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Core Entrustable Professional Activities (EPAs) and the Transition from Medical School to Residency: the Postgraduate Year One Resident Perspective

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Abstract

Introduction

The Association of American Medical Colleges (AAMC) proposed thirteen core Entrustable Professional Activities (EPAs) that all graduates should be able to perform under indirect supervision upon entering residency. As an underlying premise is that graduates ready to do so will be better prepared to transition to the responsibilities of residency, we explored the relationship between postgraduate year (PGY)-1 residents’ self-assessed preparedness to perform core EPAs under indirect supervision at the start of residency with their ease of transition to residency.

Methods

Using response data to a questionnaire administered in September 2019 to PGY-1 residents who graduated from AAMC core EPA pilot schools, we examined between-group differences and independent associations for each of PGY-1 position type, specialty, and “EPA-preparedness” score (proportion of EPAs the resident reported as prepared to perform under indirect supervision at the start of residency) and ease of transition to residency (from 1 = much harder to 5 = much easier than expected).

Results

Of 274 questionnaire respondents (19% of 1438 graduates), 241 (88% of 274) had entered PGY-1 training and completed all questionnaire items of interest. EPA-preparedness score (mean 0.71 [standard deviation 0.26]) correlated with ease of transition (3.1 [0.9]; correlation = .291, p < .001). In linear regression controlling for specialty (among other variables), EPA-preparedness score (β-coefficient 1.08; 95% confidence interval .64–1.52; p < .001) predicted ease of transition to residency.

Conclusion

Graduates who felt prepared to perform many of the core EPAs under indirect supervision at the start of PGY-1 training reported an easier-than-expected transition to residency.

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Availability of Data and Material

The data that support the findings of this study are available from the Association of American Medical Colleges and the National Board of Medical Examiners. Because these data were collected on a confidential, identified basis, restrictions apply to the availability of these data to protect the identity of participating individuals and of participating institutions in this study. Requests for AAMC data can be submitted at https://www.aamc.org/request-aamc-data and requests for NBME data can be submitted at https://nbme.org/services/request-data.

References

  1. Lomis K, Amiel JM, Ryan MS, Esposito K, Green M, Stagnaro-Green A, et al. Implementing an entrustable professional activities framework in undergraduate medical education: early lessons from the AAMC core entrustable professional activities for entering residency pilot. Acad Med. 2017;92 (6):765–70. https://doi.org/10.1097/ACM.0000000000001543.

  2. Brown D, Warren JB, Hyderi A, Drusin RE, Moeller J, Rosenfeld M, et al. Finding a path to entrustment in undergraduate medical education: a progress report from the AAMC core entrustable professional activities for entering residency entrustment concept group. Acad Med. 2017;92(6):774–9. https://doi.org/10.1097/ACM.0000000000001544.

  3. Moeller JJ, Warren JB, Crowe RM, Wagner DP, Cutrer WB, Hyderi AA, et al. Developing an Entrustment Process: Insights from the AAMC Core EPA Pilot. Med Sci Educ. 2020;30:395–401. https://doi.org/10.1007/s40670-020-00918-z.

    Article  Google Scholar 

  4. Association of American Medical Colleges. Student Records System. Association of American Medical Colleges website. © 2019. In https://www.staging.aamc.org/services/srs/. Accessed December 12, 2020.

  5. Winward ML, Lipner RS, Johnston MM, Cuddy MM, Clauser BE. The relationship between communication scores from the USMLE Step 2 Clinical Skills examination and communication ratings for first-year internal medicine residents. Acad Med. 2013;88(5):693–8. https://doi.org/10.1097/ACM.0b013e31828b2df1.

    Article  Google Scholar 

  6. Cuddy MM, Winward ML, Johnston MM, Lipner RS, Clauser BE. Evaluating validity evidence for USMLE Step 2 Clinical Skills data gathering and data interpretation scores: does performance predict history-taking and physical examination ratings for first-year internal medicine residents? Acad Med. 2016;91(1):133–9. https://doi.org/10.1097/ACM.0000000000000908.

    Article  Google Scholar 

  7. Marcus-Blank B, Dahlke JA, Braman JP, Borman-Shoap E, Tiryaki E, Chipman J, et al. Predicting performance of first-year residents: correlations between structured interview, licensure exam, and competency scores in a multi-institutional study. Acad Med. 2019;94(3):378–87. https://doi.org/10.1097/ACM.0000000000002429.

    Article  Google Scholar 

  8. Sharma A, Schauer DP, Kelleher M, Kinnear B, all D, Warm E. USMLE Step 2 CK: best predictor of multimodal performance in an internal medicine residency. J Grad Med Educ. 2019;11(4):412–9. https://doi.org/10.4300/JGME-D-19-00099.1.

  9. Pearlman RE, Pawelczak MA, Bird JB, Yacht AC, Farina GA. Incoming interns perceived preparedness for core entrustable professional activities. Med Sci Educ. 2019;29:247–53. https://doi.org/10.1007/s40670-018-00685-y.

    Article  Google Scholar 

  10. Association of American Medical Colleges. Medical School Graduation Questionnaire. 2019 All schools’ report. In https://www.aamc.org/system/files/2019-08/2019-gq-all-schools-summary-report.pdf. Accessed May 30, 2021.

  11. Lindeman BM, Sacks BC, Lipsett PA. Graduating students’ and surgery program directors’ views of the Association of American Medical Colleges core entrustable professional activities for entering residency: where are the gaps? J Surg Educ. 2015;72:e184–92. https://doi.org/10.1016/j.jsurg.2015.07.005.

    Article  Google Scholar 

  12. Raymond MR, Mee J, King A, Haist SA, Winward ML. What new residents do during their initial months of training. Acad Med. 2011;86(10):S59–62. https://doi.org/10.1097/ACM.0b013e31822a70ff.

    Article  Google Scholar 

  13. Pearlman RE, Pawelczak M, Yacht AC, Akbar S, Farina GA. Program director perceptions of proficiency in the core entrustable professional activities. J Grad Med Educ. 2017;9:588–92. https://doi.org/10.4300/JGME-D-16-00864.1.

    Article  Google Scholar 

  14. Meyer EG, Kelly WF, Hemmer PA, Pangaro LN. The RIME model provides a context for entrustable professional activities across undergraduate medical education. Acad Med. 2018;93(6):954. https://doi.org/10.1097/ACM.0000000000002211.

    Article  Google Scholar 

  15. Colbert-Getz JM, Lappie K, Northrup M, Roussel D. To what degree are the 13 entrustable professional activities already incorporated into physicians’ performance schemas for medical students? Teach Learn Med. 2019;31(4):361–9. https://doi.org/10.1080/10401334.2019.1573146.

    Article  Google Scholar 

  16. Gaffney S, Farnan JM, Hirsch K, McGinty M, Arora VM. The modified, multi-patient observed simulated handoff experience (M-OSHE): assessment and feedback for entering residents on handoff performance. J Gen Intern Med. 2016;31(4):438–41. https://doi.org/10.1007/s11606-016-3591-8.

    Article  Google Scholar 

  17. Lescinskas E, Stewart D, Shah C. Improving handoffs: implementing a training program for incoming internal medicine residents. J Grad Med Educ. 2018;10(6):698–701. https://doi.org/10.4300/JGME-D-18-00244.1.

    Article  Google Scholar 

  18. Posel N, Hoover ML, Bergman S, Grushka J, Rosenzveig A, Fleiszer D. Objective assessment of the entrustable professional activity handover in undergraduate and postgraduate surgical learners. J Surg Educ. 2019;76(5):1258–66. https://doi.org/10.1016/j.jsurg.2019.03.008.

    Article  Google Scholar 

  19. Stan VA, Correa R, Deslauriers JR, Faynboym S, Shah T, Widge AS. Support, technology and mental health: correlates of trainee workplace satisfaction. Perspect Med Educ. 2020;9:31–40. https://doi.org/10.1007/s40037-019-00555-2.

    Article  Google Scholar 

  20. Dyrbye LN, Satele D, Sloan J, Tait D. Shanafelt TD. Ability of the physician well-being index to identify residents in distress. J Grad Med Educ. 2014;6 (1):78–84. https://doi.org/10.4300/JGME-D-13-00117.1.

  21. National Resident Matching Program, Results and Data: 2019 Main Residency Match®. National Resident Matching Program, Washington, DC. 2019. In https://mk0nrmp3oyqui6wqfm.kinstacdn.com/wp-content/uploads/2019/04/NRMP-Results-and-Data-2019_04112019_final.pdf. Accessed May 30, 2021.

  22. American Urological Association. 2019 Urology Residency Match Statistics. In file:///C:/Users/dandriole/Downloads/2019-Urology-Residency-Match-Statistics%20(1).pdf. Accessed May 30, 2021

  23. Soukoulis V, Gusic ME. Comparing student and clerkship director perspectives about readiness to perform the core entrustable professional activities at the start of the clerkship curriculum. Med Sci Educ. 2018;28:277–80.

    Article  Google Scholar 

  24. Garber AM, Feldman M, Ryan M, Santen SA, Dow A, Goldberg SR. Core EPAs in the acting internship: early outcomes from an interdepartmental experience. Med Sci Educ. 2021;31:527–33. https://doi.org/10.1007/s40670-021-01208-y.

    Article  Google Scholar 

  25. Brown DR, Moeller JJ, Grbic D, Biskobing DM, Crowe R et al. Outcomes of the entrustment process in the core EPAs (Entrustable Professional Activities) for entering residency pilot. Acad. Med. 2021. In press.

  26. Coalition for Physician Accountability. Initial summary report and preliminary recommendations of the undergraduate medical education to graduate medical education review committee (UGRC). https://physicianaccountability.org/wp-content/uploads/2021/04/UGRC-Initial-Summary-Report-and-Preliminary-Recommendations-1.pdf. Accessed May 16, 2021.

  27. Walker CA, Splinter A, Khan M, Schaffernocker T, Verbeck N, Kman N, McCallister JW. Educational handoffs between medical school and residency: a national survey of residency program directors. MedEdPublish. 2018. Online published February 27, 2018. https://doi.org/10.15694/mep.2018.0000047.1.

  28. Pereira AG, Harrell HE, Weissman A, Smith CD, Dupras D, Kane GC. Important skills for internship and the fourth-year medical school courses to acquire them: a national survey of internal medicine residents. Acad Med. 2016;91(6):821–6. https://doi.org/10.1097/ACM.0000000000001134.

    Article  Google Scholar 

  29. Angus SV, Vu TR, Willett LL, Call S, Halvorsen AJ, Chaudhry S. Internal medicine residency program directors’ views of the core entrustable professional activities for entering residency: an opportunity to enhance communication of competency along the continuum. Acad Med. 2017;92(6):785–91. https://doi.org/10.1097/AC%3c.0000000000001419.

    Article  Google Scholar 

  30. LaFemina J, Ahuva V, Alseidi A, Balters M, Brasel K, Clark III C, et al. APDS consensus statement: ideal senior medical student experiences for preparedness for general surgery internship. J Surg Educ. 2020. Online July 28 2020. https://doi.org/10.1016/j.jsurg.2020.07.015.

  31. American College of Surgeons. ACS/APDS/ASE Resident Prep Curriculum. In https://www.facs.org/education/program/resident-prep. Accessed May 30, 2021.

  32. American College of Obstetricians and Gynecologists. Postmatch curriculum. In https://www.acog.org/education-and-events/creog/curriculum-resources/postmatch-curriculum. Accessed May 30, 2021.

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Acknowledgements

We thank Lynn Shaull, senior research analyst at the Association of American Medical Colleges, Washington, DC, USA, for assistance with classification of the activities/experiences reported by respondents from the open-ended questions. We thank the National Board of Medical Examiners, Philadelphia, PA, USA, for permission to use United States Medical Licensing Examination Step 2 Clinical Knowledge and Step 2 Clinical Skills data. Preliminary results of this analysis were presented at the AMEE virtual meeting, September 2020.

Funding

This work was supported by the Association of American Medical Colleges and by the medical schools participating in the core EPAs for entering residency pilot. All participating pilot institutions and individuals can be found at https://www.aamc.org/initiatives/coreepas/pilotparticipants/.

Author information

Authors and Affiliations

  1. Florida International University Herbert Wertheim College of Medicine, Miami, FL, USA

    Vivian Obeso

  2. Association of American Medical Colleges, 655 K Street, N.W., Washington, DC, 20001-2399, USA

    Douglas Grbic, Amy Jayas & Dorothy A. Andriole

  3. Michigan State University College of Human Medicine, Grand Rapids, MI, USA

    Matthew Emery

  4. Vanderbilt University School of Medicine, Nashville, TN, USA

    Kendra Parekh

  5. Oregon Health & Science University School of Medicine, Portland, OR, USA

    Carrie Phillipi

  6. McGovern Medical School at the University of Texas Health Science Center, Houston, TX, USA

    Jennifer Swails

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  1. Vivian Obeso
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on behalf of the Core Entrustable Professional Activities for Entering Residency Pilot

Corresponding author

Correspondence to Dorothy A. Andriole.

Ethics declarations

Ethics Approval

The AAMC Human Subjects Protection Program staff reviewed this study and determined that it was exempt from further Institutional Review Board review because it does not involve human subjects.

Informed Consent

Not applicable.

Conflict of Interest

The authors are all directly involved in the Core EPA pilot in various roles. Three authors are employed by the organization (AAMC) that convened the Core EPA pilot; the remaining five authors are faculty at medical schools participating in the core EPAs for entering residency pilot and are involved in core EPA implementation at their respective schools. The authors declare no competing interests.

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Obeso, V., Grbic, D., Emery, M. et al. Core Entrustable Professional Activities (EPAs) and the Transition from Medical School to Residency: the Postgraduate Year One Resident Perspective. Med.Sci.Educ. 31, 1813–1822 (2021). https://doi.org/10.1007/s40670-021-01370-3

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