Sonya Moore¹
Alex Tsirgialos¹, Elise Fraser¹ and Selina Parry¹
 1 University of Melbourne 

Post-professional clinical education aims to advance integration of granular skills within complex clinical encounters. This aligns with social constructivist learning models and entrustable professional activities (EPAs) which frame constituent skills and end-performance of more complex tasks [1]. 

Our scoping review [2] identified the Shared Decision Making (SDM) EPA [3] as well aligned to the skills needed in post-professional physiotherapy and podiatry practice. Social constructivist learning principles were used to embed SDM within a variety of clinical learning activities and video assessments. Learners explored the SDM EPA; used discussion boards to deconstruct expert clinician video demonstrations; and peer reviewed their own-practice skill integration. Ethics approval (Melbourne University, ref:2023-23744-42190-1) was obtained to evaluate subject assessment performance outcomes and student experience. 

Results 
Students completing the subject (n=10) demonstrated SDM capability within clinical video assessments. Of the subject evaluation student survey participants (n=4), all agree tutorial discussion boards improved assessment preparation. Most agreed (n=3) or neutral (n=1) this approach improved assessment preparation. Qualitatively, students valued tutor engagement, timely instructional guidance and constructive feedback. 

EPAs, such as SDM, are designed to capture performance of clinical skills in real-world settings. Good learning design can scaffold post-professional clinicians' capability to perform EPAs consistently, with a balance of automaticity and decision making. This includes organizing, integrating, co-ordinating and executing a repertoire of clinical skills in real-world encounters. Video capture with self and peer review of SDM practice enabled further skill refinement, including exposure to different interprofessional application contexts. Future evaluation with larger student numbers will extend upon initial insights. 

Using learning design to embed the SDM EPA in clinical video assessments captured meaningful task organization for practicing clinicians. 

Clinical video assessments can have:
 • Grounding in learning design models
 • Embedded post-professional EPAs, for example SDM • Expert clinician-tutor facilitation 

References (maximum three) 

[1] van Merriënboer, J. (2021). The Four-Component Instructional Design Model An Overview of its Main Design Principles. Accessed 1/8/2023 at: https://www.4cid.org/wp- content/uploads/2021/04/vanmerrienboer-4cid-overview-of-main-design-principles-2021.pdf 

[2] Moore SJ, Egerton T, Merolli M, Lees J, La Scala N, Parry SM. Inconsistently reporting post-licensure EPA specifications in different clinical professions hampers fidelity and practice translation: a scoping review. BMC Med Educ. 2023 May 24;23(1):372. doi: 10.1186/s12909- 023-04364-4. PMID: 37226147; PMCID: PMC10207741. 

[3] Baghus A, Giroldi E, Muris J, Stiggelbout A, van de Pol M, Timmerman A, van der Weijden T. Identifying Entrustable Professional Activities for Shared Decision Making in Postgraduate Medical Education: A National Delphi Study. Acad Med. 2021 Jan 1;96(1):126-133. doi: 10.1097/ACM.0000000000003618. PMID: 32739926; PMCID: PMC7769188. 

Natalie Protuder¹
Simmie Chung², Josephine Crockett³, Ben Emery⁴, Nanette Cawcutt⁵ and Steven Walker⁴
1 NAPE ITP
2 The University of Sydney
3 University of South Australia
4 Monash University
5 The University of Queensland

Australian pre-registrant pharmacists (interns) are required to complete a year-long practice period directly supervised by a registered pharmacist (preceptor) in either a hospital or community setting[1]. In 2023, Entrustable Professional Activities (EPAs), including dispensing, compounding and counselling, were introduced to facilitate intern assessment. Preceptors use Short Practice Observations (SPOs) to make entrustment decisions on an intern’s readiness for independent practice[2]. 

Summary of work:
Preceptors report the number of SPOs completed and assign an entrustment level for each EPA at 13-weeks, 26-weeks and conclusion of the program. The aim was to determine the proportion of interns entrusted to perform each EPA independently (Level 4) at 13-weeks. 

In 2023, 13-week preceptor assessments for 251 interns (53% community; 47% hospital) were evaluated. A percentage of interns were entrusted at Level 4 for dispensing (42%), compounding (28%) and counselling (36%). For the dispensing EPA, 49% of community internsattainedLevel4afterameannumberof4SPOs(SD=2.3) comparedto34%ofhospital interns (p=0.02) after 3 SPOs (SD=2.0). For compounding, 36% of community interns attained Level 4 after an average of 3 SPOs(SD=2.0) compared to 20% of hospital interns (p=<0.001) after 4 SPOs (SD=1.8). For counselling, 41% of community interns attained Level 4 after 4 SPOs (SD=2.1) compared to 30% of hospital interns (p=0.36) after 3 SPOs (SD=1.6) . 

A percentage of interns were entrusted by preceptors to dispense, counsel, and compound independently at 13-weeks and this was in part influenced by practice setting. 

Results suggest that preceptors are prepared to entrust interns to perform certain pharmacy tasks within 13-weeks but further research is required. 

Take-home messages/implications for further research/practice: 

EPA assessment could have significant implications for supervision models during pharmacy intern training. Care must be taken to investigate the validity of preceptor entrustment decisions in this context. 

References (maximum three) 

Cynthia Abbott¹
Ginette Bourgeois¹, Jolanta Karpinski², Peter Perryman¹, Lyn Sonnenberg¹ and Sofia Valanci-Aroesty¹
1 Royal College of Physicians and Surgeons of Canada
2 University of Ottawa 

Standards for medical practice and education in Canada are written using the CanMEDS framework. CanMEDS organizes competencies in seven Roles that shape physician practice. The Competence-by-Design approach includes assessment in the form of entrustable professional activities (EPAs), tasks that must be accomplished to demonstrate competence. Performance of an EPA requires integration of several competencies to carry out the task. The objective of this project was to understand how the CanMEDS intrinsic Roles’ competencies are represented in specialty disciplines. 

Two investigators independently reviewed EPAs for the CanMEDS intrinsic Roles. The CanMEDS framework was cross-referenced with specialties’ pathway-to-competence document. These were mapped to an intrinsic role and tallied. Surgical, medical, and diagnostic specialty sub-analyses were completed. Mean percentages were calculated by total, group, and stage of training. 

Mean percentages demonstrated that the Communicator Role had the largest representation within EPAs with 53%, followed by Collaborator (47%), Professional (28%), Leader and Scholar (18%), and Health Advocate (13%). Health Advocate Role by discipline specialties had the lowest representation (medical (17%), diagnostic (9%), and surgical (8%)). The highest count of EPAs containing Health Advocate came from Geriatric Medicine and Emergency Medicine with 10 and 8 EPAs. 

EPAs are intended to be brief and distinct tasks that are observable. Proportionally, there is underrepresentation of intrinsic Roles in EPAs, like Health Advocate, across disciplines. This suggests that methods of teaching and assessment other than EPAs may be needed for some of the intrinsic roles. 

There is variability in the integration of CanMEDs roles within EPAs; this may be a true reflection of differences in the practice profile of different disciplines. This variability highlights the need to consider how to incorporate teaching and assessment of intrinsic CanMEDS roles in resident training and may demonstrate an opportunity to revise EPAs to meet this goal 

References (maximum three) 

1. https://www.thoracic.org/professionals/peptda/epa.php
2. https://www.royalcollege.ca/ca/en/canmeds/canmeds-framework.html 

Monica Ramzy^1,2
Samantha Byrne¹, Pam Robertson², Rocio Quinonez³ and Clare McNally¹
1 Melbourne Dental School, The University of Melbourne
2 Melbourne Graduate School of Education, The University of Melbourne
3 Adams School of Dentistry, The University of North Carolina

Background:
The Melbourne Dental School is undertaking a curriculum redesign project implementing a programmatic approach to assessment within an Entrustable Professional Activity (EPA) framework. Understanding the challenges and learning from other’s experiences will be crucial to the success of this program. 

Summary of Work:
The Ehlinger et al (2023) review into EPAs in dental education and concluded that EPAs have been primarily used in assessment rather than for teaching and learning support.(1) Using Kotter’s 8-step Change Model (2) a staff and student co-design team will develop the EPA framework aligned to the Australian Dental Council (ADC) professional competencies.(3) This work is funded by the University of Melbourne Flex-AP and expertise is provided by the Assessment & Evaluation Research Centre (AERC). 

Results:
Through Step 1: Creating a Sense of Urgency we have identified the need to develop a student-centred assessment program that encourages continual learning across the program. The first of our EPA framework development is to conduct a scoping review that identifies the challenges experienced by other programs. Step 2: Building a Guiding Coalition will bring key stakeholders, including students, to synthesize the EPA data and by February 2024 we expect to have completed Step 3: the Formation of our strategic vision and initiatives and be ready to communicate our vision. 

Conclusion: 
This is a major shift in the design and delivery of dental education. Learning from other health professions experiences and following a process of change model should ensure the successful development of an EPA framework for the MDS ready for implementation in 2025. 

Take-home Messages:
1. Dental education has been slower than other health professions to adopt EPAs and programmatic approaches to assessment. 

2.There are other examples of the successful implementation of EPAs in dental education, developing partnerships with these school’s will increase the success of our program. 

References (maximum three) 

(1) Ehlinger, C., Fernandez, N., & Strub, M. (2023). Entrustable professional activities in dental education: a scoping review. British Dental Journal, 234(3), 171-176. 

(2) Kotter, J. (2023) The 8 Steps for Leading Change. Available from: https://www.kotterinc.com/methodology/8-steps/ Accessed 10th August 2023. 

(3) Australian Dental Council (2022) Professional competencies of the newly qualified dental practitioner, available from www.adc.org.au.