Development of entrustable professional activities for regional anesthesia and pain medicine fellowship training

Steven Porter; Elaine Prendiville; Brian Frazer Scott Allen; Gregory Booth; Jan Boublik; Garrett W Burnett; Nabil Elkassabany; Jonathan Hausman; Lisa Klesius; Linda Le-Wendling; Anthony T Machi; Robert Maniker; Michelle Parra; Richard Rosenquist; Christina M Spofford; Santhanam Suresh; Tiffany Tedore; Elizabeth H Wilson; Jon Yan Zhou; Glenn Woodworth

doi:10.1136/rapm-2022-103854

Development of entrustable professional activities for regional anesthesia and pain medicine fellowship training

Reg Anesth Pain Med. 2022 Jul 25:rapm-2022-103854. doi: 10.1136/rapm-2022-103854. Online ahead of print.

Authors

Steven Porter¹, Elaine Prendiville², Brian Frazer Scott Allen³, Gregory Booth⁴, Jan Boublik⁵, Garrett W Burnett⁶, Nabil Elkassabany⁷, Jonathan Hausman⁸, Lisa Klesius⁹, Linda Le-Wendling¹⁰, Anthony T Machi¹¹, Robert Maniker^{12

13}, Michelle Parra¹⁴, Richard Rosenquist¹⁵, Christina M Spofford¹⁶, Santhanam Suresh¹⁷, Tiffany Tedore¹⁸, Elizabeth H Wilson¹⁹, Jon Yan Zhou²⁰, Glenn Woodworth²¹

Affiliations

¹ Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Florida, Jacksonville, Florida, USA.
² Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, Oregon, USA.
³ Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁴ Department of Anesthesiology and Pain Medicine, Naval Medical Center Portsmouth Department of Anesthesiology and Pain Medicine, Portsmouth, Virginia, USA.
⁵ Anesthesiology, Stanford Hospital and Clinics, Stanford, California, USA.
⁶ Anesthesiology, Perioperative & Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
⁷ Department of Anesthesiology and Critical Care, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA.
⁸ Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, California, USA.
⁹ Department of Anesthesiology, University of Wisconsin System, Madison, Wisconsin, USA.
¹⁰ Anesthesiology, University of Florida, Gainesville, Florida, USA.
¹¹ Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA.
¹² Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California, USA.
¹³ Department of Anesthesiology, Columbia University Medical Center, New York, New York, USA.
¹⁴ Anesthesia, University of Iowa, Iowa City, Iowa, USA.
¹⁵ Pain Management, Cleveland Clinic, Cleveland, Ohio, USA.
¹⁶ Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
¹⁷ Pediatric Anesthesiology, Northwestern Medicine, Chicago, Illinois, USA.
¹⁸ Anesthesiology, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA.
¹⁹ Department of Anesthesiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA.
²⁰ Anesthesiology and Pain Medicine, University of California Davis Health System, Sacramento, California, USA.
²¹ Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, Oregon, USA woodworg@ohsu.edu.

PMID: 35878963
DOI: 10.1136/rapm-2022-103854

Abstract

Introduction: The Accreditation Council for Graduate Medical Education (ACGME) offers descriptions of competencies and milestones but does not provide standardized assessments to track trainee competency. Entrustable professional activities (EPAs) and special assessments (SAs) are emerging methods to assess the level of competency obtained by regional anesthesiology and acute pain medicine (RAAPM) fellows.

Methods: A panel of RAAPM physicians with experience in education and competency assessment and one medical student were recruited to participate in a modified Delphi method with iterative rounds to reach consensus on: a list of EPAs, SAs, and procedural skills; detailed definitions for each EPA and SA; a mapping of the EPAs and SAs to the ACGME milestones; and a target level of entrustment for graduating US RAAPM fellows for each EPA and procedural skill. A gap analysis was performed and a heat map was created to cross-check the EPAs and SAs to the ACGME milestones.

Results: Participants in EPA and SA development included 19 physicians and 1 medical student from 18 different programs. The Delphi rounds yielded a final list of 23 EPAs, a defined entrustment scale, mapping of the EPAs to ACGME milestones, and graduation targets. A list of 73 procedural skills and 7 SAs were similarly developed.

Discussion: A list of 23 RAAPM EPAs, 73 procedural skills, and 7 SAs were created using a rigorous methodology to reach consensus. This framework can be utilized to help assess RAAPM fellows in the USA for competency and allow for meaningful performance feedback.

Keywords: acute pain; education; regional anesthesia.