Background: The advent of competency-based education has led to concerns regarding reductionism in the assessment of clinical competence. This apprehension stems from a frequently utilized, fractionated approach using the assessment of isolated competencies to build a full picture of clinical competence. In contrast, others argue that the EPA framework complements the construct of competencies, as EPAs take a global approach to assessment as each describes a unit of work that requires the integration of multiple competencies.
Objective: We sought to discern whether the assessment of separate competencies to build a picture of clinical competence is equivalent to the global assessment of EPAs, which require the integration of multiple competencies with special attention to the undercurrent of the construct of trustworthiness.
Methods: We designed a simulation-based workshop as part of our school’s Transitions to Residency Course. Each student was assessed using a competency-based framework designed using the individual EPA toolkits from the AAMC Core EPAs for Entering Residency pilot program, a modified supervision scale, and a global statement regarding entrustment and readiness for residency. These assessments were then compared to aggregate workplace-based assessment data on the various individual competencies as rated by trained assessors.
Outcomes: Assessment data obtained using the individual competencies from the EPA toolkits were highly correlated with the individual competencies assessed by qualified assessors in the workplace and subsequently mapped to their corresponding EPAs. However, these individual competency-based assessments did not correlate with EPA-based global supervision scale ratings, entrustment decisions, or perceived readiness for residency.