Article: Huth K, Henry D, Cribb Fabersunne C, et al. A Multistakeholder Approach to the Development of Entrustable Professional Activities in Complex Care. Academic Pediatrics. 2022;22(2):184-189.
Fellow: Maha Kaissi, MD; Second-Year Pediatric Hospital Medicine Fellow at the University of Rochester Golisano Children’s Hospital
Summary: Children with medical complexity (CMC) are a growing population of children with a high rate of healthcare utilization, both in inpatient and ambulatory care settings. However, there are no Entrustable Professional Activities (EPAs) to guide curriculum development for the care of CMC. Thus, the authors recruited a diverse group of key stakeholders through an international complex care e-mail listserv, the Academic Pediatric Association’s complex care special interest group, and targeted outreach to national experts, developing eleven distinct EPAs. These EPAs map directly to the Accreditation Council for Graduate Medical Education (ACGME) pediatric milestones and span the domains of patient care, medical knowledge, systems-based practice, practice-based learning and improvement, professionalism, and interpersonal and communication skills.
Key Strengths: The authors developed these EPAs using a standard 5-phase multistep approach as described by Chen et al (1), using similar domain mapping and content descriptors as those currently utilized by the ACGME pediatric milestones. They also recruited a diverse group of stakeholders to obtain feedback using interprofessional focus groups and ensured the EPAs aligned with actual clinical practice.
Limitations/Flaws: Recruitment was mainly limited to the complex care e-mail listserv and attendees at the Academic Pediatric Association’s complex care special interest group at the Pediatric Academic Societies 2018 and 2019 meetings, possibly limiting the full spectrum of potential participants. Additionally, although authors engaged a diverse group of stakeholders, many notable multidisciplinary members were absent, including (but not limited to) care coordinators, social workers, speech and language therapists, school teachers, community- and home-health representatives, and current trainees.
Takeaway Message: Given the growing population of CMC and increased healthcare utilization in multiple care settings, the need for EPAs for standardized trainee assessment and curricular development is a critical gap in pediatric medical education. The authors created an excellent collection of eleven broad and comprehensive EPAs compatible with existing ACGME pediatric milestones that are applicable to multiple care settings and can be used as a foundation for future expansion with additional recruitment of key multidisciplinary stakeholders from a variety of care settings.
Practice Impact: By utilizing these outlined EPAs, medical educators and pediatric program leadership may expand upon existing curricula and create new educational activities to further educate trainees about caring for the growing population of CMC and have a standard for assessment of trainees’ attainment of these educational milestones.
1 Chen HC, McNamara M, Teherani A, Cate Ot, O’Sullivan P. Developing Entrustable Professional Activities for Entry Into Clerkship. Academic Medicine. 2016;91(2).
Fellow: Maha Kaissi, MD; Second-Year Pediatric Hospital Medicine Fellow at the University of Rochester Golisano Children’s Hospital
Summary: Children with medical complexity (CMC) are a growing population of children with a high rate of healthcare utilization, both in inpatient and ambulatory care settings. However, there are no Entrustable Professional Activities (EPAs) to guide curriculum development for the care of CMC. Thus, the authors recruited a diverse group of key stakeholders through an international complex care e-mail listserv, the Academic Pediatric Association’s complex care special interest group, and targeted outreach to national experts, developing eleven distinct EPAs. These EPAs map directly to the Accreditation Council for Graduate Medical Education (ACGME) pediatric milestones and span the domains of patient care, medical knowledge, systems-based practice, practice-based learning and improvement, professionalism, and interpersonal and communication skills.
Key Strengths: The authors developed these EPAs using a standard 5-phase multistep approach as described by Chen et al (1), using similar domain mapping and content descriptors as those currently utilized by the ACGME pediatric milestones. They also recruited a diverse group of stakeholders to obtain feedback using interprofessional focus groups and ensured the EPAs aligned with actual clinical practice.
Limitations/Flaws: Recruitment was mainly limited to the complex care e-mail listserv and attendees at the Academic Pediatric Association’s complex care special interest group at the Pediatric Academic Societies 2018 and 2019 meetings, possibly limiting the full spectrum of potential participants. Additionally, although authors engaged a diverse group of stakeholders, many notable multidisciplinary members were absent, including (but not limited to) care coordinators, social workers, speech and language therapists, school teachers, community- and home-health representatives, and current trainees.
Takeaway Message: Given the growing population of CMC and increased healthcare utilization in multiple care settings, the need for EPAs for standardized trainee assessment and curricular development is a critical gap in pediatric medical education. The authors created an excellent collection of eleven broad and comprehensive EPAs compatible with existing ACGME pediatric milestones that are applicable to multiple care settings and can be used as a foundation for future expansion with additional recruitment of key multidisciplinary stakeholders from a variety of care settings.
Practice Impact: By utilizing these outlined EPAs, medical educators and pediatric program leadership may expand upon existing curricula and create new educational activities to further educate trainees about caring for the growing population of CMC and have a standard for assessment of trainees’ attainment of these educational milestones.
1 Chen HC, McNamara M, Teherani A, Cate Ot, O’Sullivan P. Developing Entrustable Professional Activities for Entry Into Clerkship. Academic Medicine. 2016;91(2).