Comparing Entrustment Decision-Making Outcomes of the Core Entrustable Professional Activities Pilot, 2019-2020
Authors: Brown David R. , Moeller Jeremy J. , Grbic Douglas , Andriole Dorothy A. , Cutrer William B. , Obeso Vivian T. , Hormann Mark D. , Amiel Jonathan M. ,   Core Entrustable Professional Activities for Entering Residency Pilot, Amiel Jonathan , Barron Beth , Catallozzi Marina , Obeso Vivian , Biehler Jefry , Brown David R , Hormann Mark , Adams Sasha , Ownby Allison R , Swails Jennifer , Wagner Dianne , Emery Matthew , Sousa Aron , Thompson-Busch Angela , Cocks Patrick M. , Gillespie Colleen C. , Rosenfeld Melvin , Tewksbury Linda , Mejicano George , Bumsted Tracy , Phillipi Carrie A. , Warren Jamie , Yingling Sandra , Aiyer Meenakshy , Jokela Janet , Khan Asra R. , Cutrer William B. , Chastain Cody , Parekh Kendra , Vasilevskis Eduard , Ryan Michael S. , Biskobing Diane M. , Deiorio Nicole , Trimble Gregory , Green Michael , Gielissen Katherine , Moeller Jeremy J. , Wu Barry , Whelan Alison J. 
Published: September 2022

Importance

Gaps in readiness for indirect supervision have been identified for essential responsibilities encountered early in residency, presenting risks to patient safety. Core Entrustable Professional Activities (EPAs) for entering residency have been proposed as a framework to address these gaps and strengthen the transition from medical school to residency.

Objective

To assess progress in developing an entrustment process in the Core EPAs framework.

Design, Setting, and Participants

In this quality improvement study in the Core EPAs for Entering Residency Pilot, trained faculty made theoretical entrustment determinations and recorded the number of workplace-based assessments (WBAs) available for each determination in 2019 and 2020. Four participating schools attempted entrustment decision-making for all graduating students or a randomly selected subset of students. Deidentified, individual-level data were merged into a multischool database.

Interventions

Schools implemented EPA-related curriculum, WBAs, and faculty development; developed systems to compile and display data; and convened groups to make theoretical summative entrustment determinations.

Main Outcomes and Measures

On an EPA-specific basis, the percentage of students for whom an entrustment determination could be made, the percentage of students ready for indirect supervision, and the volume of WBAs available were recorded.

Results

Four participating schools made 4525 EPA-specific readiness determinations (2296 determinations in 2019 and 2229 determinations in 2020) for 732 graduating students (349 students in 2019 and 383 students in 2020). Across all EPAs, the proportion of determinations of “ready for indirect supervision” increased from 2019 to 2020 (997 determinations [43.4%] vs 1340 determinations [60.1%]; 16.7 percentage point increase; 95% CI, 13.8-19.6 percentage points; P &amp;lt; .001), as did the proportion of determinations for which there were 4 or more WBAs (456 of 2295 determinations with WBA data [19.9%] vs 938 [42.1%]; 22.2 percentage point increase; 95% CI, 19.6-24.8 percentage points; P &amp;lt; .001). The proportion of EPA-specific data sets considered for which an entrustment determination could be made increased from 1731 determinations (75.4%) in 2019 to 2010 determinations (90.2%) in 2020 (14.8 percentage point increase; 95% CI, 12.6-16.9 percentage points; P &amp;lt; .001). On an EPA-specific basis, there were 5 EPAs (EPA 4 [orders], EPA 8 [handovers], EPA 10 [urgent care], EPA 11 [informed consent], and EPA 13 [patient safety]) for which few students were deemed ready for indirect supervision and for which there were few WBAs available per student in either year. For example, for EPA 13, 0 of 125 students were deemed ready in 2019 and 0 of 127 students were deemed ready in 2020, while 0 determinations in either year included 4 or more WBAs.

Conclusions and Relevance

These findings suggest that there was progress in WBA data collected, the extent to which entrustment determinations could be made, and proportions of entrustment determinations reported as ready for indirect supervision. However, important gaps remained, particularly for a subset of Core EPAs.