Session Title: Medical Education
Session Type: Abstract Submissions (ACR)
Preliminary Entrustable Professional Activities in
Muscloskeletal Ultrasound for Rheumatology Fellowship Training
As part of the Next Accreditation System (NAS), the Accreditation Council for Graduate Medical Education (ACGME) has mandated a change in the evaluation of postgraduate trainees by including the development of Entrustable Professional Activities (EPAs) for each specialty and subspecialty. EPAs are the routine professional activities which define a profession. They also provide a means of framing the 6 ACGME competencies in a way that allows them to be meaningful to learners and faculty. The American College of Rheumatology (ACR) is developing EPAs for Rheumatology training. Although not currently an ACGME requirement, many fellowship programs have incorporated Musculoskeletal Ultrasound (MSUS) in their curricula. We seek to define EPAs for MSUS in rheumatology as an initial step towards the development of standardized curriculum and assessment tools.
A group of educators utilized a modified nominal group technique (NGT) to develop EPAs for MSUS. A literature search was completed on MSUS education, certification, best practices and curriculum development to generate a list of potential EPAs specific for MSUS in rheumatology, framed within the ACGME competency and milestone vernacular.
Each item was rated for inclusion as an EPA using a Likert scale, where 1 represented the least agreement and 9 represented the most agreement. A median score of 7-9 was considered to have highest agreement, 4-6 was intermediate agreement, and <3 was rejected. An initial postal round was followed by a teleconference call, where each group member had the opportunity to discuss, defend or dispute the item. A second round was then completed to develop a final list of EPAs.
35 initial EPAs were developed for scoring in each round. In the postal round, 24 and 11 EPAs met criteria for highest and intermediate agreement, respectively. In the final round, 19 EPAs met criteria for highest agreement and included concepts such as indications, limitations and proper performance of MSUS. Eight EPAs met criteria for intermediate agreement, and included concepts such as communication with referring providers and patients regarding MSUS findings. The remaining 8 EPAs were rejected for reasons such as redundancy with predicted sub-specialty EPAs, and a lack of specificity for MSUS. As a result of conferencing, several EPAs were merged into single EPAs to enhance cohesiveness and included concepts such as combining patient positioning with other strategies to obtain optimal images, and approaches to self-reflection and self-directed learning. Out of the initial 35 items, a final list of 16 EPAs was developed for MSUS in Rheumatology.
A preliminary set of EPAs specific for the practice of MSUS in rheumatology was developed. These EPAs are the initial step in the development of assessment tools for determination of MSUS competency for a rheumatology fellow in training. Further studies will include validation of these EPAs by a larger group of educators and practitioners of MSUS.
A. C. Cannella,
E. Y. Kissin,
G. S. Kaeley,
J. B. Higgs,
K. J. Caverzagie,
K. D. Torralba,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/preliminary-entrustable-professional-activities-in-muscloskeletal-ultrasound-for-rheumatology-fellowship-training/