Gersten Jonker

164   Chapter 8 CONCLUSION The concept of EPAs attaches competencies to clinical practice in anesthesiology. It appears to be a promising approach to demonstrating that the graduating resident has obtained the abilities that the profession, regulatory bodies and society expect. The EPA approach centers on observation of performance of essential professional tasks in different contexts from which the attainment of competencies can be inferred. EPAs may be a good way to make progress in meeting learning objectives transparent. They may also make possible justified, formal and informed delegation of clinical tasks to trainees. The mark of quality of training is demonstrable expertise in performance. A program for research and development is necessary to elicit the effects of the use of EPAs in anesthesiology training. The goal is to link quality of training with the ultimate outcome of training: quality of patient care. TABLE 4: Development and research Development Research Determine consensus set of EPAs Compare local, national and international consensus sets of EPAs in anesthesiology Describe all EPAs Map to competencies and Milestones Does set of EPAs comprise everything to be assessed in residents? Create sets of assessment tools Test (sets of) assessment tools for validity, fairness, reliability Establish role of simulation in skill and performance assessment Define performance standards Define performance standards Identify markers of professional development Train raters in use of assessment tools Calibrate raters with examples of performance standards Evaluate effect of rater training and calibration Develop portfolio Use learning analytics to benchmark trainees and institutions Use learning analytics to monitor effects of working with EPAs (duration of training, satisfaction) Evaluate process and validity of entrustment decisions