Full details of the hematopathology fellowship EPAs are published and available Open Access.1
Entrustable professional activities (EPAs)2-4 are “units of professional practice, defined as tasks or responsibilities to be entrusted to the unsupervised execution by a trainee once he or she has attained sufficient specific competence.” 2 Hematopathology EPAs are the responsibilities or tasks that a practicing hematopathologist must be able to perform to provide appropriate patient care.
Each hematopathology fellowship EPA consists of:
1. EPAs can help me identify a struggling trainee
2. EPAs can help me provide a work plan/remediation for a struggling trainee
3. EPAs can help improve my curriculum
4. EPAs can help guide entrustment decisions
5. EPAs can help guide graduated responsibility
6. EPAs can help the Clinical Competency Committee in determining trainee competency
7. EPAs can focus evaluations on a skill and not a person
8. EPAs can facilitate objective feedback on performance
9. EPAs can encourage active participation by the trainee in their own learning
10. EPAs can standardize feedback from faculty and provide prompts to faculty
Implementation of hematopathology EPAs can be customized to the needs of your hematopathology program. The following are ideas on how to use these proposed hematopathology EPAs in your fellowship program:
Be the first to use the hematopathology EPAs in your program!
Model formative and summative assessment forms have been developed for the following EPAs:
For edit access to these google forms, contact Dita Gratzinger firstname.lastname@example.org
EPA 1: Guide selection of diagnostic tests and triage and allocate specimens for ancillary studies.
EPA 3: Complete workup and diagnostic reporting of a simple hematolymphoid diagnosis.
EPA 4: Complete workup and diagnostic reporting of a complex or rare hematolymphoid diagnosis.
Formative assessments are intended to provide snapshots of where fellows are in their ability to perform discrete professional activities of hematopathology, and to provide a structure for concrete and actionable feedback in the moment. Some programs may wish to use these at the end of a week on a particular service.
Summative assessments are a broader overview of progress towards independence in these professional activities, based on multiple formative assessments over time; these may be reviewed monthly or quarterly, and used to make entrustment decisions and to help the clinical competency committee make milestone level assignments.
Examples of each are linked in FAQ 6
EPAs are discrete responsibilities or tasks that typically require multiple competencies and are comprised of many individual skills. The ACGME assessment model is a tool to assess attainment of competency in specific areas of professional development. As trainees progress towards consistent completion of an EPA, this can be used to mark their progress in gaining associated competencies.
Entrustment decisions are made each time a fellow is allowed to assume a greater degree of independence and responsibility in carrying out their duties.
Making an entrustment decision regarding an EPA implies that the supervisor will incorporate “information from observations and inferences to refer a forward-looking judgment about future performance of an activity”.7 Trust places a crucial role in clinical supervision and depends on attributes of the supervisor, attributes of the trainee, the relationship between supervisor and trainee, the workplace context, and the task being evaluated.
EPAs can provide objective evidence to aid in decision-making around entrustment decisions. One model is to use data collected via EPA-based formative and summative assessment forms to support such decision-making.
For EPAs 1 and 3, 4 we provide model summative assessment forms suggested metrics to support entrustment decision-making, see FAQ 6
The ad hoc committee for the hematopathology EPA development was formed following discussions during the 2019 Society for Hematopathology Program Directors’ meeting. The hematopathology EPAs were developed based on review of pertinent guidelines and literature and multiple rounds of expert and stakeholder input utilizing a modified Delphi approach.
The committee included: members of the Education Committee of the Society for Hematopathology, a hematopathologist with an interest and expertise in medical education, hematopathology fellowship ad hoc committee representative from the Association of Pathology Chairs, members of the ACGME working group on the Hematopathology Milestones 2.0 revision, a member of the CAP and APC working group to test EPAs in the pathology residency setting. Input was additionally sought from hematopathology fellowship program directors as well as other stakeholders through anonymous surveys.
A list of 19 EPAs for pathology residents was published in 2017 by McCloskey et al.5 and examples of possible pathology EPAs were published in 2017 by D. Powell and A. Wallschlaeger.6 While there is some overlap in the content of EPAs for pathology residents and the EPAs for hematopathology fellows, the skills and knowledge required for a Hematopathology fellow are more specific to the subspecialty and commensurate with the advanced level of training.
Implementation among hematopathology fellowship programs will likely differ according to specific program needs and assessment philosophies. A pilot study lead by members of the development committee is in progress to formally evaluate 3 of the hematopathology EPA formative and summative assessment tools.
No. The hematopathology EPAs are not mandated. However, we hope that you find them to be helpful in your hematopathology fellowship program!
Implementation of EPA-based formative and summative assessments will differ according to specific program needs and assessment philosophies as well as the experience level of the trainee and supervisor, the frequency and consistency of contact between supervisor and trainee, and the specific EPA under consideration.
We suggest evaluating a curated subset of EPAs (maximum of 2 or 3) during each rotation. Regular formative assessments – for example, weekly – may help maintain fellow progress with concrete targeted feedback. Periodic summative assessments – monthly or quarterly, depending on the EPA – may aid in entrustment or clinical competency evaluations.
Hematopathology EPAs are not a comprehensive overview of all hematopathology professional activities. Professional activities that are not discrete and observable or that are not subject to graduated responsibility during fellowship are not a good fit for the EPA model. Overarching professional activities, such as teaching and mentorship skills, should continue to be assessed via existing feedback mechanisms. Some laboratory management competencies are covered by pathology residency EPAs,5,6 and these may be modified for the fellowship level if deemed useful by individual fellowship programs.
Competency in performing bone marrow biopsies is an ACGME requirement for completion of hematopathology fellowship. Therefore, while not all practicing hematopathologists perform bone marrow biopsies as part of their practice, for the purposes of hematopathology fellowship it is a core entrustable professional activity.
1. K White, J Qualtieri, EL Courville, RC Beck, B Alobeid, DR Czuchlewski, J Teruya-Feldstein, LA Soma, S Prakash, D Gratzinger. Entrustable Professional Activities in Hematopathology Pathology Fellowship Training: Consensus Design and Proposal.
Academic Pathology. January 2021. doi:10.1177/2374289521990823
2. Cate OT. Entrustability of professional activities and competency-based training. Med Educ. 2005;39(12):1176-1177. doi:10.1111/j.1365-2929.2005.02341.x
3. Cate OT. A primer on entrustable professional activities. Korean J Med Educ. 2018;30(1):1-10. doi:10.3946/kjme.2018.76
4. Shorey S, Lau TC, Lau ST, Ang E. Entrustable professional activities in health care education: a scoping review. Med Educ. 2019;53(8):766-777. doi:10.1111/medu.13879
5. McCloskey CB, Domen RE, Conran RM, et al. Entrustable Professional Activities for Pathology: Recommendations From the College of American Pathologists Graduate Medical Education Committee. Acad Pathol. 2017;4:2374289517714283. doi:10.1177/2374289517714283
6. Powell DE, Wallschlaeger A. Making sense of the milestones: entrustable professional activities for pathology. Hum Pathol. 2017;62:8-12. doi:10.1016/j.humpath.2016.12.027
7. Hauer, K.E., ten Cate, O., Boscardin, C. et al. Understanding trust as an essential element of trainee supervision and learning in the workplace. Adv in Health Sci Educ 19, 435–456 (2014). https://doi.org/10.1007/s10459-013-9474-4