Ways to Teach and Assess EPAs

EPA4Ways to TeachWays to Assess: Is This Student Entrustable?
EPA 1: Gather a history and perform a physical examination• Ask student to observe you performing parts of a physical examination• Ask “What are the most important questions for this patient today? Why?”
• Ask student to observe you asking questions• Watch student perform components of the history and physical examination or confirm findings that were not observed
• Direct student to open-access resources for taking a history and performing a physical examination, such as the Council on Medical Student Education in Pediatrics physical examination video5• Ask “What are the most critical things to examine on this patient today? Why?”
• Ask student to take patient’s vital signs and conduct all or part of the physical examination (and then double-check)• Ask “What findings on physical examination rule in and rule out the working diagnosis?”
• Role play taking history with student• Ask patient and family if student asked questions in a logical, nonjudgmental, empathetic way
• Ask patient and family if student examined patient in a way that promoted the patient’s comfort
• Ask patient and family if the student explained what he or she was doing
EPA 2: Prioritize a differential diagnosis following a clinical encounter• Explain why you think a patient has a particular diagnosis• Ask student what the most likely diagnosis is and what features on history and physical examination led him or her to make that conclusion
• Explain what features on history and physical examination make that diagnosis most likely• Ask student what the alternate diagnoses are and what features on history and physical examination make those important to consider
• Explain which other diagnoses need to be considered and relate them to features on the history and physical examination
EPA 3: Recommend and interpret common diagnostic and screening tests• Explain why you are ordering tests• Ask student to interpret results from diagnostic tests
• Explain how you are interpreting tests• Ask students to explain how their approach to the patient would change if the test results were different
• Role model how to communicate effectively with patients and families and other members of the health care team about diagnostic and screening tests• Ask student to explain the utility of the test
• Ask student to explain how the test will be done and what the results may mean to a family
• Observe student explaining test results to a family
EPA 4: Enter and discuss orders and prescriptions• Explain how to write orders• Review orders that student has documented
• Detail the key components of a prescription• Review prescription that student has documented
• Let the student watch you document orders and prescriptions• Ask student to modify order and prescriptions for different clinical scenarios (eg, write on blank paper; vary the age, weight of patient, severity of illness, allergy history)
• Direct the student to a resource about how to write orders and prescriptions6
EPA 5: Document a clinical encounter in the patient record• Provide a framework of what should be included in each of the following types of notes: admission note, progress note, procedure note, multidisciplinary meeting note, on-call note, discharge note• Ask student to write admission note, progress note, procedure note, on-call note, multidisciplinary meeting note, discharge note in chart (if the student is not allowed to write in the chart, have the student write each of these notes for each patient on paper that is subsequently shredded)
• Review the note for clarity, completeness, and documented understanding of the patient’s issues and plans
EPA 6: Provide an oral presentation of a clinical encounter• Provide a framework of what should be included in an effective oral presentation7• Observe the student presenting a case on rounds or after a clinical encounter
• Ask the student to listen to one of your presentations (and see how well you followed the framework)• Provide detailed, specific, feedback
EPA 7: Form clinical questions and retrieve evidence to advance patient care• Model asking clinical questions and finding answers in the medical literature• Ask the student to form a clinical question about one of his or her patients
• Direct the student to resources at the university library• Ask the student to review the medical literature to answer that question
• Review the student’s search strategy and conclusions
EPA 8: Give or receive a patient handover to transition care responsibility• Provide a framework of what should be included in handover (such as IPASS)8• Watch the student give a patient handover
• Demonstrate how to effectively hand over a patient• Do a “mock” handover; ask the student to present a short handover presentation to you
• Assess the handover with an IPASS rating form
• Ask “What does the next team need to know about this patient? What problems might evolve for this patient in the next 12 hours? How would you like the next team to manage those?”
EPA 9: Collaborate as a member of an interprofessional team• If there are students from other professions (nursing students, pharmacy students, respiratory therapy students) at your site, consider arranging an interprofessional teaching session• Ask nurses and allied health personnel for feedback about the student
• Explain why you are engaging in an interprofessional team to provide patient care• Ask student to document an interdisciplinary meeting
• Role model excellent and respectful communication• Observe student interacting with members of interprofessional team
• Ask student what the role of each member of the team is and what skills each person brings
• Ask student to consult with an interprofessional team member (eg, pharmacist, therapist, lactation consultant, nurse) to gather specific insights/information about a patient
EPA 10: Recognize a patient requiring urgent or emergent care and initiate evaluation and management• Have student take Neonatal Resuscitation Program, Pediatric Advanced Life Support courses• Ask student, “Is this patient sick or not sick? How do you know?”
• Explain what it is about a particular patient that makes you know the patient is sick (eg, vitals, appearance)• Ask the student what the priorities are in management
• Observe the student in a real or simulated scenario dealing with a sick patient
EPA 11: Obtain informed consent for tests and/or procedures• Provide a framework of what should be included in such conversations9• Observe the student obtaining consent
• Ask the student to observe you obtaining informed consent• Ask the student about the risks and benefits of tests and procedures
• Role play with the student
EPA 12: Perform general procedures of a physician (eg, basic cardiopulmonary resuscitation, bag and mask ventilation, venipuncture, inserting an intravenous line)• Allow student to observe you perform procedures• Observe the student perform the procedure on a model
• Think out loud while demonstrating a procedure to explain the steps, the equipment, the indications and contraindications for the procedure• Ask the student how the procedure would be performed differently for different patients (“What would you do differently if this patient was 1 week old? 3 years old? 15 years old? If the patient’s weight was different? If the patient was acutely unwell?”)
• Use models for student to practice technical skills
EPA 13: Identify system failures and contribute to a culture of safety and improvement• Overtly discuss how you deal with system errors• Ask the student to identify a system failure
• Ask interprofessional team members to identify system errors they see and discuss them with the student• Observe the student disclosing an adverse outcome (to a patient and family or to yourself as part of a role play)
• Encourage student to attend, and reflect on, morbidity and mortality–type conference
  • IPASS, Illness severity, Patient summary, Action list, Situation awareness and contingency planning, Synthesis by receiver.