assessment in cbme

• In CBME, residents receive frequent and specific observations in the work-place. These observations are captured using Entrustable Professional Activities (EPAs).

• EPAs are key tasks of the discipline.

• Residents need to be ‘trusted’ to perform these tasks in a health care setting to be deemed competent in the discipline​

• Each EPA has a number of milestones mapped to them. The milestones are observable markers of an individual’s ability and incorporate multiple CanMEDS roles. To evaluate an EPA, you do not need to be able to assess every milestone.

• Pediatrics has been distilled down 32 EPAs distributed throughout the four stages: ​

o   Transition to Discipline (TTD):  2 EPAs​

o   Foundations (F): 11 EPAs​

o   Core (C): 14 EPAs​

o   Transition to Practice (TTP): 5 EPAs​

• Each EPA has its own requirements for number required and specific contextual variables. Examples of contextual variables include demographics and types of assessors.

EPAs can be assessed by faculty, allied health care providers and senior trainees. Senior residents need to have completed the EPA to be able to assess that specific EPA for a junior resident.

It is both the responsibility of residents AND faculty to initiate EPAs. When faculty trigger EPAs, residents receive a broader range of feedback and it sets the tone for an environment where faculty are not only expected to provide feedback, but value the feedback and process.

• Residents will aim to have 1-2 EPAs observed per week.

• Faculty should aim to complete an EPA for each clinical day spent with a resident. For example, one EPA per clinic.

There are EPAs for each stage. EPAs have also been mapped to each rotation based on rotation objectives. Residents will work with their coaches to develop a plan for EPAs to focus during specific points in their training.

EPA and mapping documents can be found in the CBME Resources & Policy section. 

Each EPA has a description at the beginning of the form. The forms can be viewed in Elentra or accessed in the Resources and Policies tab. When assessing an EPA, it is important that you assess the resident at the level expected for the stage of the EPA. For instance, if you are assessing a Core EPA you should evaluate it at the level you would expect for a resident in Core.

You will be asked to score each milestone using the following scale:

o   Not applicable

o   Working on it

o   Almost there

o   Achieved

The overall score is used to determine if you ‘entrusted’ the resident with the task (EPA). An overall score of 4 or 5 is considered ‘entrusted’ or achieved. We are using the following scale:

1.  I had to do

2.  I had to talk them through

3.  I had to direct them from time to time

4.  I needed be available just in case

5.  I did not need to be there

If you assign a score of 4 or a 5, it does not mean that you have signed off that you would ALWAYS entrust the resident, or that they have fully completed the EPA. It just indicates that you would entrust them with this specific encounter. It is the job of the Competency Committee (CC) to decide when the resident has completed all of the requirements for the EPA.