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Milestones and EPAs in the Royal College CBD Model

March 27, 2015

Hosted by: Dr. Jolanta Karpinski

Objectives

At the end of this session you will be able to:

• Define the terms milestone and Entrustable Professional Activity (EPA)

• Describe the application of these concepts within the Competence by Design framework

• Describe the application of these concepts within a residency program

• Identify some next steps in your use of milestones and EPAs

What is Competency-Based Medical Education?

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A model to prepare physicians for practice that is:• oriented to outcomes desired in physician; • based on patient needs;• based on the needs of the learner, with more

accountability and flexibility; and• focused on achieving skills and performance,

instead of time-spent in training.

Adapted from: Frank JR, Snell L, Dath, D, Sherbino, J, Holmboe ES, et al. Competency-based medical education: theory to practice. Med Teacher. 2010;32:638-45.

Outcomes Based Education

Julio Frenk et al, Lancet 2010; 376 :1923-58.

What is CBD? How Does CanMEDS 2015 Fit?

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Competence by Design (CBD) is• Multi-year, transformational change initiative aimed

at introducing a competency-based medical education (CBME) model to specialty education;

CanMEDS 2015 is• Foundational project of CBD, • Focused on updating the existing CanMEDS

Framework and introducing generic milestones across the continuum • Series IV of the Framework is now available• The final version will be released at ICRE 2015 in

October 2015 along with an updated version of the evergreen Milestones Guide

Key Concepts in CBD

• Stages of physician development

• Milestones

• Entrustable Professional Activities (EPAs)

Definitions

• What is a milestone?

• A defined, observable marker of an individual's ability along a developmental continuum

• What is an Entrustable Professional Activity (EPA)?

• An essential task of a "discipline" that an individual can be trusted to perform independently in a given context

Milestones in CBD

A defined, observable marker of an individual’s ability along a developmental continuum.

• Generic from CanMEDS 2015.

• Abilities within a CanMEDS Role.

• Bound to a stage in the progression of physician development.

Examples of Generic Milestones: Medical Expert

EPAs in CBD

• In the setting of residency training.

• A Royal College Entrustable Professional Activity (RCEPA) is a responsibility or task in the clinical setting that may be delegated to a resident by their supervisor once sufficient competence has been demonstrated.

• Linked to a specified stage of progression.

Examples of EPAs

In medicine

• Run a code

In the real world

• Parallel park

Images via: bing.com

Key Concept of EPAs: Entrustment

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“What can I safely delegate with indirect supervision?”

Question Period

15

Click to edit Master subtitle style

Using Milestones and EPAs

Milestones and EPAs

Curriculum

Abilities expected of a resident at a defined stage of training

Assessment

Meaningful, measurable markers of progression of competence

Connecting Milestones and EPAs

The key difference between EPAs and milestones is that EPAs are the tasks or

activities that must be accomplished, whereas milestones are the abilities of the

individual.

Examples of an EPA from Medical Oncology

Medical Oncology EPA: the task that must be accomplished

• Initial care for urgent and emergent oncologic situations.

Examples of Milestones from Medical Oncology

Medical Oncology Milestones: the abilities needed to accomplish the task

• Recognize urgent and emergent oncologic issues, including but not limited to, pain crisis, febrile neutropenia, uncontrolled diarrhea, hypocalcemia, epidural cord compression and malignant bowel obstruction.

• Select and administer appropriate interventions for urgent and emergent oncologic issues .

• Identify the limits of their own expertise and appropriately seek assistance and supervision

Connection to CBD

Julio Frenk et al, Lancet 2010; 376 :1923-58.

Milestones

EPAs

Medical Oncology Example:Milestones and EPA

Milestones which make up the Medical Oncology EPA (abilities needed to accomplish the task)

• Recognize urgent and emergent oncologic issues, including but not limited to, pain crisis, febrile neutropenia, uncontrolled diarrhea, hypocalcemia, epidural cord compression and malignant bowel obstruction.

• Select and administer appropriate interventions for urgent and emergent oncologic issues.

• Identify the limits of their own expertise and appropriately seek assistance and supervision.

Medical Oncology EPA (the task that must be accomplished) • Initial care for urgent and emergent oncologic situations.

What is a Milestone?

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A milestone is an observable marker of an individual's ability along a developmental continuum.

• Milestones are used for planning and teaching

What is an EPA?

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An Entrustable Professional Activity (EPA) is a task in the clinical setting that may be delegated to a resident by their supervisor once sufficient competence has been demonstrated.

• EPAs are used for overall assessment

Benefits of Milestones and EPAs

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• Link clinical activities with learning and assessment,

• Clearly defined targets for acquiring competency and meeting standards throughout training,

• Better preparation to serve patients and communities, and

• Strive towards mastery of skills and abilities beyond training and throughout practice.

As a Teacher………

• Focus on specific clinical activities with residents at different stages,

• Focus on teaching towards specific milestones within a stage, and

• Conduct assessments of specific EPAs.

Question Period

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Milestones within Each Stage of Residency

M

M

M

M

MM

MM

M

M

M

M

M

MM

M M

M

M

M

M

M

MM

M

M

MM M

Milestones within an EPA

EPA

Milestone

Milestone

Milestone

Typically, each EPA integrates

multiple milestones.

Milestones and EPAs within Four Stages of Residency

Problem with an EPA? Unpack the Milestones

Progression of Competence

Question Period

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Click to edit Master subtitle style

Developing Milestones and EPAs

Milestones and EPAs in CBD

• With CBD, specialty-specific milestones and EPAs will become part of the standards of training for each specialty and subspecialty

• Development of new standards of training will be done by the Specialty Committee including

• Determining stages of training for the discipline (duration/focus),

• Crafting milestones, and• Developing EPAs.

Milestones and EPAs in CBD…

• Milestones will make up a Pathway of Competency requirements

• Map the expected progress of a resident’s abilities

• Link to learning opportunities and educational activities

• EPAs will link to required training experiences and assessment strategies

CBD Discipline Rollout: Proposed Implementation Plan

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What Can Individual Programs or Teachers Do Now?

• Ensure solid understanding of CBD concepts

• Focus on progression of abilities

• What do you expect of the resident at this point in training?

• Consider some EPAs in your clinical environment

• Manage BP in clinic

Question Period

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Your Input Matters

How can we improve the CBD Program?Let us know at:

• cbd@royalcollege.ca

• www.facebook.com/TheRoyalCollege

• https://twitter.com/Royal_College

• www.linkedin.com

For more information, visit our website:

•www.royalcollege.ca/cbd

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Earn MOC Credits with CBD Webinars

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• Attend a CBD webinar and earn Section 1 MOC credits (Group Learning)

• View/listen to a webinar recording and earn Section 2 MOC Credits (Self-Learning)• Find webinar recordings at

www.royalcollege.ca/cbd/resources (scroll to bottom of page)

• For more information about credit allocation, please contact cpd@royalcollege.ca