Patients, Nurses, and Physicians Working Together to Develop a Discharge Entrustable Professional Activity Assessment Tool.
OBJECTIVE
The Accreditation Council for Graduate Medical Education milestones were written by physicians and thus may not reflect all the behaviors necessary for physicians to optimize their performance as a key member of an interprofessional team.


METHODS
From April to May 2013, the authors, Educational Research Outcomes Collaborative leaders, assembled interprofessional team discussion groups, including patients or family members, nurses, physician trainees, physician educators, and other staff (optional), at 11 internal medicine (IM) programs. Led by the site's principal investigator, the groups generated a list of physician behaviors related to the entrustable professional activity (EPA) of a safe and effective discharge of a patient from the hospital, and prioritized those behaviors.


RESULTS
A total of 182 behaviors were listed, with lists consisting of between 10 and 29 behaviors. Overall, the site principal investigators described all participants as emerging from the activity with a new understanding of the complexity of training physicians for the discharge EPA. The authors batched behaviors into six components of a safe and effective discharge: medication reconciliation, discharge summary, patient/caregiver communication, team communication, active collaboration, and anticipation of posthospital needs. Specific, high-priority behavior examples for each component were identified, and an assessment tool for direct observation was developed for the discharge EPA.


CONCLUSIONS
The authors are currently evaluating trainee and educator perceptions of the assessment tool after implementation in 15 IM programs. Additional next steps include developing tools for other EPAs, as well as a broader evaluation of patient outcomes in the era of milestone-based assessment.
L.B. Meade is Macy Faculty Scholar, Baystate Medical Center, Springfield, and associate professor of medicine, Tufts University School of Medicine, Boston, Massachusetts.K.H. Suddarth is associate program director for internal medicine and assistant professor of medicine, University of Colorado Denver School of Medicine, Denver, Colorado.R.R. Jones is associate program director in internal medicine, Summa Health Systems, Akron, and associate professor of medicine, Department of Medicine, Northeast Ohio Medical University, Rootstown, Ohio.A.K. Zaas is program director for internal medicine and associate professor, Duke University School of Medicine, Durham, North Carolina.T. Albanese is formerly manager of medical education, Summa Health System, Akron, Ohio.K. Yamazaki is outcome assessment research associate, Accreditation Council for Graduate Medical Education, Chicago, Illinois.C.W. O'Malley is program director in internal medicine and assistant professor of medicine, University of Arizona College of Medicine, Phoenix, Arizona.
Lauren B
LB
Meade
Kathleen Heist
KH
Suddarth
Ronald R
RR
Jones
Aimee K
AK
Zaas
Terry
T
Albanese
Kenji
K
Yamazaki
Cheryl W
CW
O'Malley