Entrustable Professional Activities and Curricular Milestones for Fellowship Training in Pulmonary and Critical Care Medicine: Report of a Multisociety Working Group

doi:10.1378/chest.14-0710

Chest

Volume 146, Issue 3, September 2014, Pages 813-834

https://doi.org/10.1378/chest.14-0710 Get rights and content

This article describes the curricular milestones and entrustable professional activities for trainees in pulmonary, critical care, or combined fellowship programs. Under the Next Accreditation System of the Accreditation Council for Graduate Medical Education (ACGME), curricular milestones compose the curriculum or learning objectives for training in these fields. Entrustable professional activities represent the outcomes of training, the activities that society and professional peers can expect fellowship graduates to be able to perform unsupervised. These curricular milestones and entrustable professional activities are the products of a consensus process from a multidisciplinary committee of medical educators representing the American College of Chest Physicians (CHEST), the American Thoracic Society, the Society of Critical Care Medicine, and the Association of Pulmonary and Critical Care Medicine Program Directors. After consensus was achieved using the Delphi process, the document was revised with input from the sponsoring societies and program directors. The resulting lists can serve as a roadmap and destination for trainees, program directors, and educators. Together with the reporting milestones, they will help mark trainees' progress in the mastery of the six ACGME core competencies of graduate medical education.

Section snippets

Background

The ACGME is responsible to the public for the accreditation of residency and fellowship training programs, whereas the ABIM is responsible for certifying the competence of individual trainees in internal medicine and its subspecialties. The ACGME is implementing what has been termed the Next Accreditation System (NAS). The NAS constitutes a comprehensive revision of the methods for accreditation of medical training programs, and of how the educational progress of individual trainees is

Methods

To achieve consensus on these EPAs and CMs, a working group was convened in March 2013. Membership was composed of two members each from the Association of Pulmonary and Critical Care Medicine Program Directors (APCCMPD), the American College of Chest Physicians (CHEST), the Society of Critical Care Medicine, and the American Thoracic Society. In addition to having clinical expertise in their respective fields, all members had significant experience as program directors of internal medicine

Results

Consensus on all items was achieved in three or fewer rounds of Delphi voting. Because our in-person meeting facilitated active discussion and revision, only a single round of voting was required for the medical knowledge and patient care competencies, despite their length. Our final proposed EPAs for pulmonary medicine and critical care medicine are each shown separately inTable 1.Table 2 lists the EPAs for combined programs in pulmonary and critical care.Table 3 lists the CMs for the four

Discussion

Using a formal process and with input from our professional societies and program directors, we have developed a list of CMs and EPAs for pulmonary medicine and critical care medicine. These documents serve several important goals. For the public, the EPAs provide a succinct summary of what subspecialists in our field can do and specify what trainees must be able to perform independently to ensure public trust. For trainees, the EPAs serve as a set of goals and reminders of what they must

Acknowledgments

Financial/NONFINANCIAL DISCLOSURES: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Other contributions: The authors are extremely grateful for the administrative support from Joyce Bruno, MBA, MIPH, and Laura Nolan from the Association of Pulmonary and Critical Care Medicine Program Directors, and Sharon Plenner, BS, from the Society of Critical Care Medicine.

References (18)

ML Green et al.
Charting the road to competence: developmental milestones for internal medicine residency training
J Grad Med Educ
(2009)
O ten Cate et al.
Competency-based postgraduate training: can we bridge the gap between theory and clinical practice?
Acad Med
(2007)
KE Hauer et al.
Developing entrustable professional activities as the basis for assessment of competence in an internal medicine residency: a feasibility study
J Gen Intern Med
(2013)
TJ Nasca et al.
The next GME accreditation system—rationale and benefits
N Engl J Med
(2012)
KJ Caverzagie et al.
The internal medicine reporting milestones and the next accreditation system
Ann Intern Med
(2013)
PJ Hicks et al.
Pediatrics milestone project: next steps toward meaningful outcomes assessment
J Grad Med Educ
(2010)
PJ Hicks et al.
The pediatrics milestones: conceptual framework, guiding principles, and approach to development
J Grad Med Educ
(2010)

There are more references available in the full text version of this article.

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*Dr Addrizzo-Harris and Dr Buckley for the American College of Chest Physicians; Dr Beck and Dr Rowley for the American Thoracic Society; Dr Pastores and Dr Spevetz for the Society of Critical Care Medicine; Dr Fessler and Dr Piquette for the Association of Pulmonary and Critical Care Medicine Program Directors.

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Special FeaturesEntrustable Professional Activities and Curricular Milestones for Fellowship Training in Pulmonary and Critical Care Medicine: Report of a Multisociety Working Group

Section snippets

Background

Methods

Results

Discussion

Acknowledgments

Charting the road to competence: developmental milestones for internal medicine residency training

J Grad Med Educ

Competency-based postgraduate training: can we bridge the gap between theory and clinical practice?

Acad Med

Developing entrustable professional activities as the basis for assessment of competence in an internal medicine residency: a feasibility study

J Gen Intern Med

The next GME accreditation system—rationale and benefits

N Engl J Med

The internal medicine reporting milestones and the next accreditation system

Ann Intern Med

Pediatrics milestone project: next steps toward meaningful outcomes assessment

J Grad Med Educ

The pediatrics milestones: conceptual framework, guiding principles, and approach to development

J Grad Med Educ

Special Features
Entrustable Professional Activities and Curricular Milestones for Fellowship Training in Pulmonary and Critical Care Medicine: Report of a Multisociety Working Group