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Assessing Clinical Skills with EPAs: Basics, Fundamentals and Mitigation of Bias

Day: Sunday 28 August
Time: 0930-1230
Venue: Lyon Congress Centre

Presenters: Rachel Poeppelman1, Justin Triemstra2, Claudio Violato1, Robert Englander1
1 University of Minnesota, Minneapolis, USA
2 Michigan State University, Grand Rapids, USA

Background: In recent years medical education has made a paradigm shift to competency-based medical education, creating greater focus on ensuring graduates attain a pre-defined level of competence1. Although competencies are useful in curricular development and providing learners with a skill development roadmap, the direct assessment of competence in the clinical workplace can be challenging. As a result, many educators are shifting to the use of entrustment-supervision (ES) scales. ES scales assess the level of supervision a trainee needs to complete a task2. These scales are better construct-aligned than competencies and milestones, making them easier for raters to use and understand with less training2. They also mitigate bias in assessment as parametric analyses can be conducted thus enhancing validity3. In this interactive workshop, learners will use real world examples of ES scales to develop a roadmap to successful implementation of an ES scale-based program of assessment for their home institution.
Who Should Participate: Medical educators responsible for assessment of learners in the clinical workplace
Structure of Workshop:

  • Part 1: Lecture: Introduction & Entrustment Basics. Activity: ES scale rating of clinical encounter videos. Lecture: Review existing ES scales, prospective vs retrospective, Entrustment Decision Commitees (EDCs). Activity: Small group mock EDCs, large group discussion of process.

  • Part 2: Lecture: Development and implementation of an ES scale assessment program. Activity: Small group “challenges worksheet”- assess potential barriers and discuss approaches to overcome them.

  • Part 3: Lecture: Literature on bias in assessment & bias mitigation approaches. Activity: Bias recognition using real world examples. Activity/Lecture: Large group reflection.

Intended Outcomes:

  • Describe entrustment and EPAs

  • Use entrustment-supervision scales to assess EPAs

  • Outline steps and potential barriers to implementing an ES scale-based program of assessment

  • Recognize gender or racial bias in trainee assessments and strategies to mitigate bias

1 Frank JR, Snell LS, Cate OT, et al. Competency-based medical education: theory to practice. Med Teach. 2010;32(8):638-645.
2 ten Cate O, Schwartz A, Chen HC. Assessing Trainees and Making Entrustment Decisions: On the Nature and Use of Entrustment-Supervision Scales. Academic Medicine. 2020;95(11):1662-1669.
3 Violato C, Cullen MJ, Englander R, et al. Validity Evidence for Assessing Entrustable Professional Activities During Undergraduate Medical Education. Acad Med. 2021;96(7S):S70-S75.

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