@Article{info:doi/10.2196/32356,
author="Peng, Cynthia R
and Schertzer, Kimberly A
and Caretta-Weyer, Holly A
and Sebok-Syer, Stefanie S
and Lu, William
and Tansomboon, Charissa
and Gisondi, Michael A",
title="Assessment of Entrustable Professional Activities Using a Web-Based Simulation Platform During Transition to Emergency Medicine Residency: Mixed Methods Pilot Study",
journal="JMIR Med Educ",
year="2021",
month="Nov",
day="17",
volume="7",
number="4",
pages="e32356",
keywords="simulation; graduate medical education; assessment; gamification; entrustable professional activities; emergency medicine; undergraduate medical education",
abstract="Background: The 13 core entrustable professional activities (EPAs) are key competency-based learning outcomes in the transition from undergraduate to graduate medical education in the United States. Five of these EPAs (EPA2: prioritizing differentials, EPA3: recommending and interpreting tests, EPA4: entering orders and prescriptions, EPA5: documenting clinical encounters, and EPA10: recognizing urgent and emergent conditions) are uniquely suited for web-based assessment. Objective: In this pilot study, we created cases on a web-based simulation platform for the diagnostic assessment of these EPAs and examined the feasibility and acceptability of the platform. Methods: Four simulation cases underwent 3 rounds of consensus panels and pilot testing. Incoming emergency medicine interns (N=15) completed all cases. A maximum of 4 ``look for'' statements, which encompassed specific EPAs, were generated for each participant: (1) performing harmful or missing actions, (2) narrowing differential or wrong final diagnosis, (3) errors in documentation, and (4) lack of recognition and stabilization of urgent diagnoses. Finally, we interviewed a sample of interns (n=5) and residency leadership (n=5) and analyzed the responses using thematic analysis. Results: All participants had at least one missing critical action, and 40{\%} (6/15) of the participants performed at least one harmful action across all 4 cases. The final diagnosis was not included in the differential diagnosis in more than half of the assessments (8/15, 54{\%}). Other errors included selecting incorrect documentation passages (6/15, 40{\%}) and indiscriminately applying oxygen (9/15, 60{\%}). The interview themes included psychological safety of the interface, ability to assess learning, and fidelity of cases. The most valuable feature cited was the ability to place orders in a realistic electronic medical record interface. Conclusions: This study demonstrates the feasibility and acceptability of a web-based platform for diagnostic assessment of specific EPAs. The approach rapidly identifies potential areas of concern for incoming interns using an asynchronous format, provides feedback in a manner appreciated by residency leadership, and informs individualized learning plans. ",
issn="2369-3762",
doi="10.2196/32356",
url="https://mededu.jmir.org/2021/4/e32356",
url="https://doi.org/10.2196/32356",
url="http://www.ncbi.nlm.nih.gov/pubmed/34787582"
}