Feedback is a critical piece of learning and improving.
Now with the updated Entrustable Professional Activities (EPA) structure, clinical preceptors have regular opportunities to provide students formative feedback on their clinical skills throughout their clerkships by observing 10 minutes of a students’ performance.
James Willig, M.D., MSPH, assistant dean for Clinical Education, said the EPA concept was designed around the idea that busy clinical educators don’t have time to dedicate an hour per student to observe students collecting a complete patient history or physical examination — components that are required by the school’s accrediting body.
“The LCME asks us to have students complete focused exams and take a full patient history, activities that usually take an hour of observation and is hard to do in a high-volume environment,” Willig said. “What EPAs do is take the full patient history and physical exam and cut down them into component parts, each that will take around 10 minutes to observe.”
“All of a sudden, a clinician observes a student for 7 to 10 minutes on the wards and puts what they observe into the students’ device,” Willig said. “This allows the students more opportunities for actionable feedback and improvement and is more manageable in a clinical workflow for the educator.”
The EPAs have been rolled out throughout the SOM community over the past few years. In the first three months of the clerkships this year, there have been almost 800 recorded EPAs.
“The idea of EPA is couched within the larger framework of competency-based medical education,” said Cecil Robinson, Ph.D., associate professor of Medical Education and director of Learning and Evaluation at the UA College of Community Health Sciences. “This model looks at necessary competencies someone needs to enter a profession and develops curriculum around those competencies so that once competency is achieved, we know learners are ready to enter the workforce. Using this model, this means we know that our medical student can hit the ground running during residency and that every one of our graduates has competency in taking patient histories, performing physical exams, and giving oral presentations as entering interns.”
Robinson, who worked with Willig and developed the online tool to measure the EPAs, said this structure is a way to operationalize components of what preceptors need to look or listen for as medical students complete histories, physical exams, and oral presentations. He said the electronic recording system provides faculty a list of behaviors expected to be seen so they do not have to develop their own.
“With this approach, we are less concerned about superlative performance,” Robinson said. “Instead, we are more focused on ensuring that every medical student can demonstrate competency relative to the goal we have for our students which is readiness for internship on their path to becoming an independently practicing physician.”
To better meet learner and preceptor needs, medical education leaders are collaborating with the Medical Education Information Services to improve the reporting system and integrate EPA data into existing medical students’ clinical performance databases so that preceptors and leaders can support medical student learning and better evaluate students.
The EPA structure also creates longitudinal and consistent cross-clerkship, cross-campus student data. This presents many scholarly and educational quality improvement project opportunities for those interested in clinical teaching, and medical student learning and development. Willig and Robinson encourage any faculty, preceptors or students interested in such projects to reach out to them.