How can Training in Primary Care be Assessed? From Theory to Practice

Optimally trained professionals are the most important prerequisite for continuing excellent health care that meets the needs of future patients. From this perspective the CanMEDS framework has been adopted as a basis for comprehensive training programs by many professional health care organizations. Expensive contemporary specialty resident training programs should also optimally adapt to the individual trainee’s competencies and learning curve. Reliable and valid assessment of the resident’s competencies therefore provides an important challenge in current busy practice. In order to ensure proper qualification, individual guidance and assessment of the progress of residents is essential.

The more integrated and task-oriented concept of Entrustable Professional Activities (EPAs) seems to be more suitable and gradually replaces the assessment based on the individual CanMEDS competencies. EPAs are well-defined professional activities that staff/consultants entrust qualified residents to perform with limited or no obligatory supervision. Well-founded, step-by-step qualification of residents by means of EPAs comprises the core of incremental individual growth from trainee towards independent practice. After a resident achieves an EPA, based on a well-informed entrustment decision by (a group of) consultants, (s)he is entitled to perform this part of the specialty without supervision. Examples of EPAs include providing outpatient clinic consultation, providing acute and on-call care, performing a cesarean section, stabilize a critically ill patient. The call for stepwise entrustment decisions not only comes from the educational reasons but also from quality, safety and legal perspectives that are pursued by medical societies, the boards of (hospital) directors and external parties such as the government and insurance companies.

In this presentation new models of EPA based (paediatric) specialist training programs will be presented as well as well-structured process by which progress of individual residents can be assessed. The latter is called the EARS-procedure (Evaluation and Assessment of Residents by Supervisors group) and enables more robust group decisions by Clinical Competency Committees (CCCs). Two years of experience of these innovative concepts in national training program will be shared.