Entrustable Professional Activity
Turning to future possibilities, Dr. Brown discussed the work of Olle ten Cate, PhD, from the University of Amsterdam, The Netherlands. He is a professor and scholar of medical education who said to show competence we should define what the work is, said Dr. Brown.
“So Olle put forth … the concept of entrustable professional activities (EPAs)—a list of things that an individual needs to do to be competent,” he said. An example would be how we approach the work of an airline pilot, said Dr. Brown. We know pilots are competent to take off, fly and land a plane even if something goes wrong.
“Competencies can be reflected in activities,” said Dr. Brown. “In the future, … if we define our fellows as being competent not in terms of the competencies but in terms of being able to perform these activities, we will have a better model that will be independent of time.”
There are 14 EPAs in rheumatology developed to be understood without “a long-winded explanation,” said Dr. Brown. Use of EPAs is, perhaps, a way to move from the tea bag model to one that focuses on fulfilling competencies independently, he said.
“I hope our education in the future becomes more centered on evaluating entrustable professional activities,” said Dr. Brown.
Recent literature indicates that milestones to measure achievement as mandated by ACGME are popular with the current population of millennial medical students. Early research also suggests that milestones are beginning to be accepted, lead to overall improvement of knowledge and skills, and correlate highly with annual evaluation summaries, according to Dr. Brown.
Work is underway to improve current milestones to render them simpler and more straightforward. “So progress continues,” he said.
Dr. Brown concluded with a reminder of another important aspect of training new doctors. Noting that students learn best from teachers they love, he encouraged the audience to always keep the importance of relationships with student fellows at the center of education and training.
“Do not forget your humanity and the care that we have for our students and the love that we express,” said Dr. Brown. “We can talk about competencies. We can talk about milestones. We can’t forget love and don’t forget the love in what it is that you do.”
Catherine Kolonko is a medical writer based in Oregon.
