Simulation and Self-assessment: A Medicalsimulation Based Exploration of Medical Trainee Understanding of EPA 6 (Oral Presentation) and EPA 8 (Handoff)

摘要

Introduction: Entrustable Professional Activities are clinical tasks that are observable, executable, and reflect one or more clinical competency. The goal of "entrustment" is that trainees perform their work safely and effectively without supervision once they have demonstrated sufficient competency. Simulation offers a unique opportunity to assess EPAs and objectively measure skills without threat to patient safety. Dr. Gielissen and Dr. Moadel chose oral presentations (EPA 6) and handoffs (EPA 8) due to their natural interconnectedness and ability to be readily measured in a simulation environment.;Methods: The study is a prospective, mixed methods approach at a single site (Yale School of Medicine). Sample: Students were recruited from all class levels (MS1-5) at Yale School of Medicine to undergo two 30 minute emergency medicine simulations. Data collection: Immediately following simulation, students were asked to complete a brief survey of 4 questions describing an ideal hand-off and oral presentation, as well as a self reflection on their own hand-off and oral presentation skills. They also rated themselves on a supervisory entrustment scale (1-5). Data analysis: Self-assessment data were analyzed for significant associations with students' demographics via SPSS. Qualitative responses were coded and analyzed via inductive reasoning and compared to the AAMC Core EPA Developers Toolkit (Core EPA Curriculum Developers Guide 2014).;Results: There was a significant correlation between higher self-assessment scores and months spent in medical school for both oral presentations and hand-offs. Furthermore, there was a significant correlation between higher self-assessment scores and number of prior simulation experience and English as a primary language for oral presentations. Self-assigned hand-off score and oral presentation score were also significantly correlated with each other. No correlation was observed between self-assessed scores of either handoff or oral presentation and gender.;Discussion: As expected, our study demonstrates a positive correlation between self-assessed entrustment scoring and the number of months in medical school as well as amount of exposure to simulation for oral presentation specifically. However, many students self-scored higher than would be expected for their level of training (expected level at graduation is 3, indicating readiness for indirect supervision). These findings mirror those observed by Dunning and Kruger in 1999, where students with greater preparation or experience demonstrate a more accurate score, whereas the early trainees appeared to demonstrate greater insight. Qualitative data from this study will form a key component of understanding between any discrepancies between attending entrustment scoring and students' self-scores as part of a larger concurrent study.