David R. Taylor, MD, MHPE; Yoon Soo Park, PhD; Christopher A. Smith, MD; Jolanta Karpinski, MD, MEd; William Coke, MD; Ara Tekian, PhD, MHPE
Acknowledgment: The authors acknowledge the participation and contributions of the members of the Specialty Committee for Internal Medicine and thank Drs. Mark Roberts, Marcy Mintz, Heather MacDonald-Blumer, and Thomas Maniatis for revising EPAs during the Delphi process.
Grant Support: This research was supported by grants from the Southeastern Ontario Academic Medical Organization Endowed Scholarship and Education Fund and the Queen's University Department of Medicine Innovation Fund.
Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-1680.
Reproducible Research Statement:Study protocol and statistical code: Not available. Data set: Available from Dr. Taylor (e-mail, email@example.com).
Requests for Single Reprints: David Taylor, MD, MHPE, Department of Medicine, Queen's University, 94 Stuart Street, Kingston, Ontario K7L 3N6, Canada; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Taylor and Smith: Department of Medicine, Queen's University, 94 Stuart Street, Kingston, Ontario K7L 3N6, Canada.
Drs. Park and Tekian: College of Medicine, Department of Medical Education, University of Illinois at Chicago, 808 South Wood Street, Chicago, IL 60612.
Dr. Karpinski: Royal College of Physicians and Surgeons of Canada, 774 Echo Drive, Ottawa, Ontario K1S 5N8, Canada.
Dr. Coke: Trillium Health Partners, 100 Queensway West, Mississauga, Ontario L5B 1B8, Canada.
Author Contributions: Conception and design: D.R. Taylor, Y.S. Park, A. Tekian.
Analysis and interpretation of the data: D.R. Taylor, Y.S. Park, A. Tekian.
Drafting of the article: D.R. Taylor, Y.S. Park.
Critical revision of the article for important intellectual content: D.R. Taylor, Y.S. Park, C.A. Smith, J. Karpinski, A. Tekian.
Final approval of the article: D.R. Taylor, Y.S. Park, C.A. Smith, J. Karpinski, W. Coke, A. Tekian.
Provision of study materials or patients: D.R. Taylor.
Statistical expertise: D.R. Taylor, Y.S. Park.
Obtaining of funding: D.R. Taylor.
Administrative, technical, or logistic support: D.R. Taylor, J. Karpinski, W. Coke.
Collection and assembly of data: D.R. Taylor, Y.S. Park, W. Coke.
Competency-based medical education has not advanced residency training as much as many observers expected. Some medical educators now advocate reorienting competency-based approaches to focus on a resident's ability to do authentic clinical work.
To develop descriptions of clinical work for which internal medicine residents must gain proficiency to deliver meaningful patient care (for example, “Admit and manage a medical inpatient with a new acute problem”).
A modified Delphi process involving clinical experts followed by a conference of educational experts.
The Royal College of Physicians and Surgeons of Canada.
In phase 1 of the project, members of the Specialty Committee for Internal Medicine participated in a modified Delphi process to identify activities in internal medicine that represent the scope of the specialty. In phase 2 of the project, 5 experts who were scholars and leaders in competency-based medical education reviewed the results.
Phase 1 identified important activities, revised descriptions to improve accuracy and avoid overlap, and assigned activities to stages of training. Phase 2 compared proposed activity descriptions with published guidelines for their development and application in medical education.
The project identified 29 activities that qualify as entrustable professional activities. The project also produced a detailed description of each activity and guidelines for using them to assess residents.
These activities reflect the practice patterns of the developers and may not fully represent internal medicine practice in Canada.
Identification of these activities is expected to facilitate modification of training and assessment programs for medical residents so that programs focus less on isolated skills and more on integrated tasks.
Southeastern Ontario Academic Medical Organization Endowed Scholarship and Education Fund and Queen's University Department of Medicine Innovation Fund.
Taylor DR, Park YS, Smith CA, Karpinski J, Coke W, Tekian A. Creating Entrustable Professional Activities to Assess Internal Medicine Residents in Training: A Mixed-Methods Approach. Ann Intern Med. [Epub ahead of print 17 April 2018]:. doi: 10.7326/M17-1680
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Published: Ann Intern Med. 2018.
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