Article
Microscopy and dipstick-based management of women with uncomplicated urinary tract infections as an Entrustable Professional Activity for medical assistants in German general practice
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Authors
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Eva Bucher
- University Hospital Wuerzburg, Department of General Practice, Wuerzburg, Deutschland
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Peter Konstantin Kurotschka
- University Hospital Wuerzburg, Department of General Practice, Wuerzburg, Deutschland
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Thien-Tri Lam
- University of Wuerzburg, Institute for Hygiene and Microbiology, Wuerzburg, Deutschland
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Ildikó Gágyor
- University Hospital Wuerzburg, Department of General Practice, Wuerzburg, Deutschland
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Anne Simmenroth
- University Hospital Wuerzburg, Department of General Practice, Wuerzburg, Deutschland
| Published: | September 23, 2024 |
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Outline
Text
Background: An entrustable professional Activity (EPA) is a professional task entrusted to learners once they demonstrate competence, with supervision adjusted to individual progress. The EPA framework enables direct application of learned competencies, with entrustment decisions based on the learner's trustworthiness, ad-hoc assessment and milestone achievement.
Research question: The aim is to plan, implement, and evaluate competency-based training sessions for medical assistants in German general practices. The training focused on phase-contrast microscopy of urine and on an algorithm-based management of uncomplicated urinary tract infections (UTIs). These sessions formed part of a complex intervention in the MicUTI randomized controlled trail, which piloted this novel management approach for uncomplicated UTIs.
Methods: Qualitative assessment involved semi-structured interviews with medical assistants based on the Consolidated Framework for Implementation Research conducted three months post-training. Transcripts were analyzed, using qualitative content analysis inspired by Kuckartz.
Results: Twenty-two medical assistants from 10 general practices participated in the training. Seventeen of them were interviewed. Interviewees had a mean of 17.3 years working experience (range 1–48). Medical assistants carried out the EPA “microscopy and dipstick analysis” independently; they reported that supervision was not necessary. Views on independent algorithm-based UTI management varied, with some preferring treatment decisions to remain physician´s responsibility. Others reported that algorithm-based UTI management was already carried out by medical assistants during the study and that medical advice was seldomly requested. Obstacles to independent patient management included perceived knowledge gaps and lack of physician trust. They also reported poor appreciation from the doctors. However, participants felt empowered by their new responsibilities during the study.
Discussion: EPA offers a promising framework for task delegation in German primary care. However, the results presented here are preliminary findings. Therefore, they should be read with caution.
Take Home Message for the practice: Independent work by medical assistants requires trust and appreciation from the doctors. EPAs can support physician’s entrustment decisions to medical assistants.
