Gersten Jonker

162   Chapter 8 TABLE 3: Expected level of supervision by training stage Expected level of supervision Training year 1 Training year 2 Training year 3 Training year 4 Post-training sub- specialization Professional activities EPA1 III IV V V V EPA2 III IV IV IV V EPA3 II III IV V V EPA4 II III IV V V EPA5 I II III III V FUTURE STEPS IN ANESTHESIOLOGY TRAINING: AN AGENDA FOR DEVELOPMENT AND RESEARCH Training programs based on EPAs are being explored and developed, across the world and across specialties, such as in psychiatry in New Zealand and Australia [21, 29], internal medicine [30], family medicine [31], and pediatrics in the USA, orthopedic surgery in Canada, obstetrics and gynecology [32], and physician assistant training [33] in the Netherlands. Anesthesiology training programs throughout the world are organized in an outcome and competency-based way [34–36] but, to our knowledge, to date, none have been based on EPAs. To build a training program with EPAs, consensus should be sought locally, nationally or even internationally on which essential clinical tasks define the specialty [12, 21, 26, 30]. For each EPA, the task content and context should be set out. Each EPA should be mapped to the relevant competencies in a competencies-activities matrix (Table 1) [12]. These competencies must be set out in an observable behavior format to make them implicitly assessable by observing the EPA. How to best assess complex tasks robustly and accurately remains the central question [23]. Currently, there is no single tool for assessing performance of EPAs; what is needed is the development of assessment systems that incorporate both quantitative and qualitative tools [1, 37, 38]. Different EPAs may use different sets of tools, such as high and low fidelity simulation, Objective Structured Assessment of Technical Skills (OSATS), Direct Observation of Procedural Skills (DOPS), Mini Clinical Evaluation Exercise (Mini- CEX) [38–40] and Multisource feedback procedures. These or other instruments should cover the competencies that have been identified as crucial for the particular EPA being assessed. The role of different tools within an EPA assessment system needs to be established and tested in practice for validity, reliability, generalizability and educational