Gersten Jonker

184   Chapter 9 EPAS IN POSTGRADUATE ANESTHESIOLOGY TRAINING This thesis includes thefirst paper that directly links EPAs to the context of anesthesiology (Chapter 8). It charted an agenda for curriculum development and research, identifying research opportunities like obtaining consensus on sets of EPAs, comparing (inter-) national programs, validating assessment tools, establishing the role of simulation assessment, identification of markers of professional development, application of performance standards, the use of learning analytics in monitoring effects of EPAs on training, and the process of entrustment decisions. A set of EPAs should cover the breadth of the specialty and determine the outcomes required of a postgraduate trainee graduating as a medical specialist [11, 12, 52, 82]. Therefore, reaching a consensus on a set of EPAs that covers the anesthetic specialty was high on the agenda. In anesthesiology, an EPA-based program was first mentioned in two Canadian papers [66, 83] and Wisman and colleagues were the first to publish a set of EPAs based on a consensus at a national level [50]. In a modified Delphi study Dutch program directors arrived at a consensus on 45 EPAs. From this set, the EPAs of the national training program were derived, which are in use since 2019. In one canton of Switzerland, junior trainees, senior trainees, and supervising anesthesiologists agreed on 7 EPAs to be entrusted in the first year of postgraduate training [84]. The seven EPAs are attainable because of their reasonably small scope pertaining to the steps in perioperative care of relatively healthy patients for low-risk surgery [84, 85]. The Dutch program, in accord with the Delphi consensus set [50], chose to nest the seven tasks within one larger EPA. A single center Delphi process in Germany resulted in a consensus set of 39 EPAs to cover the local anesthesiology curriculum [86]. The set agreed strongly with the Dutch set, but included fewer EPAs for pain and intensive care medicine. Of interest, risks of surgical procedures, risks due to patient co-morbidity, and age-related risks in children featured in both sets to differentiate levels of complexity in similar activities, requiring distinct entrustment decisions. This led, however, to higher granularity of the German EPA set with for example several EPAs around abdominal procedures, which can be considered observable index cases within a single EPA of the Dutch set. Index cases are archetypical for an EPA, represent layers of complexity within an EPA, and may be of key importance in entrustment of the EPA. Amajor difference was the inclusion of subspecialty EPAs, e.g.“providing anesthetic care for patients undergoing heart transplantation”, in the German set [86], which were voted