Entrustable Professional Activities
The College of Anaesthesiologists of Ireland (CAI) is implementing a new approach to our competency based training programme for SAT trainees, on a phased basis, from January 2017. This will be based on the concept of Entrustable Professional Activities, known as EPAs.
A Competency Based Training Programme For Specialist Anaesthetic Trainees in Ireland: An Introduction.
What is an EPA?
Entrustable Professional Activities:
· Are descriptors of work in a clinical setting, rather than of the general attributes of a doctor.
· Require integration of multiple competencies across a range of domains.
· Involve stating the level of proficiency expected at the end of a training programme.
The EPA approach to competency based medical education is intuitive to anaesthetists and to trainees. Much of an anaethetist’s work involves tasks or responsibilities that can be ‘entrusted’ to others, with evolving levels of supervision through to independent practice.
As a postgraduate training body, the College needs evidence of competence of all our trainees to:
· ensure the best possible patient care and safe practice.
· allow us to determine when trainees are ready for independent practice
· identify trainees needing support and/or mentoring at an earlier stage.
· inform progress review and progression decisions.
· ensure that our competency based programme continues to follow best international practice.
EPA Feedback Reports
Feedback Reports will be the main element of the new EPA framework which you will see and experience in 2017, during Phase 1. Feedback Reports will enable you, as trainees, to gain feedback and to provide concrete evidence of your competence in the clinical workplace. During this Phase, three tools will be available as follows:
· Direct Observation of Procedural Skill (DOPS) – Involves a trainee being observed and evaluated by a consultant whilst performing a specific clinical procedure. DOPS are completed on real patients, in real time, as part of routine clinical work.
· Case Based Discussion (CBD) – Involves a consultant and trainee reviewing a selected clinical case or an aspect of patient care. The discussion is focused on the application of the trainee’s clinical knowledge, diagnostic ability and patient management skills.
· Fieldnotes (FN) – A brief summary of an event, experience or action involving a trainee in a clinical setting, and the feedback provided. A Fieldnote can be used in a range of contexts and for a range of clinical and especially non-technical skills and professionalism.
Feedback Reports will be completed in respect of the following EPAs in Phase 1, for all SAT trainees.
· Managing Pain in Labour (for trainees in Obstetric hospitals, only)
· Paediatric Anaesthesia (ASA I/II) (for trainees in Paediatric hospitals, only)
· Vascular Access (for all other trainees)
Competencies associated with each of these EPAs have been identified as part of the College EPA development process.
How to complete a Feedback Report:
Guidelines for completing EPA Feedback Reports will be available in the new EPA section of the CAI website over the coming weeks. These resources and documents will give you clear and precise guidance on how to carry out reports. We will also provide examples of good practice – for consultants and trainees – in giving and receiving feedback.
What are the trainee responsibilities?
As a trainee it will be your responsibility to actively seek feedback in relation to one of the EPAs adopted for Phase 1. The Consultant role is to provide you with feedback. A Consultant can also initiate a Feedback Report whenever they observe an event or aspect of performance which offers a constructive learning opportunity. The CAI College Tutor will support this process in Phase 1. Everybody – trainees, consultants and tutors – will have an opportunity to contribute to a review of the process before we embark on Phase 2.
Will I have time to complete these reports in a busy clinical practice?
The Feedback Reports are designed with your clinical practice in mind. They offer an approach which helps consultants and trainees to integrate teaching, learning, feedback and assessment into the activities that you already do on a daily basis. On-the-job learning mostly happens implicitly in real time, but with the introduction of EPA Feedback Reports, the learning experience will be more explicit and structured.
What happens now?
In preparation for this significant development, the College will be providing all Consultants and trainees with the opportunity to engage in this process, supported by online resources, departmental meetings, and visits to hospitals by key clinical members of the EPA team.
By the end June 2017, trainees will be required to complete a minimum of three Feedback Reports, for one EPA, by the end of their rotation, to gain a feel for how the process works and to experience each kind of report. These paper-based reports will be anonymised for return to the College to inform the evaluation of Phase 1, but they will not form part of a trainee’s portfolio at that stage. An app and web-based platform are being developed; this will make the process of completing reports more intuitive and user-friendly.
For further Information – keep an eye on the EPA section of the website.
Members of CAT have played an invaluable role in these significant developments over the past two years. We look forward to continuing to engage with CAT and all SAT trainees in the implementation and review process.
Dr. Camillus Power, Chair of the Training and Education Committee
The College of Anaesthesiologists of Ireland EPA Team