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The Gap Between Current and Ideal Approaches to the Core EPAs: A Mixed Methods Study of Recent Medical School Graduates

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Abstract

In 2014, the Association of American Medical Colleges (AAMC) developed a list of Core Entrustable Professional Activities (Core EPAs) to optimize the transition from medical school to residency training. In the coming years, medical schools will begin implementing curriculum targeted toward the instruction and assessment of the Core EPAs. The purpose of this convergent mixed methods study was to examine the perspective of recent medical school graduates to describe their perceived preparation for each Core EPA-based skill and to identify potential predictors that contribute to those perceptions. Forty-four first-year residents from a single hospital system (representing 29 unique medical schools) completed a questionnaire and 15 residents participated in focus group sessions. Participants were asked to rate their overall preparedness for each of the Core EPAs and describe the instruction and assessment provided during medical school. Responses were further explored through three focus group sessions. Respondents felt most prepared for Core EPAs which emphasized skills related to history and physical examinations (EPAs 1, 5, and 6) and less prepared in skills such as entering orders and prescriptions (EPA 4), performing handovers (EPA 8), and identifying system failures (EPA 13). Perceived preparation was highly correlated with the presence of early and formal training, opportunities for experience, and explicit methods of assessment. Building upon the results of these data and principles of integrated curriculum design, the authors propose a longitudinal method to focus efforts in developing curriculum for the Core EPAs.

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Acknowledgments

Dr. Ryan would like to thank the faculty and fellows in the Master of Education in Health Professions program at Johns Hopkins University who provided feedback over the course of this study.

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Authors and Affiliations

  1. Department of Pediatrics, Virginia Commonwealth University School of Medicine, 1201 E. Marshall St., Suite 4-200, Box 980565, Richmond, VA, 23298-0565, USA

    Michael S. Ryan

  2. Office of Assessment and Evaluation Studies, Virginia Commonwealth University School of Medicine, Richmond, VA, USA

    Kelly S. Lockeman & Moshe Feldman

  3. Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA, USA

    Alan Dow

Authors
  1. Michael S. Ryan
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  2. Kelly S. Lockeman
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  3. Moshe Feldman
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  4. Alan Dow
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Corresponding author

Correspondence to Michael S. Ryan.

Ethics declarations

This study was deemed exempt by Institutional Review Boards at both Virginia Commonwealth University and Johns Hopkins University.

Conflict of Interest

Dr. Dow has been funded by grants from the Josiah H. Macy, Jr. Foundation, the Donald W. Reynolds Foundation, and grant award UD7HP26044A0 from the Health Resources Services Administration/DHHS. The contents of this article are solely the responsibility of the authors and do not necessarily represent official views of the Donald W. Reynolds Foundation, the Josiah H. Macy, Jr. Foundation, or the Health Resources Services Administration/DHHS. The funders had no role in the design, conduct, data analysis, or manuscript preparation of this study.

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Ryan, M.S., Lockeman, K.S., Feldman, M. et al. The Gap Between Current and Ideal Approaches to the Core EPAs: A Mixed Methods Study of Recent Medical School Graduates. Med.Sci.Educ. 26, 463–473 (2016). https://doi.org/10.1007/s40670-016-0235-x

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