553 - Experience Integrating Formative Entrustable Professional Activity Assessments in a Pediatrics Clerkship

Poster Number: 553
Publication Number: 553.115

Michael P. Goldman, Yale School of Medicine, New Haven, CT, United States; Andrew Taylor, Yale School of Medicine, West Haven, CT, United States; Ada Fenick, Yale School of Medicine, New Haven, CT, United States; Uma P. Phatak, Yale School of Medicine, New Haven, CT, United States

Background: Formative assessments (FAs) guide learning. Entrustable Professional Activities (EPAs) can be used as work-place based FAs. The AAMC derived 13 core EPAs for graduating medical students though implementation of EPA FAs into clerkship activities is in its nascency.

Objective: We aimed to assess feasibility of an EPA FA program for pediatric clerkship students on 3 EPAs – 1) oral presentations as a mock consult (C/S), 2) examining a child (PE), and 3) documenting a medical note (MN). An exploratory aim examined how preceptor type impacted EPA scoring.

Design/Methods: Preceptors and students received orientation to program logistics and rationale. Students completed up to one C/S, two PEs and two MNs as a requirement. Preceptors completed a mobile phone-based evaluation. Feasibility was measured by students’ mean EPA completion rate, percentage meeting the requirement, and median time to complete the evaluation. Evaluations included task-based checklists, 5-point EPA co-activity scales and qualitative feedback. Descriptive statistics and thematic analysis reports our experience. T-tests and ANOVA compared near-parametric data.

Results: Forty-five medical students documented completion of 217 EPA FAs over the last 20 weeks of the clerkship year (24% C/S, 37% PE, and 39% MN). The per student mean EPA completion rate was 4.8 (SD 1.4). Five FAs were documented by 76% (34/45) while 91% (41/45) documented at least three. Faculty, residents and fellows precepted 53%, 40% and 7% of the FAs, respectively. Median time to complete the evaluation was 5.3 minutes (IQR 2.6 – 12.7). The mean score on the 5-point EPA coactivity scales was 4.09 (SD 0.8), with mean C/S, PE, and MN of 3.53, 4.09, and 4.44, respectively (p = 0.00). Faculty graded students more critically than trainees, (3.80 vs. 4.41; p = 0.00). The following themes emerged from preceptor feedback: For C/S, initiating the consult with a refined clinical question. For PE, the importance of establishing rapport with children and engaging caregivers in the exam. For MN, writing succinctly and including both common and rule out diagnoses in assessments.Conclusion(s): Integrating three AAMC core EPA FAs into our clerkship proved feasible and may offer further understanding of how varied preceptors approach EPA co-activity scales. Assigning students to complete EPA FA’s at certain junctures during the clerkship may improve compliance with the clerkship requirement. Triangulation of our EPA FA program with student and preceptors’ perspectives are needed. Partnering with other clerkship leaders may allow for tracking development of core EPAs for individual students.