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Development and Implementation of Institution-Wide Entrustable Professional Activities (EPAs) for Interprofessional Education (IPE)

Gary Yee, PharmD, Associate Dean, COP Devin Nickol, MD, Assistant Dean for IPE Co-chairs, UNMC IPE Curriculum Committee

Background

• Accrediting bodies for all major health professions now mandate some form of IPE for learners

• No standard exists to determine “practice-ready” competence in interprofessional care delivery

• Entrustable Professional Activities (EPAs) emerged from the graduate medical education (GME) world and can be adapted for IPE

• Campus-level implementation of EPAs for assessment in IPE is a formidable task

Assessment in IPE is challenging.

Background

• An EPA is a task, e.g. “Insert a chest tube” or “Perform a discharge medication reconciliation”

• EPAs refer to essential activities, competencies describe people

• A trainee’s level of “entrustability” with a task will change over time as (hopefully) less supervision is needed

ABCs of EPAs

Ten Cate O. Nuts and Bolts of Entrustable Professional Activities. Journal of Graduate Medical Education 2013; 5:157-158.

Background

• What are the essential activities of team-based care? Examples: handoffs, consultation, admission

• Each of these activities depends on multiple interprofessional competencies

• Tracking entrustability with these EPAs shows the trajectory of trainee competence

• The IPE EPAs can be shared across professions • Each program can define its own profession-specific competencies

that contribute to entrustability

EPAs in IPE

University of Nebraska Medical Center (UNMC)

• Academic medical center consisting of UNMC and Nebraska Medicine

• UNMC consists of seven colleges (medicine, nursing, dentistry, pharmacy, allied health, public health, graduate) and four institutes

• Nebraska Medicine consists of two hospitals and numerous clinics

It takes a village to hatch an EPA.

IPE Structure at UNMC

Methods

• Vice Chancellor asked the Education Council to develop core IPE competencies that could be used by all colleges

• The Education Council charged the IPE Curriculum Committee to develop core IPE EPAs that each student should be able to perform at the time of graduation

• IPE Curriculum and IPE Assessment and Evaluation Committees worked together to develop EPAs

Support from senior leadership is important

Methods

For the four IPEC core competencies, what observable tasks can serve as EPAs? • Roles & Responsibilities • Interprofessional Communication • Teams & Teamwork • Values & Ethics

The Core Four

Interprofessional Education Collaborative. Core competencies for interprofessional Collaborative practice: 2016 update. Washington, DC (2016): Interprofessional Education Collaborative.

Methods

Three broadly applicable tasks identified: • Team approach to healthcare: provide care as a member of

an interprofessional team • Receptivity to teammates: give and receive feedback • Self-efficacy as a team member: fill a role on the team while

supporting the roles of others

From competency to EPA

Methods

• Define core job functions (competencies) performed during each EPA

• Describe entrustable vs. pre-entrustable behaviors of trainees (see handout)

• To do: define stages of entrustability, e.g. Likert scale • To do: develop AAMC-style vignettes to illustrate progression of

entrustability

What should be measured?

Association of American Medical Colleges. Core Entrustable Professional Activities for Entering Residency. 2014.

Results • Team approach to healthcare: the ability to work in cooperation with

those who receive care, those who provide care, and others who contribute to or support the delivery of prevention and health services

• Receptivity to teammates: the ability to give timely, sensitive, instructive feedback to others about their performance on the team, responding respectfully as a team member to feedback to others

• Self-efficacy as a team member: the ability to work with individuals of other professions to maintain a climate of mutual respect and shared values

IPE entrustable professional activities

Results

• EPAs were reviewed and approved by each College’s Curriculum Committee for further implementation

• Each college will determine the specific competencies used to demonstrate entrustability based on the skills appropriate for that profession

• Each college will develop assessments to ensure that graduates achieve each specific competency

Approval is easier than implementation.

Conclusions

• EPAs can provide a practical and flexible framework for assessment in IPE

• The support of senior leadership is essential

• Centralized tracking will be challenging

A promising start.