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.
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.
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.
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.
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:
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.
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.
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.
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.
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.
Read more from the original source:
Defining the Scope of Skills for Family Medicine Residencies
- Yes, But. The Annotated Atlantic. [Last Updated On: November 7th, 2009] [Originally Added On: November 7th, 2009]
- Health Insurance Benefit Costs by Region [Last Updated On: November 8th, 2009] [Originally Added On: November 8th, 2009]
- For an Operator, Please Press... [Last Updated On: November 8th, 2009] [Originally Added On: November 8th, 2009]
- Pollyanna With a Pen: Maine Governor Signs 18 New Health Care Bills into Law [Last Updated On: November 8th, 2009] [Originally Added On: November 8th, 2009]
- AMA Sounds the Alarm, Medicare Making Yet Another Attempt to Cut Reimbursement [Last Updated On: November 8th, 2009] [Originally Added On: November 8th, 2009]
- Mass Governor Asks Blue Cross to Keep Higher Employer Contribution [Last Updated On: November 8th, 2009] [Originally Added On: November 8th, 2009]
- Lifespan and Care New England Plan Monopoly (Again) [Last Updated On: November 8th, 2009] [Originally Added On: November 8th, 2009]
- Dirigo Health: Con Artists, Liars, and Thieves? [Last Updated On: November 8th, 2009] [Originally Added On: November 8th, 2009]
- New Orleans: Health Challenges [Last Updated On: November 8th, 2009] [Originally Added On: November 8th, 2009]
- August a Flurry of Activity [Last Updated On: November 8th, 2009] [Originally Added On: November 8th, 2009]
- Maine's Dirigo Health Savings One-Third of Original Estimate [Last Updated On: November 8th, 2009] [Originally Added On: November 8th, 2009]
- “Methodolatry”: My new favorite term for one of the shortcomings of evidence-based medicine [Last Updated On: November 8th, 2009] [Originally Added On: November 8th, 2009]
- Suzanne Somers’ Knockout: Dangerous misinformation about cancer (part 1) [Last Updated On: November 8th, 2009] [Originally Added On: November 8th, 2009]
- A science-based blog about GMO [Last Updated On: November 8th, 2009] [Originally Added On: November 8th, 2009]
- A Not-So-Split Decision [Last Updated On: November 8th, 2009] [Originally Added On: November 8th, 2009]
- Military Medicine in Iraq [Last Updated On: November 8th, 2009] [Originally Added On: November 8th, 2009]
- The effective wordsmithing of Amy Wallace [Last Updated On: November 8th, 2009] [Originally Added On: November 8th, 2009]
- A Science Lesson from a Homeopath and Behavioral Optometrist [Last Updated On: November 8th, 2009] [Originally Added On: November 8th, 2009]
- Join CFI in opposing funding mandates for quackery in health care reform [Last Updated On: November 8th, 2009] [Originally Added On: November 8th, 2009]
- Mainstreaming Science-Based Medicine: A Novel Approach [Last Updated On: November 8th, 2009] [Originally Added On: November 8th, 2009]
- Those who live in glass houses… [Last Updated On: November 8th, 2009] [Originally Added On: November 8th, 2009]
- J.B. Handley of the anti-vaccine group Generation Rescue: Misogynistic attacks on journalists who champion science [Last Updated On: November 8th, 2009] [Originally Added On: November 8th, 2009]
- When homeopaths attack medicine and physics [Last Updated On: November 8th, 2009] [Originally Added On: November 8th, 2009]
- The cancer screening kerfuffle erupts again: “Rethinking” screening for breast and prostate cancer [Last Updated On: November 8th, 2009] [Originally Added On: November 8th, 2009]
- All Medicines Are Poison! [Last Updated On: November 8th, 2009] [Originally Added On: November 8th, 2009]
- When Loud Wins: Will Your Tax Dollars Pay For Prayer? [Last Updated On: November 8th, 2009] [Originally Added On: November 8th, 2009]
- It’s All in Your Head [Last Updated On: November 8th, 2009] [Originally Added On: November 8th, 2009]
- The Skeptical O.B. joins the Science-Based Medicine crew [Last Updated On: November 8th, 2009] [Originally Added On: November 8th, 2009]
- The Tragic Death Toll of Homebirth [Last Updated On: November 8th, 2009] [Originally Added On: November 8th, 2009]
- What’s the right C-section rate? Higher than you think. [Last Updated On: November 8th, 2009] [Originally Added On: November 8th, 2009]
- Recombinant Human Antithrombin – Milking Nanny Goats for Big Bucks [Last Updated On: December 13th, 2009] [Originally Added On: December 13th, 2009]
- Does C-section increase the rate of neonatal death? [Last Updated On: December 13th, 2009] [Originally Added On: December 13th, 2009]
- Man in Coma 23 Years – Is He Really Conscious? [Last Updated On: December 13th, 2009] [Originally Added On: December 13th, 2009]
- Why Universal Hepatitis B Vaccination Isn’t Quite Universal [Last Updated On: December 13th, 2009] [Originally Added On: December 13th, 2009]
- Ontario naturopathic prescribing proposal is bad medicine [Last Updated On: December 13th, 2009] [Originally Added On: December 13th, 2009]
- Naturopaths and the anti-vaccine movement: Hijacking the law in service of pseudoscience [Last Updated On: December 13th, 2009] [Originally Added On: December 13th, 2009]
- The Institute for Science in Medicine enters the health care reform fray [Last Updated On: December 13th, 2009] [Originally Added On: December 13th, 2009]
- Neti pots – Ancient Ayurvedic Treatment Validated by Scientific Evidence [Last Updated On: December 13th, 2009] [Originally Added On: December 13th, 2009]
- Early Intervention for Autism [Last Updated On: December 13th, 2009] [Originally Added On: December 13th, 2009]
- A temporary reprieve from legislative madness [Last Updated On: December 13th, 2009] [Originally Added On: December 13th, 2009]
- A critique of the leading study of American homebirth [Last Updated On: December 13th, 2009] [Originally Added On: December 13th, 2009]
- Lose those holiday pounds [Last Updated On: December 13th, 2009] [Originally Added On: December 13th, 2009]
- Endocrine disruptors—the one true cause? [Last Updated On: December 13th, 2009] [Originally Added On: December 13th, 2009]
- Acupuncture for Chronic Prostatitis/Chronic Pelvic Pain Syndrome [Last Updated On: December 13th, 2009] [Originally Added On: December 13th, 2009]
- Evidence in Medicine: Experimental Studies [Last Updated On: December 13th, 2009] [Originally Added On: December 13th, 2009]
- Midwives and the assault on scientific evidence [Last Updated On: December 13th, 2009] [Originally Added On: December 13th, 2009]
- The Mammogram Post-Mortem [Last Updated On: December 13th, 2009] [Originally Added On: December 13th, 2009]
- An Influenza Recap: The End of the Second Wave [Last Updated On: December 13th, 2009] [Originally Added On: December 13th, 2009]
- The End of Chiropractic [Last Updated On: December 13th, 2009] [Originally Added On: December 13th, 2009]
- Cell phones and cancer again, or: Oh, no! My cell phone’s going to give me cancer! (revisited) [Last Updated On: December 20th, 2009] [Originally Added On: December 20th, 2009]
- Another wrinkle to the USPSTF mammogram guidelines kerfuffle: What about African-American women? [Last Updated On: December 20th, 2009] [Originally Added On: December 20th, 2009]
- Acupuncture, the P-Value Fallacy, and Honesty [Last Updated On: December 20th, 2009] [Originally Added On: December 20th, 2009]
- The One True Cause of All Disease [Last Updated On: December 20th, 2009] [Originally Added On: December 20th, 2009]
- Communicating with the Locked-In [Last Updated On: December 20th, 2009] [Originally Added On: December 20th, 2009]
- Are the benefits of breastfeeding oversold? [Last Updated On: December 20th, 2009] [Originally Added On: December 20th, 2009]
- Measles [Last Updated On: December 20th, 2009] [Originally Added On: December 20th, 2009]
- Radiation from medical imaging and cancer risk [Last Updated On: December 21st, 2009] [Originally Added On: December 21st, 2009]
- Multiple Sclerosis and Irrational Exuberance [Last Updated On: December 21st, 2009] [Originally Added On: December 21st, 2009]
- Medical Fun with Christmas Carols [Last Updated On: December 22nd, 2009] [Originally Added On: December 22nd, 2009]
- Lithium for ALS – Angioplasty for MS [Last Updated On: December 23rd, 2009] [Originally Added On: December 23rd, 2009]
- “Toxins”: the new evil humours [Last Updated On: December 24th, 2009] [Originally Added On: December 24th, 2009]
- 2009’s Top 5 Threats To Science In Medicine [Last Updated On: December 24th, 2009] [Originally Added On: December 24th, 2009]
- Buteyko Breathing Technique – Nothing to Hyperventilate About [Last Updated On: December 26th, 2009] [Originally Added On: December 26th, 2009]
- The Graston Technique – Inducing Microtrauma with Instruments [Last Updated On: December 29th, 2009] [Originally Added On: December 29th, 2009]
- The “pharma shill” gambit [Last Updated On: December 29th, 2009] [Originally Added On: December 29th, 2009]
- Ginkgo biloba – No Effect [Last Updated On: December 30th, 2009] [Originally Added On: December 30th, 2009]
- Oppose “Big Floss”; practice alternative dentistry [Last Updated On: January 1st, 2010] [Originally Added On: January 1st, 2010]
- Causation and Hill’s Criteria [Last Updated On: January 3rd, 2010] [Originally Added On: January 3rd, 2010]
- The life cycle of translational research [Last Updated On: January 10th, 2010] [Originally Added On: January 10th, 2010]
- The anti-vaccine movement strikes back against Dr. Paul Offit [Last Updated On: January 10th, 2010] [Originally Added On: January 10th, 2010]
- Osteoporosis Drugs: Good Medicine or Big Pharma Scam? [Last Updated On: January 10th, 2010] [Originally Added On: January 10th, 2010]
- Acupuncture for Hot Flashes [Last Updated On: January 10th, 2010] [Originally Added On: January 10th, 2010]
- The case for neonatal circumcision [Last Updated On: January 10th, 2010] [Originally Added On: January 10th, 2010]
- A victory for science-based medicine [Last Updated On: January 10th, 2010] [Originally Added On: January 10th, 2010]
- James Ray and testosterone replacement therapy (TRT) [Last Updated On: January 10th, 2010] [Originally Added On: January 10th, 2010]
- The Water Cure: Another Example of Self Deception and the “Lone Genius” [Last Updated On: January 12th, 2010] [Originally Added On: January 12th, 2010]
- Be careful what you wish for, Dr. Dossey, you just might get it [Last Updated On: January 13th, 2010] [Originally Added On: January 13th, 2010]
- You. You. Who are you calling a You You? [Last Updated On: January 15th, 2010] [Originally Added On: January 15th, 2010]
- The War on Salt [Last Updated On: January 16th, 2010] [Originally Added On: January 16th, 2010]
- Is breech vaginal delivery safe? [Last Updated On: January 16th, 2010] [Originally Added On: January 16th, 2010]