How can we provided repeated experiences with "entrustable professional activities" (EPAs) while maintaining a reasonable faculty workload?
The Office of Pharmacy and Experiential Education oversees clinical clerkships and experiential rotation hours. This office identified that the accrediting body for pharmacy programs would be moving towards requiring documentation for how our program is develops "entrustable professional activities" (EPAs) throughout our program. These EPAs encompass critical skills and tasks like taking a patient's blood pressure, using sterile technique to deliver immunizations, or verifying a prescription order. This project necessitated the development of realistic skills opportunities that allowed students to develop a process for approaching a skill or task.
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Audience: First through third year student pharmacists
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Responsibilities: Working with SMEs across specialties, gap analysis, task analysis, graphic design, interactivity development
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Tools Used: Articulate Storyline 360, SCORM, Adobe Photoshop, Pixabay, MS Excel
Our Vice Chair of Experiential and Professional Education identified that it was common for our experiential (non-faculty) evaluations to identify poor student performance on various skills and that these skills lined up with what our accrediting body describes as EPAs. The Vice Chair hoped we could close the gap on the most critical skills prior to students entering their fourth-year clerkships.
Solution
A gap analysis was performed to help solve this problem. I worked with several critical course directors and students in the program to identify how these skills were being taught. The gap analysis identified that all EPA skills were being taught correctly, but there were several key issues likely leading to poor fourth-year evaluations: 1) Skills were being taught once in class and feedback from the instructor was not always provided due to the class size 2) Many critical skills were being introduced in the first year with minimal reinforcement throughout. As a result, I incorporated skills-based activities into our longitudinal eLearning experiences to promote long-term retention of material.
Process
A gap analysis was performed to determine the skills gap between students fourth-professional year and their year -long fourth-year clerkship. I met with course directors who taught in courses that introduced critical EPAs and inquired about when, at what depth, and how often important EPAs were being taught in their courses. I also collected feedback from students who were currently completing their fourth-year clerkships to identify their comfort with these skills. An eLearning approach was developed to reinforce skills that were process-oriented as some tactile skills were best reinforced in an in-person laboratory environment. A task analysis was performed for each skills to ensure steps were recreated and highlighted effectively in Articulate Storyline.
Task Analysis
A task analysis was crucial to ensure the steps introduced matched what the SME taught in the classroom. This also allowed for discussion regarding which steps may need repeated practice. Each skill included in the longitudinal experience required a separate and distinct task analysis (e.g., order verification, clinical recommendations, blood pressure, immunization technique). The blood pressure task analysis is included below.
Takeaway
Deciding on whether current training is ineffective or if an alternative strategy should be implemented can save a great deal of time. A gap analysis allowed us to recognize that we did not need to revamp the current training, build in more in-person lab time, or rebalance in-person credit hours for EPA vs non-EPA content within a given block. This ultimately allowed faculty workload to remain unchanged while improving student exposure to real-life skills and tasks.