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Defining entrustable professional activities for entry into residency in Brazil to better translate competency-based medical education into practice

Grant number: 18/26011-2
Support type:Scholarships abroad - Research
Effective date (Start): February 11, 2019
Effective date (End): February 10, 2020
Field of knowledge:Health Sciences - Medicine
Principal Investigator:Ieda Francischetti
Grantee:Ieda Francischetti
Host: Harm Peters
Home Institution: Faculdade de Medicina de Marília (FAMEMA). Secretaria de Desenvolvimento Econômico (São Paulo - Estado). Marília , SP, Brazil
Local de pesquisa : Charité - Universitätsmedizin Berlin, Germany  

Abstract

This study starts from the need to define the professional practices of medicine trainee graduated by one Brazilian medical school with 20 years of experience with an innovative curriculum mediated by the PBL method and a competency-based approach to meeting the people's and societal needs in health care. The need for curriculum reform is a demand not only of this institution, but as well as in many other medical school in Brazil. They reproduce innovative curriculum models in attention to the National Curricular Guidelines but without being clear where they should arrive.In our course, the benefits of using active methods and learning from practice are well recognized. Like many other medical schools in Brazil, we face insufficiently standardized graduation outcomes and expectations about the performance of entering residents. A key question is how to assure that the resident has acquired the required competency to deal satisfactorily with the needs of care at the first weeks of in his/ her practice? The Entrustable Professional Activities (EPAs) concept has recently shown to allow tangible and meaningful answers to this question. The concept of EPAs was introduced in 2005 as a practical approach to overcoming the limitations created by the abstract nature of competencies. EPAs are observable and measurable units of work that focus on care delivery, important for the assessment of the medical students and graduates level of competency achieved.The Dieter Scheffner Center for medical education and educational research form the Charité, Berlin, Germany has an internationally recognized expertise in the EPA field, has significantly contributed to its conceptual and practical advances and has recently defined core EPAs for entry into residency according to their German context.The project proposal involves three main objectives: 1) to define a set of core EPAs for entry into residence in Brazil; 2) to develop a blueprint for an outcome-based curriculum re-construction of the undergraduate medical program in our institution based on the defined core EPAs; and 3) to write and publish a scientific article as post-doctoral research in an international peer-reviewed journal. The project will be carried out at the Charité Berlin by the applicant under the supervision of Prof. Dr. med Harm Peters, MHPE, Director Scheffner Center with ongoing interactions with the Brazilian faculty staff.The methodology in year 1 will be based on a systematic approach to define a full set of core EPAs for entry into residency for Brazilian context. Content of EPAs will be elaborated as seven-category description for each EPA according to current recommendations in the literature. The process will be based on a modified Delphi study procedure.The methodology in year 2 will be based on a participative and outcome-based approach to curriculum re-construction. Participatory delineates to the ongoing involvement of the Brazilian faculty, as key stakeholders and curriculum experts, in the process of developing a blueprint for the reconstructed undergraduate medical program. Outcome-based refers to that the in year 1 developed core EPAs for entry into residency in Brazil will serve as the outcomes for the reconstructed curriculum. Backwards, from year 6 to year 1 of the curriculum, the various modules and segments will be adjusted so that the teaching, learning and assessment will be longitudinally aligned with the core EPA outcomes.To summarize, the proposed project aims at modernizing the undergraduate medical training program exemplarily in one Brazilian medical school to align with recent international advances in medical education. The results can likely serve as a best practice model for many other medical schools in Brazil. The development and implementation of core EPAs for entry into residency are expected to significantly better meet the needs of our patients and community in health care.