Entrustable Professional Activities for Entering Residency: Establishing Common Osteopathic Performance Standards in the Transition From Medical School to Residency.

Entrustable professional activities (EPAs) are measurable units of observable professional practice that can be entrusted to an unsupervised trainee. They were first introduced as a method of operationalizing competency-based medical education in graduate medical education. The American Association of Medical Colleges subsequently used EPAs to establish the core skills that medical students must be able to perform before they enter residency training. A recently published guide provides descriptions, guidelines, and rationale for implementing and assessing the core EPAs from an osteopathic approach. These osteopathically informed EPAs can allow schools to more appropriately assess a learner's whole-person approach to a patient, in alignment with the philosophy of the profession. As the single accreditation system for graduate medical education moves forward, it will be critical to integrate EPAs into osteopathic medical education to demonstrate entrustment of medical school graduates. The authors describe the collaborative process used to establish the osteopathic considerations added to EPAs and explores the challenges and opportunities for undergraduate osteopathic medical education.

Reliability and benefits of medical student peers in rating complex clinical skills.

BACKGROUND: Peers have been shown to be reliable raters in an objective structured clinical exam (OSCE). While the literature supports the use of senior level students in rating basic clinical skills, little is known about the reliability of peers of the same level of training in assessing complex clinical skills. AIM: To investigate the reliability of student peers of the same level of training in rating complex clinical skills in a geriatric OSCE. METHODS: Peer (n = 115) ratings were compared to faculty ratings using correlation and generalizability analysis. Paired Wilcoxon Signed-Rank test was used to establish peer learning benefits. RESULTS: Reliability of the OSCE was moderately strong (G-coefficient = 0.70) with strong correlations between peer and faculty ratings for the overall OSCE (r = 0.78, p = 0.001) and for each case (r = 0.70-0.85, p = 0.001). Generalizability analysis indicated that raters contributed minimally to score variance. Peers reported gaining learning benefits from the rating process. CONCLUSION: Peer raters of the same level of training can provide accurate ratings of complex clinical tasks and can serve as an important resource in assessing student performance in an OSCE. The peer review process can also serve an important role in enhancing student learning.

Developing osteopathic competencies in geriatrics for medical students.

CONTEXT: Minimum core competencies for allopathic medical students in the specialty area of geriatrics have been developed, comprising 26 competencies divided into 8 topical domains. These competencies are appropriate for osteopathic medical students, but they do not include competencies relating to osteopathic principles and practice (OPP) in geriatrics. There remains a need within the osteopathic profession to develop specialty-specific competencies specific to OPP. OBJECTIVE: To develop more specific and comprehensive minimum competencies in OPP for osteopathic medical students in the field of geriatric medicine. METHODS: The Delphi technique (a structured communication technique that uses a panel of experts to reach consensus) was adapted to generate new core competencies relating to OPP. Osteopathic geriatricians and members of the Educational Council on Osteopathic Principles (ECOP) of the American Association of Colleges of Osteopathic Medicine participated in a breakout session and 2 rounds of surveys. Proposed competencies with 80% of the participants ranking it as "very important and should be added as a competency" were retained. Participants were also asked if they agreed that competencies in OPP should include specific types of osteopathic manipulative treatment techniques for the elderly. RESULTS: Responses were received from 26 osteopathic physician experts: 17 ECOP members and 9 geriatricians. Fourteen proposed competencies were developed: 7 related to the existing topic domains, and 7 were placed into a new domain of osteopathic manipulative medicine (OMM). Six proposed competencies were retained, all of which were in the new OMM domain. These competencies related to using OMM for gait and balance assessment, knowing adverse events and contraindications of OMM, using OMM for pain relief and end-of-life care, using OMM in the hospital and nursing home setting, adapting OMM to fit an elderly individual, and using OMM to address limited range of motion and ability to perform activities of daily living. Thirteen of 22 participants (59%) agreed that OPP competencies should include specific osteopathic manipulative treatment techniques. CONCLUSIONS: The Delphi consensus building process was used to create 6 new minimum competencies in OMM for osteopathic medical students for the specialty area of geriatrics. Using data from this consensus, medical schools, residencies, and fellowships can create standards and expectations for osteopathic physicians regarding the best care of geriatric patients.