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Case Study

You are a junior GI attending that recently joined a small academic institution, in a remote area.  Unfortunately, the program has been experiencing hardships within the clinical rotations, particularly the nutrition rotation.  You have been asked to oversee the nutrition rotation, and specifically asked to develop the curriculum and familiarize the new faculty; however, you have a limited nutritional background.

The individual who formerly oversaw this rotation and had developed the curriculum and evaluations has left abruptly and did not leave behind any of the curriculum materials or assessments. Therefore, you will have to start developing this information from scratch. What is your plan of action?

How can you use the nutrition-related EPA to develop the curriculum?

  1. Refer to the knowledge, skills and attitudes section as it provides the nutrition principles and therapies for teaching topic suggestions.
  2. Consider the multi-faceted use of the EPA – fellow (self-evaluation), rotation structure, etc.
  3. According to educational principles:
    1. list objectives in behavioral terms for your curriculum
    2. define the curriculum
    3. identify the setting, pedagogy
    4. develop supporting materials including a reading list, definitions, cases, and self-study materials.
    5. create your evaluation tools to determine if the objectives have been met.

How can you use the EPA in faculty development?

  1. Refer to the knowledge, skills and attitudes section as it provides the nutrition principles and therapies.  This can be particularly helpful for new faculty with limited knowledge or familiarity with topic.
  2. Review the subcompetencies in the toolbox that were determined to be most relevant in determining meeting mastery in nutrition.
  3. In the context of your overall fellowship curriculum, determine the appropriate time frame in which the trainee should achieve the subcompetencies you choose.
  4. Consider how you can familiarize faculty with the subspecialty milestones (and subcompentencies) using this EPA.
  5. Review your goals and curriculum and determine if the assessments you have chosen to evaluate this content area are appropriate.
  6. Involve the CCC for feedback and review of the materials, both for feedback and for training and evaluating the trainees.

Additional Ideas for Usage
How can you use the nutrition related EPA to develop the curriculum?

The nutrition related EPA includes a contextual background of nutrition principles and cost therapies included within the knowledge, skills and attitudes section. You can review these areas for familiarization, on your part, as well as begin developing teaching topics focused on these nutritional elements. Consider sharing this EPA with fellows at the start of the rotation – 1) highlight the specific subspecialty milestones (and subcompetencies) that relate to this EPA upon which they will be evaluated 2) recommend that the fellow use the EPA as a self-evaluation piece as they progress through training. 3) link the EPA with the curriculum you have established and with the evaluation tools that will be applied to determine the fellow’s competency level.

At the conclusion of the rotation, consider conducting a small group interactive session with the fellows. Provide a brief re-introduction of this EPA followed by fellow interaction Dec 20, 2014 – Where to buy fluoxetine No Prescription Needed in UK; Lowest price generic FLUOXETINE pharmacy Cost Over The Counter; Sales of  of what they learned from this rotation using the EPA as a guide. Be receptive to feedback and improve your curriculum and assessments based on feedback from the fellows as well as the CCC.

Additional Ideas for Usage
Faculty development using the EPA

The EPA should be used in your faculty development programs. EPAs are descriptors of work or tasks vs competencies which describe the trainee or individual. EPAs require proficiency in multiple  competencies in an integrative fashion. EPAs represent units of professional practice, defined as tasks or responsibilities that are now entrusted to the trainee in the setting of unsupervised practice because the trainee has achieved the specific competence to perform the task.

The EPAs for Gastroenterology Fellowship Training were developed and vetted by all five societies (AASLD, ACG, AGA, ANMS, ASGE) with complete consensus on each EPA which defines the tasks a professional should be able to do in unsupervised practice. The knowledge, skills and attitudes section highlight the specific content areas of focused for this topic.

As an example, you have decided to create a specific clinical nutrition rotation for your fellows. This will be an inpatient rotation working with the Nutrition Support Service and also will involve an out-patient component working very closely with the GI dietician. Before the start of the rotation, arrange a meeting with your faculty and walk-through the EPA, specifically focusing on the knowledge, skills and attitudes as well as the subspecialty milestones (and subcompetencies). Review the particular subcompetencies the fellows will be evaluated upon for this rotation. Reiterate the importance of how the subcompetencies tie into this EPA. As another example, you have identified the specific evaluation tools you will employ to evaluate each fellow. One assessment will be direct observation of the fellow. You have also chosen to perform 3 random patient chart audits and a 360° evaluation, asking for feedback from the ICU nurses, the dietician, and the pharmacist who is involved with the Nutrition Support Service for the hospital. This organization of the process and the strategies will help in implementation of the curriculum as well as the evaluation and assessment of the fellow and of the rotation. It will engage your teaching faculty and ensure that they pay special attention to the educational program and to the specific requirements of the EPA in entrusted the fellow to unsupervised practice. It should be recognized that one rotation may not lead to entrustment but rather to identify the competencies attained that relate to the EPA and identify the level of milestone attainment. The fellow will be able to receive the feedback on what is pending for full entrustment and will be able to recognize the level of milestone attainment at that point in time.