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Diagnostic Radiology EPAs (SAB Approved)-2

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Infographics For EPA Implementation in SH Rad Residency

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Infographics For EPA Implementation in SH Rad Residency

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Units of Professional Practice (Tasks) that may be entrusted to a learner to execute unsupervised, once he or she has demonstrated required competency.

EPAs: Essential units of professional practice (eg. counselling patient, insertion of central line, resuscitation)
Competencies: Knowledge, skills, attitudes, values (eg. communication skills, medical knowledge)

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An Updated Primer on Entrustable Professional Activities (EPAs)

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An Updated Primer on Entrustable Professional Activities (EPAs)

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1st MOH recommended primer on EPAs, good to give general overview to residents and physician faculty.

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1. Always be attentive to each other’s concerns and doubts

2. Trust each other’s intentions

3. Keep an open mind, emphatic to other views

4. Be non-judgemental, always something to learn

5. Make the process fun and get to know each other better, keep a positive spirit

6. Keep the hierarchy flat as much as possible, be inclusive

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GME Office

DIO: Prof Tan Hak Koon

RAC Committee
Chair: A/Prof Andrew Tan, other radiology PDs in NHG and NUHS

RADSC ACP
Chair: A/Prof Andrew Tan; Education Vice-Chair: Dr Yu Wai Yung; HODs of all departments
College of Radiologists Singapore
Chair: A/Prof Andrew Tan

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Basic Concepts to Outcome and Competency Based Education.

We use the 6 ACGME Core Competencies:

1. Patient Care (PC)

2. Medical Knowledge (MK)

3. System Based Practice (SBP)

4. Practice Based Learning & Improvement (PBLI)

5. Professionalism (Prof)

6. Interpersonal Skills & Communications (ICS)

CMBE = “an outcomes-based approach to the design, implementation, assessment and evaluation of a medical education program using an organizing framework of competencies”.

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Competency based medical education theory to practice

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Learning Strategy

Wendy Cheong, Joel Liu, Elizabeth Cheong, May Lim, Gary Gu, Ngoo Yongmin

Learning Environment

Sivashanker Subramaniam, Huang Hian Liang, Thida Win, Kelvin Koh, Wong Hui Lin, Jocelyn Sim

Academic Growth

Tan Min-On, Tang Phua Hwee, Jasmine Chua, Tan Tien Jin, Amanda Liew, Tan Jee Cheng, Sherrie Leong

Faculty Development

Ranu Taneja, Ganti Srujana, Shaun Previn, Charlene Ng

Resident's Exco Committee

CR: Audrey Chia, Martin Wong

Subspecialty CF / SR Teams

ABD - WHL/RTA, BRE - LLF, CTR - TMN, MSK - CLR/SSU, NRL - SPA/KKK, NUC - HHL, PAE - THW, URS - CHL/KSX, VIR - CME, GEN - KSX

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“In a traditional educational system, the unit of progression is time and it is teacher-centered. In a CBET system, the unit of progression is mastery of specific knowledge and skills and is learner-centered.”

Core Components:

1. Outcome Competencies: Competencies required for practice are clearly articulated.

2. Sequenced Progressively: Competencies are arranged progressively.

3. Tailored Learning Experiences: Learning experiences facilitate the progressive development of competencies.

4. Competency Focused Instructions: Teaching practices promote the progressive development of competencies.

5. Programmatic Assessment: Assessment practices support and document the progressive development ofcompetencies.

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Competency based medical education in postgraduate medical education

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Milestones are simply a significant point in development. They can enable the learner and the program determine individual trajectories of professional development in narrative terms

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Radiology Milestones 2.0 Supplementary Guide

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Radiology Milestones 2.0 Supplementary Guide

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Elaboration of Radiology Milestones

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Tentative Posting Roadmap with EPA Schedule

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Tentative Posting Roadmap with EPA Schedule

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Singhealth Radiology Rotation Plan 2023 EPA V2

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A. Work Place Learning (Clinical Rotations)

Y1: Foundational Rotations

Y2-3: Intermediate Skills & Early Subspecialty Exposure

Y4-5: Advanced Skills & Deep Subspecialty Exposure

Year 1 -4: 7 x ABD, 4 x NRL, 6 x MSK, 4 x MAM, 3 x PAE, 3 x GEN, 5 x THO, 2 x ENT, 4 x VIR, 4 x ULS, 3 x NUC, 3 x ELE
Year 5: 4 x 3 monthly Subspecialty Rotations including 1 cross cluster

B. Structured Learning

National Didactic Lectures under CRS - R1-4 depending of schedule

Department Learning Events (DLE) - 16 sessions per week as declared by departments

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R1 Orientation Slides on Structure of Program Curriculum

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R1 Orientation Slides on Structure of Program Curriculum

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Each department to designate 16 hours of Department Learning Activities (DLE) per month. Minimum 70% attendance. Residents are free to attend DLEs from any Singhealth site to hit attendance requirement. 1 national didactic session may also count as 1 DLE session.

E-modules hosted on google classroom (code: vyghj73), will NOT count to PTT wet Jul 2023 onwards.

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New KPI for Residents Funding AY22 (Circulated guidelines)v3

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Summative Assessments

FRCR Exams

SOEE (expiring)

DXIT(unknown status after APMES)

Formative Assessments

End of Rotation Assessment (E1)

360 Evaluation (E4)

Entrustable Professional Activities (EPAs)

Portfolio / Logbooks

All assessment data to be captured via Medhub and reviewed at 3 monthly CCC meetings. Feedback provided to residents at semi-annual reviews by PD and mid posting reviews by CF.

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Data will feed directly to milestone collection.

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Likert Scale for ease of understanding. 3 monthly to radiographers / nurses / peers.

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Capped at 30% outstanding / exceed expectations per cohort

Paper exercise using collected data via E1 forms

2 Stage scoring system

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All Core Faculty members aim to hit 3 x scholarly activities each year as part of role modelling.

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Programme dashboard (FSA for ACGME-I programmes)

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Videos: https://www.youtube.com/playlist?list=PL3EqS2fXwIhf5qIrCILxkgdBBlVzQl518

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Twelve tips to maximize the value of a clinical competency committee in postgraduate medical education

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5 levels of entrustment:

1. Observation

2. Direct Supervision

3. Indirect Supervision

4. Oversight / Distant Supervision

5. Supervise Others

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Ingredients of Rich Entrustment Decision

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Ingredients of Rich Entrustment Decision

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Entrustment decisions stem from judgments of a trainee’s competence and include the permission to act with a higher level of responsibility or autonomy and a lower level of supervision.

Making entrustment decisions differs from regular assessment of trainees, which usually has no consequences beyond marking trainee progress.

5 factors for consideration in entrustment decision making:

1. Capability (specific knowledge, skills, experience, situational awareness)

2. Integrity (truthful, benevolent, patient-centered)

3. Reliability (conscientious, predictable, accountable, responsible)

4. Humility (recognizes limits, asks for help, receptive to feedback)

5. Agency (proactive toward work, team, safety, personal development)

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Tips for supervising clinicians:

1. Talking to learners about trust

2. Using EPA descriptions to guide learning and teaching

3. Providing learners with greater ad hoc responsibilities

4. Using EPAs to identify/create opportunities for assessment and feedback

5. Including case-based discussions

6. Acknowledging gut feelings about learner readiness for more autonomy

Tips for curriculum leaders:

1. Enabling the trust development

2. Applying trust decisions at all levels of the supervision scale

3. Employing all available information sources for entrustment

4. Empowering learner ownership of the assessment process

5. Using technology for learner tracking

6. Use aggregate data as metric for program evaluation

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Twelve tips for the implementation of EPAs for assessment and entrustment decisions

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Performance prediction

Shared local mental model

Workplace assessment

High-stakes entrustment decisions

Outcomes based

Value of the collective

Informed clinical competency committee members

Construct alignment

Qualitative data

Entrustment decision consequences

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A. R2C2 Resident Feedback Model Trifold Handout

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Applying Science of Learning to Health Professions Education

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Applying Science of Learning to Health Professions Education

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12 tips for applying the science of learning to health professions education_2017_medical teacher

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Resident / Faculty Wellbeing

ACGME-I Well-being Survey

Resident Performance

Promotion / Progression

Scholarly Activities

QI Participation

Faculty Performance

Faculty Scholarly Activities

Faculty Development Participation

Faculty Evaluation by residents (E5)

Graduate Performance

Graduate Survey (Graduates) & (HOD)

Programme Quality

Annual Programme Evaluation by Faculty (E6A) and Residents (E6B)

Rotation Evaluation (E7)

ACGME-I Citations

Annual Programme Evaluation & Improvement (APEI)
Singhealth Internal Review

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Current TOR
1. Reviewing the Diagnostic Radiology Residency Program quality by monitoring and tracking quality indicators for

a) Resident Performance
Using faculty evaluations of residents, 360 degree evaluations, residents’ scholarly activity, residents’ attendance at various didactic teaching sessions, duty hours monitoring, in training exam results, professional exam (FRCR, MMed) results.

b) Faculty Performance
Using resident evaluations of faculty, faculty scholarly activity, teaching activities, faculty attendance of faculty development courses/conferences.

c) Graduate Performance
Using graduate survey results.

d) Program Quality
Using evaluations of the residency program by the faculty and residents, evaluation of subspecialty rotations by residents, resident survey on national didactic lectures, resident survey on Monday evening didactic teaching, results of internal reviews, GMEC/RAC/ACGME-I communications, and ACGME-I resident survey results if any.

2. Addressing and ensuring that areas of non-compliance with ACGME-I requirements are corrected.

3. Conducting an annual review of program curriculum and overall educational goals of the program.

4. Preparing an annual summative evaluation of the quality of the residency program, and making specific recommendations/action plans as necessary for its improvement.

The committee meets annually.

Proposed New TOR

Contribute to continuous quality control and improvement of residency program by:

Review all available qualitative and qualitative data pertaining to resident performance, faculty performance, graduate performance and external audit (ACGME/GME)

Assess whether the program is meeting educational goals, aligned with mission and vision

Evaluate and advise on the process of program evaluation

Prepare annual evaluation report (program to provide semi-annual progress report to PEC)

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Chair: Education Vice Chair RADSC ACP
Vice-Chair: Tan Tien Jin
Members: All CFs in quality subcommittee, PD/APDs, 5 residents from residency exco, 3 HOD nominated physician faculty

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4 Faculty Meetings Per Year

Mar - Core Faculty Mini-CCC Meeting (Physical / All CF)

Jun - Combined Faculty CCC Meeting (Virtual / All CF + optional site reps)

Sep - Core Faculty Mini-CCC Meeting (Physical / All CF)

Dec - Combined Faculty CCC Meeting (Virtual / All CF + optional site reps)

2 CF-Site Rep Meetings Per Year

Before Combined Faculty CCC Meeting (Jun & Dec)

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2025 Dates: 25 Mar 2025 and 30 Sep 2025

Time: 2pm-6pm

Venue: Outram Campus Academia

Agenda for Meeting:

1. Subcommittee Updates

2. Workplan Management

3. Strategic Planning

4. Short CCC Review

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2025 Dates: 27 May 2025 and 2 Dec 2025

Time: 2pm-6pm

Venue: Zoom

Agenda for Meeting:

CCC milestones review

Program updates and feedback

Short followup on important workplaces

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Date/Time: To be planned by CF, at least 1 week before Combined Faculty CCC Meetings (twice yearly)

Agenda:

Performance of residents in subspecialty rotations for last 6 months

Review of rotation feedback

Update curriculum and SRLE

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Local program accreditation model replacing ACGME-I in 2023.

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APMES Engagement Slides (ACGME-I programmes)

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Recommended Description / Components of an EPA

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Recommended Description / Components of an EPA

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1. Title

2. Specification and limitations

3. Risks in case of failure

4. Most relevant competency domains; knowledge

5. Skills, attitudes and experiences

6. Information sources to assess progress and support summative entrustment;

7. Entrustment/supervision level expected at which stage of training

8. Time period to expiration if not practiced

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V: We nurture doctors into leaders in medical imaging, always bettering clinical care.

M: A people-first approach to higher medical education, emphasising on:

Accountable competency-based training curriculum though collaborations

Enabling innovations though a conducive learning culture and working environment

Professionalism though role modelling and reflective learning

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Programmes are required to submit to GME the faculty FTE declaration and supporting documents (i.e. dept rosters) every 6 months.

Prior to submission, we will need to review the dept rosters to ensure that it tallies with the PET and SET hours stated in the declaration file.

All faculty’s FTE declaration will also need to be endorsed by the HODs.

List of PET: Continuity clinics, simulator training, case-based teaching, residency journal club, core lectures, tutorials, workshops, operative simulation, faculty supervising resident performing operation in OT, administrative work related to residency training.

List of SET: Ward rounds, exit rounds, consults, specialty clinics, teaching resident while faculty performs surgery in OT.