How much is enough? Proposing achievement thresholds for core EPAs of graduating medical students in Canada

Abstract

Purpose

The transition towards Competency-Based Medical Education at the Cumming School of Medicine was accelerated by the reduced clinical time caused by the COVID-19 pandemic. The purpose of this study was to define a standard protocol for setting Entrustable Professional Activity (EPA) achievement thresholds and examine their feasibility within the clinical clerkship.

Methods

Achievement thresholds for each of the 12 AFMC EPAs for graduating Canadian medical students were set by using sequential rounds of revision by three consecutive groups of stakeholders and evaluation experts. Structured communication was guided by a modified Delphi technique. The feasibility/consequence models of these EPAs were then assessed by tracking their completion by the graduating class of 2021.

Results

The threshold-setting process resulted in set EPA achievement levels ranging from 1 to 8 across the 12 AFMC EPAs. Estimates were stable after the first round for 9 of 12 EPAs. 96.27% of EPAs were successfully completed by clerkship students despite the shortened clinical period. Feasibility was predicted by the slowing rate of EPA accumulation overtime during the clerkship.

Conclusion

The process described led to consensus on EPA achievement thresholds. Successful completion of the assigned thresholds was feasible within the shortened clerkship.

Practice points

• The modified Delphi technique is a feasible methodology that can be used to propose achievement thresholds for all 12 EPAs for graduating undergraduate medical students.

• Recommended achievement thresholds for each EPA ranged from 1 (e.g. ‘Participate in health quality improvement initiatives’) to 8 (e.g. ‘Obtain a history and perform a physical examination adapted to the patient’s clinical situation’).

Keywords:

• Competency-based medical education
• entrustable professional activities (EPAs)
• medical education research
• modified Delphi technique
• undergraduate

Author contributions

All of the authors listed (AH, MP, KM, KB, CT, CN, JD) have made substantial contributions to this manuscript in conception and design, acquisition of data, and analysis and interpretation of data. All authors drafted the article for important intellectual content and have approved the manuscript for submission.

Disclosure statement

The authors report no conflict of interest.

Additional information

Funding

The authors report there is no funding associated with the work featured in this article.

Notes on contributors

Adrian Harvey

Adrian Harvey is the Assistant Dean of Program Evaluation at the Cumming School of Medicine’s (CSM’s) Undergraduate Medical Education (UME) at the University of Calgary, the CBD Lead of the General Surgery Residency Program and an Associate Professor of Surgery and Oncology at the CSM. He is also an endocrine surgeon in Calgary, Alberta.

Michael Paget

Michael Paget is the Manager of the Academic Technologies team at the CSM’s UME at the University of Calgary, Alberta.

Kevin McLaughlin

Kevin McLaughlin is a Professor in the Department of Medicine at CSM at the University of Calgary. He is also a nephrologist and a transplant surgeon in Calgary. Previously, he was the Assistant Dean within the UME in Calgary, Alberta.

Kevin Busche

Kevin Busche is the Assistant Dean of Clerkship for CSM’s UME, and is an Associate Professor in the Department of Clinical Neurosciences at the CSM. He is also a neurologist in the Department of Clinical Neurosciences and a Site Lead at Rockyview Hospital in Calgary. Dr. Busche is also a member of the Hotchkiss Brain Institute in Calgary, Alberta.

Claire Touchie

Claire Touchie is the Chief Medical Education Advisor at the Medical Council of Canada (MCC). She is also a physician in the outpatient clinics for the care of HIV-infected patients, and supervises general internal medicine teaching clinics in the Department of Medicine at the University of Ottawa, Ontario.

Christopher Naugler

Christopher Naugler is the Associate Dean of the CSM UME. He is also a pathologist and is a Professor in the Department of Pathology and Laboratory Medicine at the CSM. He was previously the Medical Director of Alberta Precision Laboratories in Alberta, and the Department Head of Pathology and Laboratory Medicine at CSM in Calgary. Dr. Naugler holds cross-appointments in the Departments of Family Medicine and Community Health Sciences at the CSM, and is also a member of the O’Brien Institute for Public Health and Arnie Charbonneau Cancer Institute in Calgary, Alberta.

Janeve Desy

Janeve Desy is the Assistant Dean of Research and Evaluations of the CSM UME Program at the University of Calgary. She is also a Clinical Assistant Professor in the Department of Medicine at the CSM and is a physician in the Division of General Internal Medicine in Calgary, Alberta.