Growing trust: Entrustable professional activities within competency-based veterinary education

Abstract

The main goal of this thesis was to bridge the gap between veterinary education and veterinary practice, by extending competency-based education (CBE) with the use of entrustable professional activities (EPAs) and entrustment decisions. EPAs are professional tasks that can be entrusted to a learner within a classified level of supervision, once she or he has demonstrated the necessary competence to do so. By making the level of independent clinical responsibility more visible for faculty, learners, young veterinarians, and clinical practice EPAs are a valuable addition within the veterinary profession. The chapters of this thesis will attempt to determine whether the concept of entrustable professional activities (EPAs) can be applied to veterinary education, to identify activities that can be entrusted to veterinary learners, and to ascertain what supports entrustment decision making. A first step in building an EPA-based veterinary curriculum is to identify the core EPAs of the profession. EPAs should be as specific and objective as possible to reduce the effect of interpretation discrepancy. It is necessary to develop EPAs for every clinical track (companion animal, equine health and farm animal health) specifically, because EPAs should be as specific and objective as possible. When implementing EPAs, the concept of workplace-based education and assessment needs attention. There is a need for better understanding of the process of giving, receiving, interpreting, and using feedback as a basis for progress toward entrustment decisions. Providing and seeking performance-relevant information is often difficult for both supervisors and learners. To ensure entrustment decisions are based on competencies and not perceptions of experience or exposure, supervisors and learners need to be trained in giving and receiving feedback. Accurate and up-to-date information about the readiness of independent practice turned out to be of crucial importance to the recent graduate and her employer in order to facilitate the transition and to optimize the curriculum. As illustrated by the relatively high burnout percentages of young veterinarians, the transition from learner to professional can be an intense and stressful phase. Veterinary EPAs can illustrate what employers could expect from graduates by providing a tool to directly identify entrustability. Using the EPA framework can serve to guide between theory and practice along the continuum from learner to professional.