title: Rating the Quality of Entrustable Professional Activities: Content Validation and Associations with the Clinical Context.
abstract: BACKGROUND
  Entrustable professional activities (EPAs) have been developed to assess resident physicians with respect to Accreditation Council for Graduate Medical Education (ACGME) competencies and milestones. Although the feasibility of using EPAs has been reported, we are unaware of previous validation studies on EPAs and potential associations between EPA quality scores and characteristics of educational programs.
  
  
  OBJECTIVE
  Our aim was to validate an instrument for assessing the quality of EPAs for assessment of internal medicine residents, and to examine associations between EPA quality scores and features of rotations.
  
  
  METHODS
  This was a prospective content validation study to design an instrument to measure the quality of EPAs that were written for assessing internal medicine residents.
  
  
  METHODS
  Residency leadership at Mayo Clinic, Rochester participated in this study. This included the Program Director, Associate program directors and individual rotation directors.
  
  
  METHODS
  The authors reviewed salient literature. Items were developed to reflect domains of EPAs useful for assessment. The instrument underwent further testing and refinement. Each participating rotation director created EPAs that they felt would be meaningful to assess learner performance in their area. These 229 EPAs were then assessed with the QUEPA instrument to rate the quality of each EPA.
  
  
  METHODS
  Performance characteristics of the QUEPA are reported. Quality ratings of EPAs were compared to the primary ACGME competency, inpatient versus outpatient setting and specialty type.
  
  
  RESULTS
  QUEPA tool scores demonstrated excellent reliability (ICC range 0.72 to 0.94). Higher ratings were given to inpatient versus outpatient (3.88, 3.66; p = 0.03) focused EPAs. Medical knowledge EPAs scored significantly lower than EPAs assessing other competencies (3.34, 4.00; p < 0.0001).
  
  
  CONCLUSIONS
  The QUEPA tool is supported by good validity evidence and may help in rating the quality of EPAs developed by individual programs. Programs should take care when writing EPAs for the outpatient setting or to assess medical knowledge, as these tended to be rated lower.
authors.affiliation: College of Medicine, Department of Internal Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA. post.jason@mayo.edu.
authors.forename: Jason A
authors.initials: JA
authors.lastname: Post
authors.affiliation: College of Medicine, Department of Internal Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Wittich
authors.affiliation: College of Medicine, Department of Internal Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
authors.forename: Kris G
authors.initials: KG
authors.lastname: Thomas
authors.affiliation: College of Medicine, Department of Internal Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
authors.forename: Denise M
authors.initials: DM
authors.lastname: Dupras
authors.affiliation: College of Medicine, Department of Internal Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Halvorsen
authors.affiliation: College of Medicine, Department of Health Sciences Research, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
authors.forename: Jay N
authors.initials: JN
authors.lastname: Mandrekar
authors.affiliation: College of Medicine, Department of Internal Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
authors.forename: Amy S
authors.initials: AS
authors.lastname: Oxentenko
authors.affiliation: College of Medicine, Department of Internal Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Beckman
mesh_terms: D000068:Accreditation; D002983:Clinical Competence / Q000592:standards*; D004503:Education, Medical, Graduate / Q000592:standards*; D004521:Educational Measurement / Q000379:methods* / Q000592:standards; D006801:Humans; D007388:Internal Medicine / Q000193:education; D007396:Internship and Residency / Q000592:standards; D008910:Minnesota; D011446:Prospective Studies; D015203:Reproducibility of Results
keywords: medial education–graduate; medical education–assessment/evaluation; medical education–quantitative methods