Implementing Core Entrustable Professional Activities in Emergency Medicine Clerkships: A Psychometric Study of Student Growth.

Background: The purpose of the present study was to conduct a psychometric analysis of student growth of Entrustable Professional Activities (EPAs) in an Emergency Medicine (EM) clerkship. Methods: A total of 481 third or fourth-year medical students at the University of Minnesota Medical School participated. Students were enrolled in a required 4-week EM clerkship during 3 academic years across 13 Core EPAs. Regression analyses were employed to examine if the growth curve of each of the EPAs follows a curvilinear structure as hypothesized in learning theory. Reliability or dependability of the EPA assessments was assessed using two-facet generalizability analysis defined as Ep2 coefficients indicating the reliability of the scores. Results: There were 7707 EPA-based assessments (mean = 16 [SD = 5.0] assessments per student), provided by 793 assessors; 494 (62.3%) residents and 299 (37.7%) faculty members. The growth curves for most EPAs ratings followed the predicted negative exponential curve (EPAs 1, 2, 3, 5, 6, 8, 10, 12) but not for others (4, 7, 9, 11, 13). The slope of the growth curves showed variation by EPA. Adequate reliability of ratings was achieved with six raters assessing on six assessment occasions (Ep2 coefficient ≥ 0.70). Conclusions: Analyses of more than 7700 assessments of students in an emergency medicine rotation are consistent with long-standing negative exponential learning theory. Adequate reliability was achieved with an acceptable Ep2 coefficient with six assessors. Results indicate the EPA framework is a practical approach to assessing real-world competency within the emergency medicine clerkship. Moreover, student growth on these EPAs provides important information for clerkship design, instruction, and assessment.