Tensions in Competence by Design implementation: A qualitative multidisciplinary study to identify factors that promote and impede Entrustable Professional Activity acquisition among faculty and residents at a Canadian university

Authors

Quinten S. Paterson, Department of Emergency Medicine, University of SaskatchewanFollow
Sharon E. Card, Division of General Internal Medicine, Department of Medicine, University of Saskatchewan.
Benjamin Leis, Department of Medicine, University of Saskatchewan
Lindsey Broberg, Department of Obstetrics and Gynecology, University of Saskatchewan
Stéphanie Beckett, Department of Hospitalist Medicine, Cornwall Community Hospital
Tanya Robertson-Frey, Postgraduate Medical Education Office, University of Saskatchewan
Nina Gao, Men’s Health Research Program, School of Nursing, University of British Columbia
Brian Ulmer, Department of Surgery, University of Saskatchewan
Lynsey J. Martin, Department of Emergency Medicine, University of Saskatchewan

Abstract

Purpose. The purpose of this qualitative study was to explore residents’ and faculty’s experiences with EPAs to identify barriers and facilitators to EPA acquisition. This supported the subsequent development of recommendations for residents and faculty, residency program leadership, and institution to ensure that residents’ training and Competence Committee promotional decisions are optimized. Method. The authors conducted a qualitative study utilizing grounded theory and quality improvement research methods with residents and faculty from various specialties at a Canadian University. Through the utilization of a process mapping exercise, an interactive fishbone diagram exercise, and semi-structured focus groups, barriers and facilitators to EPA acquisition were identified and then thematically analyzed using a constant comparative technique, thereby generating a final codebook of results. Results. Six residents and six faculty from eight specialties participated. Two resident focus groups and one individual resident interview generated 2 hours and 36 minutes of audio-recorded data and 43 pages of transcribed data. Two faculty focus groups generated 1 hour and 44 minutes of audio-recorded data and 33 pages of transcribed data. Four primary categories for EPA barriers and facilitators were pre-defined according to the fishbone diagram. Fifteen themes of barriers and fifteen themes of facilitators, with varying degrees of subthemes, were inductively identified through the coding process. Discussion. This study found that the barriers residents and faculty face during EPA acquisition are similar to the challenges previously described in the pre-CBD assessment literature, suggesting that simply changing the assessment paradigm and modality will not necessarily alleviate pre-existing challenges to the assessment process or automatically improve assessment quality. Based on the results, a list of recommendations was generated as a starting point for change and improvement at a resident and faculty level, residency program leadership level, and institutional level.

Recommended Citation

Paterson, Quinten S.; Card, Sharon E.; Leis, Benjamin; Broberg, Lindsey; Beckett, Stéphanie; Robertson-Frey, Tanya; Gao, Nina; Ulmer, Brian; and Martin, Lynsey J. (2024) "Tensions in Competence by Design implementation: A qualitative multidisciplinary study to identify factors that promote and impede Entrustable Professional Activity acquisition among faculty and residents at a Canadian university," Health Professions Education: Vol. 10: Iss. 1, Article 5.
Available at: https://hpe.researchcommons.org/journal/vol10/iss1/5