This is part of the CanadiEM Teaching That Counts Infographic Series, where we take the current research and evidence on how to teach well in the emergency department, and distill it down into bite-sized chunks that are rapidly digestible and memorable.
Teaching That Counts: 7 Tips for Filling Out EPA Assessments
With medical education programs in Canada moving towards a competency-based medical education (CBME) framework, we are challenged to learn which ways this will shape how we teach and evaluate learners1. Keeping all of the lingo straight is one thing (CBME, CBD, EPA, milestones)2. Completing an Entrustable Professional Activity (EPA) assessment that is helpful to the learner during a busy shift is another. In this issue of Teaching That Counts, we give you some quick tips on filling out EPA assessments in a way that is efficient and learner-centred.
1. Plan the EPA
Have you ever found yourself searching for an EPA that matches what you observed the learner doing? Not only does this take time, but it can result in an EPA that is less accurate and less meaningful. Instead, decide which EPA you will observe at the beginning of the shift. This can naturally be incorporated into your first five minutes with the learner, when you are negotiating learning goals for the day.
2. Prioritize the EPA
Let’s face it. At the end of your shift, you and your learner are both tired and cognitively saturated. This isn’t the most ideal time to add another task to your list of things to complete before going home. Try to get the EPA done within the first two hours of the shift, right after the observation. This way, the resident can focus more on learning than their performance for the remainder of the shift. It also frees up the end of the shift for informal debriefing and feedback.
3. Focus on the resident’s performance that day
The purpose of EPAs are to provide an objective and accurate assessment of whether a resident can perform an activity independently at the time you evaluate them, not what they were capable of a month ago, and not what you believe them to be capable of. Keep it simple and focus on your observation on that day.
4. Adapt when new opportunities arise
Some EPAs involve presentations that we don’t encounter often. Thus, it is important to be flexible enough to take advantage of these situations when they arise, even if it means abandoning the original plan.
5. Give feedback
Make the observation more than just another educational hurdle by giving the resident meaningful feedback to take away. Give feedback that is both specific and actionable by letting the resident know specifically how they could perform the skill differently next time (e.g. stand at the foot of the bed while leading a resuscitation, so you can be seen and heard by the whole time). Make it concise, and limit the feedback to only a couple of points. To learn all the tips and tricks on how to give great feedback, see our previous Teaching That Counts infographic.
6. Unpack the EPA
EPAs are made up of several milestones2. For example, the EPA “resuscitation of a critically ill patient” involves milestones such as performing a focused history and physical exam, developing a working differential diagnosis, and recognizing when specialist help is required. If the resident is struggling, dissect the EPA into its’ milestones to identify where the problem lies so you can tailor feedback to their specific challenge.
7. Remember – your job is not to “pass” or “fail” them
Your job is to be a coach in the resident’s learning journey. When it comes to EPAs, your goal is to provide observational data from a particular point in time to the competency committee2,3, and perhaps more importantly, to use that opportunity to support the learner in becoming more competent with every assessment.
Click here for more information on implementing CBME and filling out EPA assessments in Emergency Medicine!
- 1.Hart D, Franzen D, Beeson M, et al. Integration of Entrustable Professional Activities with the Milestones for Emergency Medicine Residents. WestJEM. November 2018:35-42. doi:10.5811/westjem.2018.11.38912
- 2.EPAs and Milestones. The Royal College of Physicians and Surgeons of Ontario. http://www.royalcollege.ca/rcsite/cbd/implementation/cbd-milestones-epas-e. Published 2016. Accessed January 15, 2020.
- 3.ten Cate O. Nuts and Bolts of Entrustable Professional Activities. Journal of Graduate Medical Education. March 2013:157-158. doi:10.4300/jgme-d-12-00380.1