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Voortgangsverslag

Samenvatting
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Dit onderzoek wordt uitgevoerd door een AIOTHO huisartsgeneeskunde (arts in opleiding tot huisarts en onderzoeker). Zij combineert in projectperiode van 6 jaar haar opleiding tot huisarts (3 jaar) met de uitvoering van dit onderzoeksproject, dat moet leiden tot een promotie. In het afgelopen projectjaar zijn grote stappen gezet in de data verzameling en analyse van verschillende onderdelen van dit project. Het eerste artikel met de resultaten van het project is gepubliceerd in een tijdschrift en er zijn 2 stukken ingestuurd. Daarnaast heeft de onderzoeker haar bevindingen gepresenteerd op een internationaal congres. De voortgang van het project loopt naar wens.

Resultaten
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Het afgelopen jaar werd vooral ingevuld door het zwangerschapsverlof en opleidingsperiode in de huisartsenpraktijk van de aiotho. Dit betekent dus dat het onderzoek in deze periode (zoals gepland) slechts beperkt voortgezet is. Het project loopt goed. We krijgen steeds meer zicht op het gebruik van EPA (voor de nederlandse huisartsopleiding KBA) in de opleiding van huisartsen. Hierover is een eerste publicatie verschenen in een tijdschrift. In die studie komt naar voren dat opleiders en aios enthousiast zijn, maar tegelijkertijd dat de formulering en het hoge aantal KBA beperkingen opleveren voor gebruik. Andere deelprojecten over variatie in gebruik van EPA in andere vervolgopleidingen, opbouw van vertrouwen tussen opleider en aios (een belangrijk concept bij gebruik EPA) en het belang van verschillende EPA voor de huisarts zijn inmiddels gereed worden verzonden naar tijdschriften voor publicatie. Komende periode starten we met de dataverzameling voor de laatste studies voor dit project.

Samenvatting van de aanvraag

Samenvatting
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Postgraduate GP specialty training mainly takes place as workplace-based learning. To enhance the professional development of GP trainees, continuous feedback on their performance in the workplace, aligned with the goals of the curriculum, is needed. Currently, methods for assessing clinical competence focus on the 7 isolated roles as defined in the CanMEDS system. In daily clinical practice, these roles are never applied in isolation, therefore assessing clinical competence in such a manner lacks ecological validity and is considered a difficult task for trainers. Assessing trainees using Entrustable Professional Activities (EPA) is a recently suggested method, describing meaningful, integrated, daily clinical activities, combining the relevant CanMEDS roles. These activities are well known to clinical trainers, and the extent to which they trust the trainee to take care of their patients with the problem as described in the EPA is considered an adequate manner to assess medical competence. Possible drawbacks of the use of EPA in assessment are the large number of EPA needed to cover the total spectrum adequately, resulting in low feasibility, an unknown added value over current assessment systems and unknown validity of the use for high-stakes decisions. For the Dutch General Practice training programs EPA are currently being developed as basis for the new nation-wide learning plan for GP training. This results in a need, and at the same time provides an excellent opportunity, to assess the feasibility, reliability and validity of an EPA-based assessment program for the documentation of readiness for practice of trainees.

 

For this 3-year project we therefore have the following aims:

1) To develop an assessment program using EPA and explore how this program can be used in a feasible manner in GP specialty training programs;

2) To explore reliability and validity aspects of EPA-based assessment.

 

In this implementation study, mixed-methods methodology, involving all stakeholders, is used to fulfill the above aims. The project can be subdivided into two main parts following from the projects aims.

 

In part 1 the development and evaluation of an EPA-based assessment program will be based on the methods as described by the Medical Research Council for the development and evaluation of complex interventions. As a first step, one or more literature-based outline(s) of possible formats for an EPA-based assessment program will be described. This outline(s) will be used as basis for a focus group study, using focus groups composed of all stakeholders, with the aim to identify all relevant considerations regarding EPA-based assessment in Dutch GP training. Based on the results of these studies, an expert group will develop a concrete proposal for EPA-based assessment in the Dutch GP training programs. At least 20 trainers and trainees will be asked to complete selections of the assessment-program while thinking aloud it to gain insight in the consistency of the terminology used and the requirements and training needed to work with the program successfully. Preliminary feasibility of the system will be tested by means of a pilot implementation with a duration of 3 months in 8 GP training practices, related to 4 of the GP training institutes. Individual interviews with trainers and trainees will focus on the feasibility of the program. If necessary, at any stage adjustments will be made to the program, and a new pilot will be performed.

 

In part 2, an in-depth study of feasibility, reliability and validity aspects of EPA-based assessment is made using a mixed-methods design. To do so we will include at least 40 trainer-trainee couples in at least 4 training institutes. After training, included couples will be required to execute the newly developed assessment system and the current assessment system simultaneously for comparison, at 3 and 6 months after inclusion, and answer additional questions on questionnaires regarding feasibility and validity. Using three-step-test-interviews, additional qualitative data will be collected from trainers. Also trainees and administrative staff will be interviewed. Feasibility will be studied by analyzing the questionnaires, the number and completeness of assessments. Interviews are analyzed for possible barriers and facilitators regarding the implementation. By studying the uniformity of interpretations of the EPA we will assess reliability. Validity will be assessed in terms of face validity, content-validity, divergent validity, convergent validity, and formative validity.

 

During the last part of the project, an expert team will develop a final advice on the contents and implementation of EPA-based assessment, for the heads of the 8 GP training institutes.

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