Aligning Medical Student Workplace-Based Assessments with Entrustable Professional Activities and the RIME Model in a Psychiatry Clerkship.

OBJECTIVE: The authors piloted use of workplace-based assessments of students during the psychiatry clerkship utilizing both entrustable professional activities (EPAs) and the reporter, interpreter, manager, and educator (RIME) model. METHODS: After supervising clinicians conducted assessments of medical students (N=109) during the psychiatry clerkship using a supervisory scale aligned with both EPA and RIME models, each student received individualized formative feedback. Students were then surveyed on the usefulness of this feedback, and participating faculty/residents were surveyed on the ease of completion of the supervisory scale. RESULTS: Students' mean skill profile suggested they no longer needed direct supervision on EPA1 and EPA6. Mean scores on other studied EPAs suggested students were well on their way toward performing these EPAs without direct supervision. Students had mean RIME scores that exceeded the suggested levels identified for a Reporter to start clerkships, for an Interpreter to start clerkships, and for a Manager to transition to the fourth year. Close to half of the students found the feedback helpful in their development as a clinician but most felt their performance should not be shared with residency program directors, either before or after the Match. Almost all responding preceptors felt the supervisory ratings were easy to complete. CONCLUSIONS: This pilot RIME/EPA framework served as a successful step toward a more competency-based medical education in the psychiatry clerkship with relatively little additional faculty time commitment by using workplace-based assessments already in place and a supervisory scale based on EPAs and RIME.

Assessing Entrustable Professional Activities During the Psychiatry Clerkship.

OBJECTIVE: Within 10 years, the Association of American Medical Colleges envisions graduating medical students will be entrusted by their school to perform 13 core entrustable professional activities (EPAs) without direct supervision. The authors focused on eight EPAs that appear most relevant to clinical training during the psychiatry clerkship at their institution to evaluate whether students assess themselves as making progress in EPAs during this clerkship, to see how students' self-assessments compare with the clerkship director's assessments, and to see if weaknesses in the curriculum were found. METHODS: An EPA-assessment scale was designed (ratings 1 to 5) to assess progress toward entrustment in each EPA. Medical students completed pre- and post-psychiatry clerkship self-assessments. The clerkship director independently assessed each student's progress in EPAs utilizing assessment methods already present in the curriculum. RESULTS: Seventy of 116 students (60.3%) completed both pre- and post-clerkship self-assessments. These ratings increased significantly from pre- to post-clerkship, representing large effect sizes from 0.83 to 1.13. The largest mean rating increase was observed for EPA 2, Prioritize a differential diagnosis following a clinical encounter. Mean post-clerkship self-assessment ratings were significantly higher than mean post-clerkship instructor ratings for seven of the eight EPAs. CONCLUSIONS: The results suggest training during the psychiatry clerkship can contribute to the professional development of medical students in the eight EPAs studied but that student self-assessments tend to be higher than those of the clerkship director. Further study is needed of the relative value and role of student self-assessments versus faculty assessments of progress in EPAs.