Seeing potential opportunities for teaching (SPOT): Evaluating a bundle of interventions to augment entrustable professional activity acquisition

Abstract

Introduction Within the Canadian competency based medical education (CBME) system, entrustable professional activities (EPAs) are used to assess residents on performed clinical duties. This study aimed to determine if implementing a bundle of two interventions (a case-based discussion intervention, and a rotation-based nudging system) could increase the number of EPA assessments that could occur for our trainees. Methods The authors designed an intervention bundle with two components: 1) a case-based workshop where trainees discussed which EPAs could be assessed with multiple cases; 2) a nudging system wherein each trainee was reminded of EPAs that would be useful to them on each rotation in their first year. We conducted a retrospective program evaluation to compare the intervention cohort (2019) to two historical cohorts using similar EPAs (2017, 2018). Results Data from 22 trainees (7 in 2017, 8 in 2018, and 7 in 2019) were analyzed. There was a marked increase in the total number of EPA assessments acquired in the 2019 cohort (average per resident = 285.7 (95%CI 256.1-312.3; Range: 195-350) as compared to the two other years [2018 (average = 132.4, 107.5-157.2; Range: 107-167), and 2017 (70.1, 95%CI 45.3-91.0; Range: 49-95), yielding an effect size of Cohen’s d = 4.02 for our intervention bundle. Conclusions Within the limitations of a small sample size, there was a strong effect of introducing two interventions (a case-based orientation and a nudging system) upon EPA assessments with PGY1 residents. These strategies may be useful to others seeking to improve EPA assessment numbers in other specialties and clinical environments.