EPA-based assessment: Clinical teachers' challenges when transitioning to a prospective entrustment-supervision scale

Background This study explores the challenges clinical teachers face when first using a prospective entrustment-supervision (ES) scale in a curriculum based on Entrustable Professional Activities (EPAs). A prospective ES scale has the purpose to estimate at which level of supervision a student will be ready to perform an activity in subsequent encounters. Methods We studied the transition to prospective assessment of medical students in clerkships via semi-structured interviews with twelve purposefully sampled clinical teachers, shortly after the introduction of a new undergraduate EPA-based curriculum and EPA-based assessment employing a prospective ES scale. Results While some clinical teachers showed a correct interpretation, rating strategies also appeared to be affected by the target supervision level for completion of the clerkship. Instructions to estimate readiness for a supervision level in the future were not always understood. Further, teachers' interpretation of the scale anchors relied heavily on the phrasing. Discussion Prospective assessment asks clinical teachers to make an extra inference step in their judgement process from reporting observed performance to estimating future level of supervision. This requires a change in mindset when coming from a retrospective, performance-oriented assessment method, i.e., reporting what was observed. Our findings suggest optimizing the ES-scale wordings and improving faculty development.

Automated summary

This study explores the challenges faced by clinical teachers when using a prospective entrustment-supervision (ES) scale for the first time in a curriculum based on Entrustable Professional Activities (EPAs). The findings indicate that some teachers struggle with correct interpretation and rating strategies of the scale, which are influenced by the target supervision level for completion of the clerkship. Additionally, instructions for estimating readiness for a supervision level in the future are not always clear to teachers.