ABSTRACT
Background The Association of American Medical Colleges (AAMC) has recently identified a list of integrated activities to be expected of all medical school graduates entering residency: the core Entrustable Professional Activities (EPAs). Direct observation and deliberate practice of individual EPA behaviors in the clinical setting has multiple challenges, and there is limited literature describing a comprehensive, longitudinal curriculum dedicated to formative EPA assessment. Approach We present a model curriculum to develop and provide formative assessment of EPA skills longitudinally throughout the clinical years. Each EPA-focused training session includes a simulation case followed by several small group activities with content related to the clinical vignette in the initial simulation. We have designed this curriculum to be longitudinal and modular, and present the general framework here. Outcomes Step-wise implementation began in 2013. Over 450 medical students have participated in the third year (MS3) clerkship sessions, 30 in the MS4 sub-internship sessions, and over 300 thus far in the fourth year (MS4) capstone course, including students from 10 different medical schools. MS3 sessions focused on EPAs 4, 7, 8, 9, 10, and MS4 sessions had an additional focus on EPA 8. The capstone course encompassed nearly all 13 EPAs in active simulation-based learning. Opportunities to provide formative assessment through on-the-spot feedback exist throughout the curriculum. Student feedback was overwhelmingly positive. Next steps We found that simulations are an effective method of providing formative assessment of EPAs that are exceptionally well-received by medical students. We have demonstrated that these can be implemented for medical students from multiple educational backgrounds. We believe that deliberate practice and longitudinal formative assessment is of utmost importance in effectively developing core EPAs prior to final entrustment decisions.
ABSTRACT
Research on the ways older people use prescription medications (Rx) is a mainstay of the gerontological literature because use of Rx medications is common, and appropriate use is central to effective management of chronic disease. But older adults are also major consumers of over-the-counter (OTC) medications, which can be equally significant for self-care. Nearly half of older adults aged 75-85, for example, are regular users of an OTC product. Ensuring that consumers safely and effectively use OTC products is critical in order to minimize potential drug-drug interactions and unintentional misuse. Yet we know surprisingly little about the ways older adults select OTC medications and decide when to start or stop use, how older people actually take these medications, or how involved clinicians and family members are in older adult OTC behavior. Research in this area is critical for developing interventions to help ensure safe and appropriate OTC use. For this reason, The Gerontological Society of America (GSA), in partnership with the Consumer Healthcare Products Association (CHPA), convened a summit of experts to set an agenda for research in OTC behaviors among older adults. The panel suggested a need for research in 5 key areas: Health literacy and OTC behavior, decision making and OTC use, the role of clinicians in OTC medication behavior, older adult OTC behavior and family care, and technologies to promote optimal use of OTC medications.
