Flexibility in individualized, competency-based workplace curricula with EPAs: Analyzing four cohorts of physician assistants in training

Abstract

Background: Entrustable professional activities (EPAs) were introduced as a principle for individualized physician assistant (PA) workplace curricula at the University of Applied Sciences (UAS) Utrecht in 2008. We studied how the focus on EPAs served the competency-based flexibility intention of the program.

Methods: We analyzed data of those 119 students who enrolled in the program 2010 through 2013, and completed the program before April 2016. We analyzed the number of EPAs per student at start and end of the program, number changed during training and the reasons for change.

Results: Data of 101 students were suitable for evaluation. Excluded were 16 students ending the program prematurely and two with study delay.

Mean number of EPAs per student at the start was 6.8 (range 4–12) and at the end 6.6 (range 3–13). On average 1.5 EPAs were altered (range 0–13). Reasons included extension of the EPA package during training (n = 10), lack of proficiency at planned moments of summative entrustment decisions (n = 9) and procedures not being suitable for PAs at closer look (n = 6). All changes resulted in a curriculum meeting the school’s standards for graduation.

Conclusions: The flexibility of the EPA concept enabled changes in the individualized curriculum of students, according to the intended competency-based nature of the educational program.

Acknowledgments

The authors thank Arina Groenheide for the provision of her individual workplace curriculum as an example.

Disclosure statement

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

Glossary

Individual EPA-based workplace curriculum A competency-based program, defined by a set of entrustable professional activities as learning outcomes, tailored to both the needs of a specific workplace and the background and ambitions of an individual student, while meeting the requirement of a school, with the intent to employ the student after graduation at this or a similar workplace.

Notes on contributors

Fraukje Wiersma, MD PhD, was trained as a radiologist and is a staff member for Master PA training at UAS Utrecht.

Josephine Berkvens, MD, is a coordinator of Master PA course at UAS Utrecht.

Olle ten Cate, PhD, is a professor of medical education, the director of the Center for Research and Development of Education at University Medical Center Utrecht and adjunct professor of medicine at the University of California, San Francisco.