Entrustable professional activities and facets of competence in a simulated workplace-based assessment for advanced medical students

Abstract

Background: Competence-based assessment formats in medical education usually focus on individual facets of competence (FOCs). The concept of ‘Entrustable Professional Activities’ (EPAs) encompasses supervisors’ decisions on which level of supervision a trainee requires to perform a professional activity including several FOCs. How the different FOCs as perceived by clinician raters contribute to entrustment decisions is yet unclear.

Objective: How do FOC perceptions relate to entrustment-decisions?

Methods: Sixty-seven advanced medical students participated in an assessment simulating the first day of a resident physician. Participants were rated by supervisors for seven FOCs and twelve EPAs.

Results: There was a positive correlation between FOC and EPA scores. Each EPA displayed a different correlation pattern with FOC ratings.

Discussion: For most EPAs high levels of entrustment were associated with high ratings for selected FOCs. The results are in alignment with the assumption that each EPA encompasses a different set of FOCs.

Conclusions: In our simulated workplace-based assessment, entrustment decisions for EPAs reflect the FOCs observed in a trainee. Thus, assessment of FOCs alongside with EPA ratings could add to the understanding of factors contributing to entrustment decisions.     

Preparation for practice and the arguments for standardisation in view of the forthcoming medical licensing exam: A literature review

Abstract

Aims: The aim of this paper is to address whether the introduction of a national licensing exam will improve preparedness for practice. This review will explore and identify the areas in which UK medical graduates are feeling underprepared. In addition, this review will discuss the need for the Medical Licensing Assessment in the UK.

Methods: A literature search of several databases was performed in December 2018. Studies which identified the areas in which medical graduates were prepared/unprepared for, and those which explored whether UK medical schools were adequately preparing their graduates for practice, were included. Studies exploring the preparedness of international medical graduates were excluded.

Results: Sixteen articles met the final inclusion criteria and are included in this review. All the final studies are cross-sectional and are varied in their use of methods used, with the vast majority using questionnaires to identify the preparedness of medical students and junior doctors.

Conclusions: This review conveys that junior doctors are mostly underprepared in emergency work. This can be associated to a lack of exposure to emergency situations during their undergraduate training. Moreover, this review suggests that the preparedness of medical graduates may remain unaffected by the implementation of the MLA.     

Teaching,reflecting, and learning: The value of an intercalated medical education programme

Abstract

Objectives: Teaching programmes within medicine focus primarily on pathways of a shorter length with little regard to teaching lasting longer than a month. This study is different from other studies as it examines the benefits of a nine month-long medical education degree programme and its impact beyond graduation. This study set out to explore the impact of a medical education intercalated degree programme for its graduates and their careers.

Methods: A small scale, exploratory qualitative case study was conducted with 10 graduates of an intercalated degree programme.

Results: The findings highlight the longer term value of an intercalated degree programme with particular emphasis on academic and personal skills; research and teaching skills; independence and confidence; its impact on future practice and the notion that ‘student as teacher’ programmes are a valuable asset to medical education as a whole. Participants advocated more teaching opportunities as a core longitudinal teaching component in preparation for the teaching responsibilities in their working lives.

Conclusions: The programme enables the development of a range of academic and personal skills, with particular emphasis on research and teaching skills, independence and confidence.     

The education and training of gastroenterologists for the 21st century: a paradigm for the education of medical specialists in technology-intensive fields - an international and Israeli perspective

Gastroenterology in the developed world as a paradigm for technologically intensive medical specialties has undergone dramatic changes during the last half-century with expansion, proliferation and affluence followed by serious reactions on the part of cost-conscious and demanding governments, insurers and consumers. A review of events in several regions within the developed world reveals tremendous technological progress but inadequate attention to professional, economic and ethical issues, which are crucial for the education of a model gastroenterologist who will embody the qualities that will enable him/her to function well clinically, technologically, scientifically, professionally and ethically and thus enable him/her to cope with the increasingly complex challenges that are likely to arise during the next decades. The possibility and need for defining a specific ethic for technology-intensive medical specialists is discussed.     

The DISCuSS model: Creating connections between community and curriculum – A new lens for curricular development in support of social accountability

Abstract

Medicine’s social mandate recognizes the importance of introducing changes to systems and practices to meet the healthcare needs of marginalized populations. Social accountability efforts encompass a wide array of actions, including equity, diversity and inclusion initiatives, and adapting knowledge relevant to practice across education, research, and clinical domains. To influence change in education, ongoing structures and processes are needed to ensure adequacy, relevance, and effectiveness of curricular coverage. In support of this, we created an innovative and creative approach to developing curricular modules to prepare medical students to provide care that is responsive to the cultural, economic, and psychosocial realities of diverse patient populations. The DISCuSS model (Diversity, Identify, Search, Create module (with community engagement), Sustainability, Social accountability) provides a community-engaged, iterative approach to curriculum development relevant to social accountability. Over the past 5 years, we have created nine curricular modules focused on health-related inequities and social concerns, including modules on Indigenous and refugee health, sexual and gender minority health, human trafficking, and addiction. AFMC Graduation Questionnaire results have shown a statistically significant increase in our students ‘preparedness to provide care to diverse populations.’ The DISCuSS model, which continues to evolve, can be adapted and used in other settings.