Entrustable Professional Activities as a Framework for Assessment in Pharmacy Experiential Education

Entrustable professional activities (EPAs) and their corresponding entrustment-supervision (ES) scales are an innovative education assessment model to provide authentic competency assessment. While EPAs are emerging in pharmacy education being recently developed by the American Association of Colleges of Pharmacy (AACP), more information is needed to better understand best practices in implementation of this model and what the growth of pharmacy learners are across their longitudinal experiential curriculum. The purpose of the research program was to 1.) determine the growth of the pharmacy students across their experiential curriculum; 2.) evaluate the pharmacy student-perceived growth across their experiential curriculum; 3.) determine differences in growth from the faculty and student perspectives; and 4.) describe facilitators and barriers to assessing students utilizing entrustment-supervision scales within an EPA framework through a mixed methods study design. First, EPA-based assessments from the perspective of the preceptor and learner via ES scales at each rotation’s terminus were evaluated across the experiential curriculum at UIC College of Pharmacy. The cohort included 12,426 assessments from 510 preceptors and 10,098 assessments from 509 UIC pharmacy students. Conditional growth curve modeling showed appropriate growth of pharmacy learners across core clinical introductory and advanced pharmacy practice experiences (IPPE and APPE, respectively) as assessed by both preceptors and students. From a preceptor assessment perspective, lower levels of entrustment were noted across EPAs 1-6 for students on inpatient rotations (p<0.05) and at academic medical centers (p<0.05). A linear relationship is noted between preceptor and student assessments across the experiential curriculum, with equivalent assessments between preceptors and students nearly half the time (48%). When preceptors and student assessments differed, students assessed themselves higher at higher levels of supervision (less entrustment) on the scale (p<0.05) and faculty assessed the students higher at lower levels of supervision (higher entrustment). Secondarily, faculty perspectives on ES scale utilization in pharmacy experiential curricula were evaluated. Eleven APPE preceptors with practice in direct patient care areas from across the US participated in two focus sessions. For best practices, preceptors expressed that ongoing preceptor development was important, particularly identifying case vignettes that demonstrate specific learner performances that warrant each ES level. Other best practices included robust student orientation to the assessment and expectations, clear delineation of minimum competency level, frequent discussions with preceptors, and utilization of institutional resources such as the experiential education department. Preceptors identified five main themes related to barriers for EPA-based assessment implementation into pharmacy experiential education, including entrustability, subjectivity, grading schemes, integration, and assessments. Preceptors identified four main themes of facilitators to support EPA-based assessment implementation, including clear definitions, grading schemes, education, and assessments. Paired with ES scales, EPAs can be used as a longitudinal experiential assessment framework in pharmacy education to delineate the demonstration and growth of competency of a learner. The data presented in this dissertation is a beacon and roadmap for other pharmacy experiential departments for feasible, longitudinal integration of EPAs. But also, a call for organizational support for standard setting and research on additional mechanisms, such as technology.