The Minnesota Method: A Learner-Driven, Entrustable Professional Activity-Based Comprehensive Program of Assessment for Medical Students.

PROBLEM: Assessment has been the Achilles heel of competency-based medical education. It requires a program of assessment in which outcomes are clearly defined, students know where they are in the development of the competencies, and what the next steps are to attaining them. Achieving this goal in a feasible manner has been elusive with traditional assessment methods alone. The Education in Pediatrics Across the Continuum (EPAC) program at the University of Minnesota developed a robust program of assessment that has utility and recognizes when students are ready for the undergraduate to graduate medical education transition. APPROACH: The authors developed a learner-driven program of assessment in the foundational clinical training of medical students in the EPAC program based on the Core Entrustable Professional Activities for Entering Residency (Core EPAs). Frequent workplace-based assessments, coupled with summative assessments, informed a quarterly clinical competency committee and individualized learning plans. The data were displayed on real time dashboards for the students to review. OUTCOMES: Over 4 cohorts from 2015 to 2019, students (n = 13) averaged approximately 200 discrete Core EPA workplace-based assessments during their foundational clinical training year. Assessments were completed by an average of 9 different preceptors each month across 8 different specialties. The data were displayed in a way students and faculty could monitor development and inform a clinical competency committee's ability to determine readiness to transition to advanced clinical rotations and residency. NEXT STEPS: The next steps include continuing to scale the program of assessment to a larger cohort of students.

Validity Evidence for Assessing Entrustable Professional Activities During Undergraduate Medical Education.

PURPOSE: To explore validity evidence for the use of entrustable professional activities (EPAs) as an assessment framework in medical education. METHOD: Formative assessments on the 13 Core EPAs for entering residency were collected for 4 cohorts of students over a 9- to 12-month longitudinal integrated clerkship as part of the Education in Pediatrics Across the Continuum pilot at the University of Minnesota Medical School. The students requested assessments from clinical supervisors based on direct observation while engaging in patient care together. Based on each observation, the faculty member rated the student on a 9-point scale corresponding to levels of supervision required. Six EPAs were included in the present analyses. Student ratings were depicted as curves describing their performance over time; regression models were employed to fit the curves. The unit of analyses for the learning curves was observations rather than individual students. RESULTS: (1) Frequent assessments on EPAs provided a developmental picture of competence consistent with the negative exponential learning curve theory; (2) This finding was true across a variety of EPAs and across students; and (3) The time to attain the threshold level of performance on the EPA for entrustment varied by student and EPA. CONCLUSIONS: The results provide validity evidence for an EPA-based program of assessment. Students assessed using multiple observations performing the Core EPAs for entering residency demonstrate classic developmental progression toward the desired level of competence resulting in entrustment decisions. Future work with larger data samples will allow further psychometric analyses of assessment of EPAs.

Crossing the Gap: Using Competency-Based Assessment to Determine Whether Learners Are Ready for the Undergraduate-to-Graduate Transition.

In 2011, the Education in Pediatrics Across the Continuum (EPAC) Study Group recruited four medical schools (University of California, San Francisco; University of Colorado; University of Minnesota; and University of Utah) and their associated pediatrics clerkship and residency program directors to be part of a consortium to pilot a model designed to advance learners from undergraduate medical education (UME) to graduate medical education (GME) and then to fellowship or practice based on competence rather than time spent in training. The central design features of this pilot included predetermined expectations of performance and transition criteria to ensure readiness to progress from UME to GME, using the Core Entrustable Professional Activities for Entering Residency (Core EPAs) as a common assessment framework. Using this framework, each site team (which included, but was not limited to, the EPAC course, pediatric clerkship, and pediatric residency program directors) monitored learners' progress, with the site's clinical competency committee marking the point of readiness to transition from UME to GME (i.e., the attainment of supervision level 3a). Two of the sites implemented time-variable transition from UME to GME, based on when a learner met the performance expectations and transition criteria. In this Article, the authors describe each of the four sites' implementation of Core EPA assessment and their approach to gathering the data necessary to determine readiness for transition. They conclude by offering recommendations and lessons learned from the pilot's first seven years of development, adaptation, and implementation of assessment strategies across the sites, and discussing next steps.