Blog | Friday, June 13, 2014

QD: News Every Day--AAMC guidelines state 13 skills all residents should have 'day 1'

All medical students should be able to perform 13 skills on day 1 of residency, the American Association of Medical Colleges stated.

The organization released its Core Entrustable Professional Activities (EPAs) for Entering Residency in response to feedback from residency program directors about the clinical preparedness of residents, and from literature documenting a performance gap between medical school and residency training.

All medical students should be able to perform these 13 skills regardless of specialty to standardize the expectations for both learners and teachers and better prepare students for their roles as clinicians, the organization said in a press release.

The 13 skills are:
1. gather a history and perform a physical examination;
2. prioritize a differential diagnosis following a clinical encounter;
3. recommend and interpret common diagnostic and screening tests;
4. enter and discuss orders and prescriptions;
5. document a clinical encounter in the patient record;
6. provide an oral presentation of a clinical encounter;
7. form clinical questions and retrieve evidence to advance patient care;
8. give or receive a patient handover to transition care responsibility;
9. collaborate as a member of an interprofessional team;
10. recognize a patient requiring urgent or emergent care and initiate evaluation and management;
11. obtain informed consent for tests and/or procedures;
12. perform general procedures of a physician; and
13. identify system failures and contribute to a culture of safety and improvement.

The core skils, which include activities such as gathering a patient history, prioritizing differential diagnoses, and recommending tests, were chosen as the framework for the guide because they offer a promising approach for assessing the real-world impact of a resident physician’s education on patient care, the press release stated.

The guidelines describe expected behaviors and provide clinical vignettes demonstrating how new residents ready to be entrusted for performance without direct supervision would handle each of the specific skills.

This summer, the AAMC will engage medical schools to launch a multi-year pilot and develop a learning community to share ideas about how the these programs can be broadly implemented.

Academic Medicine recently published 2 ahead-of-print online articles that examine the efforts of a U.S. medical school to develop and implement EPAs:
An Entrustable Professional Activity (EPA) for Handoffs as a Model for EPA Assessment Development, which provides a model for other institutions moving toward an EPA framework; and
From Theory to Practice: Making Entrustable Professional Activities Come to Life in the Context of Milestones, which discusses the importance of more opportunities for EPA assessment and concordance among the academic medicine community.