Obstetrics and Gynecology Modified Delphi Survey for Entrustable Professional Activities: Quantification of Importance, Benchmark Levels, and Roles in Simulation-based Training and Assessment

摘要

Objective Competency-based medical education (CBME) is playing a central role in physicians’ training. It focuses on competencies, measured by entrustable professional activities (EPAs). The aim of this survey is threefold for each EPA to (1) quantify the importance for Obstetrics and Gynecology (OBGYN) residency training; (2) set benchmarks; (3) identify the importance of simulation-based training (SBT). Methods The EPAs were defined based on a review of five OBGYN curricula. Two rounds of a modified Delphi via online questionnaire were performed from January to March, 2017. Experts were North American OBGYN program directors. Using a Likert scale, they rated the importance of each EPA for residency training, identified benchmark levels of competence, and roles of simulation. Consensus was defined as ≥80% agreement. Results Item analysis yielded 15 EPAs. Survey response rate was 17.47% (40 out of 229) for part 1 and 6.55% for part 2 (15 out of 229). All experts rated the importance of each EPA for residency training as “moderately important” or “absolutely essential”. For benchmarking, experts agreed with a stepwise increase in the level of competence, dependent on residency stage. Two EPAs, “Gynecological Technical Skills & Procedures” and “High-Risk Childbirth”, reached consensus (rating 4 or 5) for simulation. Conclusion CBME requires EPAs and benchmarks for each residency stage. Simulation will become a valuable tool in this model. However, experts remain neutral about its role, except for technical skills. An OBGYN curriculum based on predefined EPAs, benchmarks, and adequate assessment tools, including simulation, needs to be further explored for CBME to be successful.