The EPA-based Utrecht undergraduate clinical curriculum: Development and implementation

Abstract

Aim: As reports of the application of entrustable professional activities (EPAs) increase, not only for postgraduate but also for undergraduate medical education, there is a need for descriptions of what a UME curriculum with EPAs could look like. We provide such a description based on the experiences at University Medical Center Utrecht, the Netherlands, which can be used as an example by other curriculum developers.

Methods: In a three-year process, the UMC Utrecht Curriculum Committee developed a clinical workplace curriculum with an EPA structure, taking into account examples, such as the US Core EPAs for Entering Residency, and recommendations to integrate and increase the length of clerkships.

Results: In the resulting curriculum, operational from 2016, students train to be trusted with indirect supervision before graduation in five broad EPAs: the clinical consultation; general medical procedures; informing, advising and guiding patients and families; communicating and collaborating with colleagues; and extraordinary patient care. Each of these integrates smaller (nested) EPAs that receive focused training attention in integrated clerkships at various moments and must be signed off for entrustment with indirect supervision to complete the clerkship.

Discussion: The framework of EPAs went through many iterations before it was consolidated. Among the issues that required special attention was the application of a supervision levels scale for sign-off, the necessity to cover all relevant clinical content while not labeling too many small tasks each as a separate EPA, methods of EPA-focused assessment in the workplace and the creation of an e-portfolio model to serve assessment and entrustment.

Note

Acknowledgments

The authors wish to particularly thank Menne van Boven MD, Sanne van de Munckhof MD, and Karlijn Hofstraat MSc, for their thoughtful contributions to the EPA framework. Further, the authors are grateful to other faculty and student members of the Curriculum Committee and associated clinical faculty involved in implementation of LINKs: Heleen Brehler, Carlijn Dolmans, Mick van Eijs, Samuel Fidder, Joost Frenkel, Sibyl Geelen, Timon van Haeften, Reinier Hoff, Laura van der Kamp, Bastiaan van der Klis, Bregje Koomen, Floor van Leeuwen, Berent Prakken, Joni Remmits, Patricia Schothorst, Anke Steerneman, Suzanne van der Velden, Renee van de Wetering, Tineke Westerveld, Janneke Witte, and Dorien Zwart.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Notes on contributors

Olle ten Cate, PhD, is Professor of Medical Education, Scientific Director of Education, and Senior Scientist at the Center for Research and Development of Education at University Medical Center, Utrecht, the Netherlands and was Vice-chair of the CRU + curriculum committee.

Lysanne Graafmans, MD, is a staff member and educational advisor of the Curriculum Committee 2016–2017 at University Medical Center, Utrecht, the Netherlands.

Indra Posthumus, MD, was a staff member and educational advisor of the Curriculum Committee 2016–2017 at University Medical Center, Utrecht, the Netherlands.

Lisanne Welink, MD, was staff member and educational advisor of the Curriculum Committee 2014–2016 at University Medical Center, Utrecht, the Netherlands, and now combines a PhD-trajectory with vocational training in General Practice at the Julius Center for Health Sciences and Primary Care.

Marijke R. van Dijk, MD, PhD, was Program Director and Chair of the CRU + Curriculum Committee until March 2017 at University Medical Center, Utrecht, the Netherlands.

Notes

1 In the Dutch language there is an accepted and well understood word (“bekwaamverklaring”) that has been translated as Statement of Awarded Responsibility (STAR (36)) based on a summative entrustment decision.

Additional information

Funding

The work on EPAs of the first, third and fourth author (OtC, IP, and LW) was partly funded by a multi-institutional project called Workplace-based e-Assessment Technology for Competency-based Higher Multi-professional Education (WATCHME) from EU’s Seventh Framework Programme for research, technological development, and demonstration, under grant agreement [619349].