Review of the competency in entrustable professional activities in internal medicine residency training

Abstract

Entrustable professional activities (EPAs) are discrete clinical tasks which must be assessed, approved, and entrusted during training. They are being progressively used as an academic framework in a variety of educational programs worldwide. In the field of internal medicine (IM), however, the empirical evidence is sparse. The objective of this study is to review the topics and details of EPAs and entrustment levels aligned with milestones during IM residency training. The approach for this study was based on PICO (Population-Intervention-Comparison-Outcome) framework. The author searched for articles published since 2005 that included quantitative and qualitative research as well as pedagogical reports on EPAs in IM residency training. All included articles with full-text English language were assessed for content (topics, details, and entrustable levels) and subsequent analyzed using guideline key questions in the Critical Appraisal Skills Program (CASP) Checklist. Of 292 unique articles identified, 16 studies were found to meet the inclusion criteria. All were grouped into 1) development of EPAs, 2) implementation of EPAs and 3) evaluation of EPAs. Simple mnemonic “FOE-ME” for creating and implementing of EPAs was proposed, which was derived from Focus, Observable, Essential, Measurable, and independently Executable. Appropriate content and level of entrustment in EPAs are required to evaluate and monitor IM residents’ competency. Implication of the Thematic Paper: 1. Discharge planning, family meeting, specific EPAs for each subspecialty rotation, and essential procedures of IM may be added to an existing list of EPAs in IM residency training in Thailand. 5-level entrustment should be applied in this program. 2. Since high-level evidence-based evidence is still scarce, further study to define and compare the effectiveness of different EPAs in this field should be investigated.