Entrustable Professional Activities (EPA's)
The SIWF is pursuing the goal of realigning postgraduate medical education towards competency-based medical education. This concept is to replace the previous specification of pure numbers (number of assessments per year, number of operations). Competency-based medical education (CBME) focuses on the actual skills and the acquisition of competencies of each individual in various areas of medical roles, which are defined in the so-called CanMeds® model and lead to the role as a doctor/surgeon meeting today's environment and requirements.
An important part of CBME are entrustable professional activities (EPAs).
The progress of a person in training is evaluated by various supervisors with regard to the level of supervision required in performing a professional activity. The SIWF turns the implementation of CBME over to the specialist societies, which are responsible for defining the EPA's in their field and thus the introduction of competency-based medical education. The Swiss College of Surgeons is planning to introduce EPA's within the Core Surgical Curriculum (with the aim of harmonizing surgical training in the first two years of training). The aim is thus to transform the training regulations for surgical specialists into a competency-based curriculum based on EPAs.
Immediately after observing an activity that is mapped as an EPA in the continuing medical education program, a feedback discussion takes place between the person in training and the supervising person with the aim of certifying a level of independence or competence for the next such activity for the trainee.
Level of competence:
Competence level 1 - Observation:
Learning by observing, actively assisting in an activity.
Competence level 2 - Direct supervision:
Carries out an activity in the presence of the supervisor under direct guidance.
Competence level 3 - Indirect supervision:
Carries out an activity largely independently in the presence of the supervisor. The supervisor only intervenes when necessary.
Competence level 4 - Remote supervision:
Can carry out an activity independently. The supervisor is not directly present but is directly available if required.
Competence level 5 - Supervise others:
Can supervise an activity performed by others.
The introduction of EPA's in the surgical disciplines will begin with postgraduate surgical training. Within the harmonization of the first two years of surgical training in the Core Surgical Curriculum by the Swiss College of Surgeons, the EPA's play an important role and are already at an advanced stage of development. They represent the basic activities that are expected of all candidates for a surgical career (urology, hand surgery, thoracic surgery, vascular surgery, pediatric surgery & general surgery) and should be embedded in the overall concept of postgraduate training to become a surgical specialist in the future.
As the SIWF no longer accepts any further postgraduate training programs that are not based on competency-based medical education (CBME) with the integration of EPAs, the SGC has set up a working group for the creation and introduction of EPAs. This group is to develop the EPA's for the specialist title in surgery, including the level of competence needed to becoming a surgeon. The SGC has filled a 20% position for coordination of the working group, which is held by KD Dr. med. Henning Fischer, Co-Chief Emergency Department, Lucerne. Together with a group of experts from the SGC, he is currently working on the EPAs, which will later form the basis for the revision of the postgraduate training program.