Abstract
Interprofessional education (IPE) and entrustable professional activities (EPAs) represent two topics in health professions education that have attracted significant attention in recent years. IPE (when different health professionals learn with, from and about each other with the aim of optimal care) has an inherent focus on the collective. EPAs (units of professional practice that can be fully entrusted to a trainee, once he or she has demonstrated the necessary competence to execute this activity unsupervised) have a focus on the individual. Attempts to relate the two may cause friction and the question is: can they be reconciled? Are interprofessional EPAs or team-EPAs useful concepts and if so what should they look like? The authors argue that most work in modern healthcare involves interprofessional collaboration. Some EPAs have an inherent strong interprofessional nature, such as emergency teamwork, running multidisciplinary team meetings, and surgery. Other EPAs are less inherently dependent on interprofessional collaboration. The authors conclude that neither interprofessional team-EPAs (for which a team can or should be certified), nor IP-EPAs for individuals, as opposed to other EPAs, are viable concepts. However, the authors do not question that certifying health care professionals and entrusting trainees with most clinical tasks will require to ascertain their competence in interprofessional collaboration. This must be included when assessing learners for most EPAs and making entrustment decisions. This can help to strengthen interprofessional competence in the clinical workplace.
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References
Brandt, B. F., Kitto, S., & Cervero, R. M. (2018). Untying the interprofessional gordian knot: The national collaborative for improving the clinical learning. Environment, 93(10), 1437–1440.
Brandt, B., Lutfiyya, M. N., King, J. A., & Chioreso, C. (2014). A scoping review of interprofessional collaborative practice and education using the lens of the triple aim. Journal of Interprofessional Care, 28(5), 393–399.
Brown, D. R., Gillespie, C. C., & Warren, J. B. (2016). EPA 9—Collaborate as a member of an interprofessional team: A short communication from the AAMC core EPAs for entering residency pilot schools. Medical Science Educator, 26(3), 457–461.
Chen, H. C., & ten Cate, O. (2018). Assessment through entrustable professional activities. In C. Delany & E. Molloy (Eds.), Learning & teaching in clinical contexts: A practical guide (pp. 286–304). Chatswood: Elsevier Australia.
Engeström, Y. (2018). Expertise in transition—Expansive learning in medical work. Cambridge: Cambridge University Press.
Englander, R., Flynn, T., Call, S., Carraccio, C., Cleary, L., et al. (2014). Core entrustable professional activities for entering residency—Curriculum developers guide. Washington DC: Association of American Medical Colleges.
Hammick, M., Freeth, D., Koppel, I., Reeves, S., & Barr, H. (2007). A best evidence systematic review of interprofessional education: BEME Guide no. 9. Medical Teacher, 29(8), 735–751.
Interprofessional Education Collaborative. (2016). Core competencies for interprofessional collaborative practice: 2016 update. Interprofessional Education Collaborative. https://doi.org/10.1097/ACM.0b013e3182308e39.
Koff, N., DeFriese, A., & Witzke, D. (1994). Loosely coupled systems as a conceptual framework for interdisciplinary training. Educational Gerontology, 20(1), 1–13.
Lingard, L. A. (2012). Rethinking competence in the context of teamwork. In B. D. Hodges & L. A. Lingard (Eds.), The question of competence (pp. 42–69). New York: Cornell University Press.
Lingard, L. (2016). Paradoxical truths and persistent myths: Reframing the team competence conversation. Journal of Continuing Education in the Health Professions, 36, S19–S21.
Lutfiyya, M. N., Brandt, B. F., & Cerra, F. (2016). Reflections from the intersection of health professions education and clinical practice: The state of the science of interprofessional education and collaborative practice. Academic Medicine, 91(6), 766–771.
Meade, L. B., Suddarth, K. H., Jones, R. R., Zaas, A. K., Albanese, T., Yamazaki, K., et al. (2016). Patients, nurses, and physicians working together to develop a discharge entrustable professional activity assessment tool. Academic Medicine, 91(10), 1388–1391.
Mihaljevic, A. L., Schmidt, J., Mitzkat, A., Probst, P., Kenngott, T., Mink, J., et al. (2018). Heidelberger Interprofessionelle Ausbildungsstation (HIPSTA): A practice- and theory-guided approach to development and implementation of Germany’s first interprofessional training ward. GMS Journal for Medical Education, 35(3), Doc33. https://doi.org/10.3205/zma001179.
Nisbet, G., Lincoln, M., Dunn, S., Nisbet, G., Lincoln, M., & Informal, S. D. (2013). Informal interprofessional learning: An untapped opportunity for learning and change within the workplace learning and change within the workplace. Journal of Interprofssional Care, 27(6), 469–475.
Paradis, E., & Whitehead, C. R. (2015). Louder than words: Power and conflict in interprofessional education articles, 1954–2013. Medical Education, 49(4), 399–407.
Patterson, E. S., Roth, E. M., Woods, D. D., Chow, R., & Gomes, J. O. (2004). Handoff strategies in settings with high consequences for failure: Lessons for health care operations. International Journal for Quality in Health Care, 16(2), 125–132.
Post, J. A., Wittich, C. M., Thomas, K. G., Dupras, D. M., Halvorsen, A. J., Mandrekar, J. N., et al. (2016). Rating the quality of entrustable professional activities: Content validation and associations with the clinical context. Journal of General Internal Medicine, 31(5), 518–523.
Reeves, S., Goldman, J., Freeth, D., & Zwarenstein, M. (2013). Interprofessional education: Effects on professional practice and healthcare outcomes. The Cochrane Database of Systematic Reviews, 3, 1–47. https://doi.org/10.1002/14651858.CD002213.pub3.www.cochranelibrary.com.
Schmelter, V., März, E., Adolf, C., Wölfel, T. L., Lottspeich, C., Fischer, M. R., et al. (2018). Ward rounds in internal medicine: Validation of an entrustable professional activity (EPA) observation checklist. GMS Journal for Medical Education, 35(2), Doc17. https://doi.org/10.3205/zma001164.
Shorey, S., Lau, T. C., Lau, L. S. T., & Ang, E. (2019). Entrustable professional activities in health care education: A scoping review. Medical Education, 53(7), 766–777.
Szasz, G. (1969). Interprofessional education in the health sciences: A project conducted at the University of British Columbia. Milbank Memorial Fund Quarterly, 47(4), 449–475.
Taylor, D. R., Park, Y. S., Egan, R., Chan, M. K., Karpinski, J., Touchie, C., et al. (2017). EQual, a novel rubric to evaluate entrustable professional activities for quality and structure. Academic Medicine: Journal of the Association of American Medical Colleges, 92(11), S110–S117.
ten Cate, O. (2005). Entrustability of professional activities and competency-based training. Medical Education, 39(12), 1176–1177.
ten Cate, O. (2013). Nuts and bolts of entrustable professional activities. Journal of Graduate Medical Education, 5(1), 157–158.
ten Cate, O. (2014). Trusting graduates to enter residency: What does it take? Journal of Graduate Medical Education, 6(1), 7–10.
ten Cate, O., Chen, H. C., Hoff, R. G., Peters, H., Bok, H., & van der Schaaf, M. (2015). Curriculum development for the workplace using entrustable professional activities (EPAs): AMEE guide no. 99. Medical Teacher, 37(11), 983–1002.
ten Cate, O., Hart, D., Ankel, F., Busari, J., Englander, R., Glasgow, N., et al. (2016). Entrustment decision making in clinical training. Academic Medicine, 91(2), 191–198.
ten Cate, O., & Hoff, R. G. (2017). From case-based to entrustment-based discussions. Clinical Teacher, 14(6), 385–389.
ten Cate, O., & Scheele, F. (2007). Viewpoint: Competency-based postgraduate training—Can we bridge the gap between theory and clinical practice? Academic Medicine, 82(6), 542–547.
Van Leijen-Zeelenberg, J. E., Van Raak, A. J. A., Duimel-Peeters, I. G. P., Kroese, M. E. A. L., Brink, P. R. G., & Vrijhoef, H. J. M. (2015). Interprofessional communication failures in acute care chains: How can we identify the causes? Journal of Interprofessional Care, 29(4), 320–330.
Wagner, S. J., & Reeves, S. (2015). Milestones and entrustable professional activities: The key to practically translating competencies for interprofessional education? Journal of Interprofessional Care, 29(5), 507–508.
Wölfel, T., Beltermann, E., Lottspeich, C., Vietz, E., Fischer, M. R., & Schmidmaier, R. (2016). Medical ward round competence in internal medicine—An interview study towards an interprofessional development of an entrustable professional activity (EPA). BMC Medical Education, 16(1), 1–10. https://doi.org/10.1186/s12909-016-0697-y.
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The authors gratefully acknowledge comments on an early version of the manuscript from Dr. Bridget O’Brien and Dr. Marije Hennus.
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ten Cate, O., Pool, I.A. The viability of interprofessional entrustable professional activities. Adv in Health Sci Educ 25, 1255–1262 (2020). https://doi.org/10.1007/s10459-019-09950-0
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DOI: https://doi.org/10.1007/s10459-019-09950-0