December 2023: Pamela Lipsett

Entrustable Professional Activities: A Primer 

Our systems for assessing performance and providing feedback to learners is changing with a greater emphasis on providing real-time assessments of directly observed behaviors to learners. These direct observations are intended to provide formative feedback to the learner. Over time, variation in patient presentation, disease and complexity, these assessments should form a portfolio that demonstrates evidence of learner progress, possibly the rate of progress, and area in which the learner may need additional development. For these assessments to be helpful to the learner and easy for the supervisor to complete, they must share a mental model about what constitutes a good and effective performance and what components are needed for the trainee to practice independently.

In Graduate Medical Education (GME) the ACGME (Accreditation Council for Graduate Medical Education) has utilized both “Competencies” and “Milestones” to help describe the abilities of our resident and fellow trainees over time to independent practice. For some, these terms are rather obtuse and not easily applied to every day observations and assessments in the workplace.  More recently, Entrustable Professional Activities (EPA’s) have been operationalized as part of assessments in both GME and soon in Undergraduate Medical Education. EPA’s are units of work that a learner performs that can be directly observed. This is in contrast to competencies which are broad domains of ability such as medical knowledge, and milestones, which describe the progress of a learner across a domain from novice to expert. EPA’s are believed to be more applicable to day to day interactions as a supervisor inherently makes a decision with an individual learner how much (or how little) they will need to supervise and/or provide autonomy to an individual learner.

November 2023: Douglas Robinson

We are educators and mentors for our trainees across many domains - in the classroom, lab, and life. We are gifted with a rich community of highly inspired and inspiring trainees. We must constantly value this privilege we have with our trainees.

Here are some thoughts:

• Our trainees bring heart-warming motivation, spirit, and intellect.
• We must challenge our students and trainees while giving them space to think independently and to pursue their vision. Of course, their vision needs to be aligned with their mentors, but mentors need to be flexible and allow for growth. Often, trainees push their mentors to expand their own thinking.
• In the research domain, the goals must always be to truth-seek. Research cannot be structured “to show” anything; there cannot be “preferred answers”. Research teams should not “care what the answer is”, but they should be super-motivated to “figure out what the answer is.” This should be the lab mantra!
• It is important to remember that trainees come from all over the world. They can be far away from their support network. Lab environments often fill this gap and should be ready and willing to support their members when needed.
• Because we sit in an inspiring community, we leverage this community to provide supportive, enriching experiences for those who might not otherwise have such opportunities. We built the Johns Hopkins Initiative for Careers in Science and Medicine (CSM) to provide research experience with academic fortification, complete with wholistic, longitudinal mentorship, for scholars from socioeconomically under-resourced backgrounds. In addition to making impact on our scholars, our graduate and postdoctoral trainees get to feel the impact of mentoring a young person, helping them to grow, achieve, and succeed. This is highly rewarding for all trainees.

You may find additional resources through the Institute of Excellence in Education website and by participating in IEE’s Foundations of Teaching and Learning course or the Summer Teaching camp.

October 2023: Jessica Bienstock

What’s are some of the most important things you can do to enhance your learner’s experience early on in their time on your service?

• One of the easiest things to do is to learn their name! If you’re like me and are juggling many different ideas and tasks simultaneously, once you know your learner’s name, writing their name down somewhere that allows you to quickly reference it even if you forget it initially.
• When your learner first joins you in clinic or in the OR, introduce them to the other members of your team (you already know their name so this is easy). This allows the learner to benefit from your “standing” within the team and more quickly be seen as part of the team.
• Ask the learner about their goals for the day, the week, or even the whole rotation. This can help you be aware of learner self-identified areas for growth upon that you can use to provide them educational resources and feedback.
• With the learner’s goals in mind, identify for your learner how they can help facilitate the work of the team.
• Remember to send them home. Learners are hesitant to leave before the entire team leaves even if there is nothing specific for them to do or learn.

Okay, now that you know how to start, you can build upon this foundation through accessing some of the IEE resources including the Foundations of Teaching and Learning course or the Summer teaching camp.

And (because this IS Johns Hopkins after all) remember that Sir William Osler said “I desire no other epitaph than the statement that I taught medical students in the wards, as I regard this as by far the most useful and important work I have been called upon to do.”