestones (not
time)
• More frequent, direct observation to evaluate
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Royal College
• Continuing evolution of CBME
• CanMEDS 2015:
– Competence continuum
•
•
•
•
Transition to discipline
Foundations of discipline
Core of discipline
Transition to practice
– Milestones
• Observable marker of an individual’s ability along a
developmental continuum
– Earlier final examination (out-of-scope for this project)
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Entrustable Professional Activities
(EPAs)
• Capture the work that is central/critical to a
specialty
• Link competencies/milestones to practice in an
integrated/holistic manner
• Be more explicit about assessing and
documenting performance of specific
activities/tasks
• Support graded supervision – entrust the activity
to a trainee to execute once obtained adequate
competence
• Being pursued by multiple disciplines around the
world
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Objectives of Training –
Analytic Approach
ten Cate. ICRE 2013
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EPAs - Synthetic Approach
ten Cate. ICRE 2013
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EPAs and Milestones
• RC intends to use milestones and EPAs to
redesign specialist training and assessment
– Milestone is observable marker of an individual's
ability along a developmental continuum
– EPA is the task that must be accomplished - each EPA
integrates multiple milestones
• Vision for application:
– Use milestones to design educational activities and
teach specific abilities, skills and attitudes
– Assess overall achievement of various milestones
using an EPA
http://www.royalcollege.ca/portal/page/portal/rc/resources/
publications/dialogue/vol15_2/epa_milestones
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EPAs are the tasks
that must be
accomplished,
whereas milestones
are the abilities of
the individual
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Example*
• EPA: Manage an infectious disease outbreak
• Milestones (examples)
– Transition to discipline (post-MD clinical)
• Elicit relevant information for a suspect reportable disease
– Foundations (coursework)
• Describe steps in an outbreak investigation
– Core (early rotations)
• Assume under direct supervision a support role (e.g., case
finding plan; generate case definition; etc.)
– Transition to practice (late rotation)
• Assume under minimal supervision the lead role (e.g.,
declare outbreak; organize team; plan/implement
investigation; etc.)
*Calgary EPAs
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RC, PHPM & EPAs
• Number of broader issues that need to be
explored with RC (note: opportunity to do so
at March meeting):
– Looking initially for PHPM EPAs to be a resource to
all programs and be non-prescriptive – issues?
– Looking forward, how might EPAs align with RC
activities (e.g., accreditation, final examination)?
– Potential for RC support for future tasks? (e.g.,
packaging the EPAs, translation, learning &
assessment tools, etc.)
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Check-In
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Path to PHPM EPAs
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Queen’s 2-Day Workshop (Mar 2015)
• Attendance: Queen’s, McMaster, Toronto,
Ottawa, McGill, Calgary
• Inputs:
– Calgary EPAs (with milestones) – 31
– Ontario EPAs (titles) – 27 (in 9 domains)
– Experience in EPA development (e.g., Queen’s
pursuing across multiple disciplines)
• EPAs
– Literature: 15-30 typically to describe a discipline;
fewer better than many
– Focus is on ‘end of training’ EPAs – eventually may
have others for earlier stages of training
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Queen’s 2-Day Workshop (Mar 2015)
• Outputs:
– 20 end-of-training EPAs in 4 groups/domains
– Preliminary milestone work on 6 new EPAs
– Discussed issue of optional ‘clinical’ EPAs
– Discussed need for case-based learning &
assessment
– Discussed need to seek feedback from other PDs
• Plan for online survey
• Need to bring other PDs up-to-speed
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End-of-Training EPAs (20)
• Core/critical tasks for PHPM graduate – 4 groups:
–
–
–
–
Monitor & assess the health of the public
Leadership and management
Protect the public’s health
Promote health and prevent diseases and injuries
• Reflect what was in Calgary and Ontario EPAs
– For same concepts  wording preference
– For differences in scale  went macro
– Sought better language consistency:
• Verbs: ‘lead and manage’; manage ‘x’ = manage all aspects
(reflected in EPA descriptions)
– Addressed balance of content areas:
• Identified health promotion/disease prevention items
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Online Survey – Core EPAs
• 20 items are ‘draft’ – need feedback!
• Seek level of agreement and comments on
each:
– EPA statement
– EPA brief description
• Plus, when view collectively, whether any
suggested deletions or improvements
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Additional ‘Optional’ EPAs
• At the Queen’s workshop, it was noted that
some residents pursue work in various clinical
settings and in the broader health system;
e.g.,:
– Community-oriented primary care practice
– Focussed clinical practice (TB clinic, STI clinic,
addictions, travel medicine, etc.)
– Broader health system leadership and stewardship
(e.g., RHA).
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Additional ‘Optional’ EPAs (cont’d)
• Challenge:
– These career streams mentioned in introduction
of the Objectives of Training,
– But are not explicitly addressed in the
competencies (or the draft core EPAs).
• Approach:
– Workshop participants requested the survey ask
all PDs whether optional EPAs should be
developed for one or more of these career
streams.
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Case-Based Learning & Assessment
• EPAs’ focus on observable and measureable
learning and assessment
• Considering the expected breadth of PHPM
practice, there are intrinsic challenges:
– Training stages do not build seamlessly
– Limited overall field placement time
– Tasks: low volume and high duration
– Some scenarios rare – cannot expect residents to
have universal opportunity to address
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Case-Based Learning & Assessment
(cont’d)
• Implication is that cannot rely on placements
alone for learning and assessment of EPAs
• Need a range of case-based learning and
assessment scenarios and simulations
• Ideally, would enable roles for different levels of
training
• Online survey will include questions:
– To prioritize the EPAs that are most dependent on
scenarios and simulations
– To develop inventory of existing tools
•  inform future work…
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Survey Logistics
• Planning for distribution week of April 20th
• Provide 2.5-3 weeks to complete
• Have results summarized for end of May
meeting with recommendations for next
steps.
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Further Information
• PHPM EPA development resources:
http://familymedicine.queensu.ca/education/
phpm/competency_by_design_initiative/reso
urces
• Brent Moloughney:
[email protected]
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