Entrustable professional activities and facets of competence in a simulated workplace-based assessment for advanced medical students

Abstract

Background: Competence-based assessment formats in medical education usually focus on individual facets of competence (FOCs). The concept of ‘Entrustable Professional Activities’ (EPAs) encompasses supervisors’ decisions on which level of supervision a trainee requires to perform a professional activity including several FOCs. How the different FOCs as perceived by clinician raters contribute to entrustment decisions is yet unclear.

Objective: How do FOC perceptions relate to entrustment-decisions?

Methods: Sixty-seven advanced medical students participated in an assessment simulating the first day of a resident physician. Participants were rated by supervisors for seven FOCs and twelve EPAs.

Results: There was a positive correlation between FOC and EPA scores. Each EPA displayed a different correlation pattern with FOC ratings.

Discussion: For most EPAs high levels of entrustment were associated with high ratings for selected FOCs. The results are in alignment with the assumption that each EPA encompasses a different set of FOCs.

Conclusions: In our simulated workplace-based assessment, entrustment decisions for EPAs reflect the FOCs observed in a trainee. Thus, assessment of FOCs alongside with EPA ratings could add to the understanding of factors contributing to entrustment decisions.

Keywords:

• Undergraduate medical education
• facets of competence
• entrustable professional activities
• assessment of competence

Ethical approval

The study was performed in accordance with the declaration of Helsinki. The Ethics Committee of the chamber of Physicians, Hamburg, confirmed the innocuousness of this study with consented, anonymized, and voluntary participation (PV3649). The study was further approved by the Medical Ethics Committee of the Carl von Ossietzky University Oldenburg (2017-033).

Acknowledgements

We would like to thank all health professionals and medical students from the University Hospital Hamburg-Eppendorf, from the Carl von Ossietzky University Oldenburg and from the Technical University Munich involved in this project.

Disclosure statement

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

Additional information

Funding

This study has been developed as part of the ÄKHOM-Project, which is funded by the German Ministry of Education and Research (Bundesministerium für Bildung und Forschung), reference number: 01PK1501 A/B/C.

Notes on contributors

Fabian Fincke

Fabian Fincke, MD, is a neurologist and scientific research associate at the Department of Medical Education and Educational Research, Faculty of Medicine and Health Science, University of Oldenburg, Germany.

Sarah Prediger

Sarah Prediger, M.A., is a sociologist and scientific research associate at the Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Germany.

Kristina Schick

Kristina Schick, M.Ed., is an educational researcher and a scientific research associate at the TUM Medical Education Center, TUM School of Medicine, Technical University of Munich, Germany.

Sophie Fürstenberg

Sophie Fürstenberg, Dr. rer. biol. hum., is a psychologist and contributed as junior researcher at the Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Germany.

Nadine Spychala

Nadine Spychala, M.Sc., holds a Master’s degree in neurocognitive Psychology and is a data-analyst at the department of Medical Education and Educational Research, Faculty of Medicine and Health Science, University of Oldenburg, Germany.

Pascal O. Berberat

Pascal O. Berberat, MD, MME, is an associate professor and chair of medical education. He is dean of studies at the TUM School of Medicine and chair of the deans of studies at the Technical University of Munich, Germany.

Sigrid Harendza

Sigrid Harendza, MD, MME, is a full professor of internal medicine and educational research. She was vice-dean of education from 2006–2007 at the Medical Faculty of Hamburg University, Germany. She received the Ars legendi award for excellent academic teaching in 2006 and a fellowship for academic teaching in 2015.

Martina Kadmon

Martina Kadmon, MD, MME, is founding dean and professor for Medical Education Sciences at the faculty of medicine, Augsburg University.