Newswise BOSTON (April 9, 2013) Medical school graduates entering one family medicine residency program might receive training that is markedly different than another family medicine residency program. While these new medical school graduates, called residents, will gain the clinical knowledge needed to practice medicine, their scope of skills depend on their specific experiences as residents. A team of healthcare professionals from the Family Medicine Residency Program at Tufts University School of Medicine have published a paper in the Journal of Graduate Medical Education that suggests a way to evaluate family medicine residents based on their level of competency. <\/p>\n
Family medicine resident training is currently determined by the types of patients that the residents treat at their specific hospital or clinic, rather than being determined by the curriculum. We have created a list of entrustable professional activities or EPAs to assess clinical competencies that clearly define the breadth of skills required at the completion of residency, said Allen Shaughnessy, Pharm.D., M.Med.Ed., professor at Tufts University School of Medicine and fellowship director of the Tufts University Family Medicine Residency Program at Cambridge Health Alliance. <\/p>\n
Shaughnessy worked with a team of healthcare professionals from Tufts University School of Medicines Family Medicine Residency Program to develop a list of 76 EPAs around which to structure a competency-based assessment of family medicine residents. <\/p>\n
Competence is defined as the ability to do something successfully. Defining the list of somethings in family medicine residencies has been difficult for both educators and regulators, said Gregory L. Sawin, M.D., M.P.H., assistant professor at Tufts University School of Medicine and program director, Tufts Family Medicine Residency at Cambridge Health Alliance. <\/p>\n
Competency-based medical education ensures that medical residents acquire a certain set of skills, behaviors, and attitudes in addition to the clinical knowledge needed to practice medicine. When these skills, behaviors, and attitudes are integrated and performed in an educational setting, they become known as entrustable professional activities. An activity is entrustable when a supervisor deems that a medical resident could have performed a task without supervision; in this case, the resident has demonstrated competency in a given area. As an example, the authors write: <\/p>\n
For example, a competent family medicine physician is expected to provide care for a child with a respiratory illness. This includes eliciting a history, performing a physical examination, arriving at a diagnosis, and implementing a plan of care that is evidence based and takes into account the needs and values of the patient. Although each of these skills can be separately measured and documented in a variety of settings, the overall performance of them in situ constitutes the entrustable activity. <\/p>\n
In addition to confirming that family medicine residents know how to treat a specific disease or condition, the EPAs can ensure that residents acquire skills that enable them to effectively interact with medically-diverse patients, uphold ethical principles, use information sources at the point of care, and develop skills relating to running a medical practice. <\/p>\n
The leading effort to define competencies is the Outcome Project, from the Accreditation on Graduate Medical Education (ACGME) and the American Board of Medical Specialties. The Outcome Project is shifting medical education from assuring quality through intense training processes to measuring outcomes and specific skill. This shift in medical training was the result of calls for greater accountability in all aspects of the profession. <\/p>\n
Shaughnessy notes that the Outcome Project leaves the definition of actual competencies and their assessment to individual residencies. Interpretation may lead to vague competency categories that are not specific enough to provide definitive guidance to residents or faculty members regarding what learning needs to be accomplished and documented. In response, the EPAs provide a detailed, concrete approach to training and evaluating residents in how they provide care. <\/p>\n
The initial EPAs presented in the paper were developed at the Tufts University School of Medicine Family Medicine Residency Program, based on the ACGME guidelines, over a two year period. Twenty-one experts were recruited to further determine and refine the EPAs that are most relevant to family medicine education. The experts participated in two rounds of anonymous, internet-based surveys to compile the final list of EPAs. The process began with 91 EPAs that were then narrowed down to 76 based on the feedback. <\/p>\n
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Defining the Scope of Skills for Family Medicine Residencies<\/a><\/p>\n","protected":false},"excerpt":{"rendered":" Newswise BOSTON (April 9, 2013) Medical school graduates entering one family medicine residency program might receive training that is markedly different than another family medicine residency program. While these new medical school graduates, called residents, will gain the clinical knowledge needed to practice medicine, their scope of skills depend on their specific experiences as residents. A team of healthcare professionals from the Family Medicine Residency Program at Tufts University School of Medicine have published a paper in the Journal of Graduate Medical Education that suggests a way to evaluate family medicine residents based on their level of competency Continue reading