gms | German Medical Science

Gemeinsame Jahrestagung der Gesellschaft für Medizinische Ausbildung (GMA) und des Arbeitskreises zur Weiterentwicklung der Lehre in der Zahnmedizin (AKWLZ)

30.09. - 03.10.2015, Leipzig

Towards a Realistic View on Future Doctors: A Descriptive Follow-up Study on Entrustable Professional Activities

Meeting Abstract

  • corresponding author presenting/speaker Ansgar Koechel - Uniklinik Heidelberg, II. Med. Klinik, Heidelberg, Deutschland
  • author Till Johannes Bugaj - Uniklinik Heidelberg, II. Med. Klinik, Heidelberg, Deutschland
  • author Jan Gröner - Uniklinik Heidelberg, I. Medizinsche Klinik, Heidelberg, Germany
  • author Jan Stiepak - Uniklinik Heidelberg, III. Medizinische Klinik, Heidelberg, Deutschland
  • author Julia Huber - Uniklinik Heidelberg, II. Med. Klinik, Heidelberg, Deutschland
  • author Andreas Möltner - Uniklinik Heidelberg, II. Med. Klinik, Heidelberg, Deutschland
  • author Wolfgang Herzog - Uniklinik Heidelberg, II. Med. Klinik, Heidelberg, Deutschland
  • author Christoph Nikendei - Uniklinik Heidelberg, II. Med. Klinik, Heidelberg, Deutschland

Gemeinsame Jahrestagung der Gesellschaft für Medizinische Ausbildung (GMA) und des Arbeitskreises zur Weiterentwicklung der Lehre in der Zahnmedizin (AKWLZ). Leipzig, 30.09.-03.10.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. DocP12-157

doi: 10.3205/15gma258, urn:nbn:de:0183-15gma2587

Veröffentlicht: 31. August 2015

© 2015 Koechel et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen. Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden. Lizenz-Angaben siehe http://creativecommons.org/licenses/by-nc-nd/3.0/.


Gliederung

Text

Fragestellung/Einleitung: Doctors’ clinical core responsibilities enfold in communicative, procedural, interprofessional and team-related activities. Therefore, on-ward team integration, independent patient management, and supervision are crucial for workplace learning. The concept of ‘Entrustable Professional Activities’ (EPAs) allows faculties to make objective and individual competency-based decisions on the basis of supervision. EPAs are units of professional practice to be confided to the execution by a student who has attained sufficient specific competence. The possibility of independent execution, observation, and measurement in process and outcome make EPAs highly efficient for the decision process of entrustment allowing for standardized measurement based on the implementation of milestones and competency-requirements1. Inspite of the increasing significance of this concept there still has been little research on the practical implementation.

The aim of the study were to

1.
descriptively assess the status of final year students’ objective competencies in four clinical activities using EPAs,
2.
to examine changes in performance-level in course of their 16-week clinical internal medicine rotation, and
3.
to gain first insights in statistical properties of EPAs.

Methoden: We carried out a descriptive, clinical follow-up study with 24 final-year medical students in their Internal Medicine rotation as well as 48 internal medicine inpatients at the Department for Internal Medicine, University of Heidelberg. Participating students were filmed at the beginning and in the end of their rotation while performing four highly relevant clinical activities: history taking, physical examination, IV cannulation, and case presentation. Two independent, blinded video assessors rated the clinical performance using the concept of EPAs, binary checklists, and global rating scales.

Ergebnisse: Final year medical students show severe deficits when performing clinical on-ward activities. Although they improve during their internship, the performance-level at the end of their rotation in Internal Medicine was rated as not sufficient for independent practice. Entrustability of clinical activities seems to be especially endangered in duties that were less often practiced in clinical settings in preceding education. Inter-rater reliabilities, correlations between EPAs and other instruments implemented showed high correlation coefficients except for correlation with global ratings of physical examination performance. Highest EPA levels were reached for IV cannulation, while case presentation yielded lowest EPA scores.

Diskussion/Schlussfolgerung: Despite the limitations of our pilot-study, we could show that future doctors seem unprepared for independent practice as physicians. Further research has to be done investigating the implementation and quality management of EPAs [http://www.abim.org/program-directors-administrators/milestones.aspx citied 2015-05-29, ][1], [2],


References

1.
van Loon KA, Driessen EW, Teunissen PW, Scheele F. Experiences with EPAs, potential benefits and pitfalls. Med Teach. 2014;36(8):698-702. DOI: 10.3109/0142159X.2014.909588 Externer Link
2.
Ten Cate O. Nuts and bolts of entrustable professional activities. J Grad Med Educ. 2013;5(1):157-158. DOI: 10.4300/JGME-D-12-00380.1 Externer Link