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      Working with entrustable professional activities in clinical education in undergraduate medical education: a scoping review

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          Abstract

          Background

          Entrustable professional activities (EPAs) are increasingly used in undergraduate medical education (UME). We conducted a scoping review to summarize the evidence for the use of EPAs in clinical rotations in UME.

          Methods

          We searched multiple databases for scoping reviews based on the PRISMA guidelines for articles reporting qualitative and quantitative research, as well as conceptual and curriculum development reports, on EPAs in UME clinical rotations.

          Results

          We identified 3309 records by searching through multiple databases. After the removal of duplicates, 1858 reports were screened. A total of 36 articles were used for data extraction. Of these, 47% reported on EPA and EPA-based curriculum development for clerkships, 50% reported on implementation strategies, and 53% reported on assessment methods and tools used in clerkships. Validity frameworks for developing EPAs in the context of clerkships were inconsistent. Several specialties reported feasible implementation strategies for EPA-based clerkship curricula, however, these required additional faculty time and resources. Limited exposure to clinical activities was identified as a barrier to relevant learning experiences. Educators used nationally defined, or specialty-specific EPAs, and a range of entrustability and supervision scales. We found only one study that used an empirical research approach for EPA assessment. One article reported on the earlier advancement of trainees from UME to graduate medical education based on summative entrustment decisions.

          Conclusions

          There is emerging evidence concerning how EPAs can be effectively introduced to clinical training in UME. Specialty-specific, nested EPAs with context-adapted, entrustment-supervision scales might be helpful in better leveraging their formative assessment potential.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12909-021-02608-9.

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          Most cited references50

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          PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation

          Scoping reviews, a type of knowledge synthesis, follow a systematic approach to map evidence on a topic and identify main concepts, theories, sources, and knowledge gaps. Although more scoping reviews are being done, their methodological and reporting quality need improvement. This document presents the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) checklist and explanation. The checklist was developed by a 24-member expert panel and 2 research leads following published guidance from the EQUATOR (Enhancing the QUAlity and Transparency Of health Research) Network. The final checklist contains 20 essential reporting items and 2 optional items. The authors provide a rationale and an example of good reporting for each item. The intent of the PRISMA-ScR is to help readers (including researchers, publishers, commissioners, policymakers, health care providers, guideline developers, and patients or consumers) develop a greater understanding of relevant terminology, core concepts, and key items to report for scoping reviews.
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            Rayyan—a web and mobile app for systematic reviews

            Background Synthesis of multiple randomized controlled trials (RCTs) in a systematic review can summarize the effects of individual outcomes and provide numerical answers about the effectiveness of interventions. Filtering of searches is time consuming, and no single method fulfills the principal requirements of speed with accuracy. Automation of systematic reviews is driven by a necessity to expedite the availability of current best evidence for policy and clinical decision-making. We developed Rayyan (http://rayyan.qcri.org), a free web and mobile app, that helps expedite the initial screening of abstracts and titles using a process of semi-automation while incorporating a high level of usability. For the beta testing phase, we used two published Cochrane reviews in which included studies had been selected manually. Their searches, with 1030 records and 273 records, were uploaded to Rayyan. Different features of Rayyan were tested using these two reviews. We also conducted a survey of Rayyan’s users and collected feedback through a built-in feature. Results Pilot testing of Rayyan focused on usability, accuracy against manual methods, and the added value of the prediction feature. The “taster” review (273 records) allowed a quick overview of Rayyan for early comments on usability. The second review (1030 records) required several iterations to identify the previously identified 11 trials. The “suggestions” and “hints,” based on the “prediction model,” appeared as testing progressed beyond five included studies. Post rollout user experiences and a reflexive response by the developers enabled real-time modifications and improvements. The survey respondents reported 40% average time savings when using Rayyan compared to others tools, with 34% of the respondents reporting more than 50% time savings. In addition, around 75% of the respondents mentioned that screening and labeling studies as well as collaborating on reviews to be the two most important features of Rayyan. As of November 2016, Rayyan users exceed 2000 from over 60 countries conducting hundreds of reviews totaling more than 1.6M citations. Feedback from users, obtained mostly through the app web site and a recent survey, has highlighted the ease in exploration of searches, the time saved, and simplicity in sharing and comparing include-exclude decisions. The strongest features of the app, identified and reported in user feedback, were its ability to help in screening and collaboration as well as the time savings it affords to users. Conclusions Rayyan is responsive and intuitive in use with significant potential to lighten the load of reviewers.
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              Workplace-based assessment as an educational tool: AMEE Guide No. 31.

              There has been concern that trainees are seldom observed, assessed, and given feedback during their workplace-based education. This has led to an increasing interest in a variety of formative assessment methods that require observation and offer the opportunity for feedback. To review some of the literature on the efficacy and prevalence of formative feedback, describe the common formative assessment methods, characterize the nature of feedback, examine the effect of faculty development on its quality, and summarize the challenges still faced. The research literature on formative assessment and feedback suggests that it is a powerful means for changing the behaviour of trainees. Several methods for assessing it have been developed and there is preliminary evidence of their reliability and validity. A variety of factors enhance the efficacy of workplace-based assessment including the provision of feedback that is consistent with the needs of the learner and focused on important aspects of the performance. Faculty plays a critical role and successful implementation requires that they receive training. There is a need for formative assessment which offers trainees the opportunity for feedback. Several good methods exist and feedback has been shown to have a major influence on learning. The critical role of faculty is highlighted, as is the need for strategies to enhance their participation and training.
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                Author and article information

                Contributors
                severin.pinilla@upd.unibe.ch
                eric.lenouvel@upd.unibe.ch
                andrea.cantisani@upd.unibe.ch
                stefan.kloeppel@upd.unibe.ch
                werner.strik@upd.unibe.ch
                soeren.huwendiek@iml.unibe.ch
                christoph.nissen@upd.ch
                Journal
                BMC Med Educ
                BMC Med Educ
                BMC Medical Education
                BioMed Central (London )
                1472-6920
                19 March 2021
                19 March 2021
                2021
                : 21
                : 172
                Affiliations
                [1 ]GRID grid.5734.5, ISNI 0000 0001 0726 5157, University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, ; Bern, Switzerland
                [2 ]GRID grid.5734.5, ISNI 0000 0001 0726 5157, Department for Assessment and Evaluation, Institute for Medical Education, , University of Bern, ; Bern, Switzerland
                [3 ]GRID grid.5734.5, ISNI 0000 0001 0726 5157, University Hospital of Psychiatry and Psychotherapy, University of Bern, ; Bern, Switzerland
                Author information
                http://orcid.org/0000-0002-0797-2043
                Article
                2608
                10.1186/s12909-021-02608-9
                7980680
                33740970
                3bac6192-8592-465d-89d3-82889fd4ac54
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 12 November 2020
                : 10 March 2021
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2021

                Education
                entrustable professional activities,undergraduate medical education,clinical education,scoping review

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