Background
The Education in Pediatrics Across the Continuum (EPAC) pilot project envisions an educational system quite different from the current medical school/residency experience. In this proposed competency-based model the continuous curriculum spans medical school and residency and allows flexibility in curriculum design to meet the individual’s career goals but standardizes intended outcomes within that context.
As a result of this redesign, we will be able to meet the learners in the different levels of expertise with which they enter and allow them to proceed according to their own ability to learn. At the same time, we can ensure that when transitioning from medical school to residency and from residency to practice they bring the requisite skills to the next level.
Setting requirements that can be assessed for these transition points will enable progressive skill building across the educational continuum.
Relating to patients and the healthcare team are central organizing principles of this pilot. Creating opportunities for experiences that provide longitudinal meaningful interactions with patients, peers and supervisors and that integrate the learners into the care team as active participants rather than as observers is critical to achieving these principles.
The curriculum will be deliberately designed to maximize educational experiences important for the practice of children’s healthcare. Students will be expected to assume responsibility for their learning and will become skilled in adapting to different environments and systems of healthcare.
The EPAC pilot will be evaluated both locally and nationally using a developmental model of evaluation in which we study both the outcomes for learners and the implementation issues for programs and regulatory bodies. This approach will allow us to capture contextual issues in addition to learner outcomes, thus facilitating later adaptation/adoption by other programs.
Guiding Principles
Framework for Curriculum and Assessment/Evaluation
1) Entrustable professional activities (EPAs) for a general pediatrician are the framework for the program. These EPAs are mapped to the domains of competence and competencies, and their corresponding pediatric milestones providing a clear linkage for learners and faculty.
2) In addition to meeting the school and LCME graduation requirements, subsequent transition points (UME to GME and GME to fellowship or practice) will be contingent upon meeting the predetermined thresholds for transitioning within this program as follows:
- Learners will meet expected levels of performance for milestones and levels of entrustment for designated core EPAs
- Learners will bring a “portfolio” of individual learning needs at transition points.
3) Learners, teachers and the learning environment have a shared responsibility in achieving program and individual goals.
4) Advancement according to demonstrated ability that results in entrustment will be the primary criteria. Learner progress in the program must be based on performance against specified outcomes (the competencies as demonstrated through certifiable or entrustable activities), not only on time.
5) Learner assessments will be performed using tools and processes common to all EPAC sites and tied to the Pediatric Milestones supplemented by assessment tools required by individual schools for their curriculum.
6) Learners are both empowered and expected to be key participants in their own assessment.
7) Qualitative and quantitative data about programs and learners will be collected longitudinally and shared with the consortium
8) Learners will be required to pass all components of USMLE in accordance with USMLE guidelines
9) The curriculum must cover the breadth and depth required by the LCME.
Continuity of Experience
10) Continuity of relationships will be an organizing principle of this pilot. As such there must be continuity of relationships with faculty, other students in the cohort (locally and nationally), the interprofessional health care team, and patients over the continuum of training to ensure relationship building, role modeling, mentoring, and the degree of direct observation essential for entrustment.
11) Learners must have longitudinal experiences as part of the health care team that allows them to follow patients in a meaningful role over time, with progressive responsibility and entrustment for care.
12) Learners should be able to develop a comprehensive understanding of the development of health and disease throughout the life cycle and through the lens of a future pediatrician, (e.g. through an understanding of the childhood determinants of many adult diseases and the implications for prevention).
Logistical Considerations
13) Each program site must allocate residency positions for learners to enter when they meet the requirements for the UME-GME transition.
14) Each site must allow re-entry to existing traditional M.D. program for learners who decide to opt out. This will be done in time to allow completion of other traditional pre-residency requirements. Each site must accommodate voluntary leave of absence during the training period as required by the LCME or ACGME.
15) Learners should be identified and enrolled in the pilot by the mid-point of year 2 but must be enrolled no later than the beginning of the major clinical experiences.
16) The EPAC pilot sites should create a national learning community.
Quality and Safety Considerations
17) Continuity experiences should occur at sites that have demonstrated commitment to continuous improvement of patient outcomes.
18) The program offers a unique opportunity for learners to follow and work on projects to improve the health outcomes for the population of patients that they follow over time. Sites should make this a goal of the program, and select health care environments where this can be accomplished.
Faculty Development
19) The program (EPAC) will provide the project team faculty with guidance and support to prepare for the implementation of the project at their sites. The sites will plan and implement faculty development that addresses the competency-based assessment and mentoring necessary to support the program.
Revised October 12, 2012