University of Colorado
Aurora, CO

Program Director: Eva Grayck, MD
Type of Program: Pediatric Critical Care Medicine
Abstract Authors: Angela S. Czaja, MD; Eva N. Grayck, MD, and Todd C. Carpenter, MD

RATIONALE
Although graduate medical education has based its educational curriculum and evaluation tools on core competencies for many years, practical implementation and meaningful assessment remains a challenge. Clinician educators have struggled with evaluating learners based on a list of separate behaviors, rather than their ability to integrate these competencies into real-life professional tasks.

To overcome this barrier, ten Cate and Scheele recommended identifying key EPAs that individuals within a medical specialty would be expected to perform independently. A trainee can then be evaluated based on whether he or she can be trusted to perform a professional activity without supervision, a level only achieved once the essential competencies have been attained. This EPA-based framework has been perceived as more intuitive by both learner and teacher, and is being adopted by organizations responsible for ensuring competency of medical professionals including the American Board of Pediatrics (ABP).

The ABP is actively developing relevant EPAs for each pediatric subspecialty including PCCM. One proposed PCCM EPA is the “acute management of the critically ill patient, including those with underlying chronic disease”. Under this broad EPA, more specific activities will need to be defined by PCCM training programs. Anticipating this, we developed and piloted an educational module for a PCCM-relevant EPA which could then serve as a model for other EPAs.

EDUCATIONAL STRATEGY
The EPA selected for this pilot module was “Care of the Patient with Acute Respiratory Distress Syndrome (ARDS).” To achieve competence of this EPA, a fellow would require a solid understanding of physiology and pathophysiology, an ability to apply this knowledge to decision-making under varying circumstances and then integrate these skills into the overall care of patients with ARDS.

Thus, the goal for this module was to impart, in an engaging manner, essential knowledge for the delivery of high level clinical care for an important ICU problem. Our curriculum committee, composed of the program co-directors, core teaching faculty and senior fellows, developed the module. As real-life practice involves a multi-disciplinary team, we sought involvement of colleagues from respiratory therapy, pharmacy, nutrition and our advanced practice team. We outlined the essential topics in the care of a patient with ARDS throughout the ICU course. To maximize effectiveness based on adult learning theory, we integrated diverse teaching methods into the curriculum: didactic sessions with discussion, interactive teaching sessions including hands-on experience (e.g. ventilator), and journal clubs to critically appraise ARDS literature. The courses of three actual ARDS cases were “followed” throughout the module to highlight different clinical issues. Finally, to encourage self-directed learning and independent thinking, selected sessions were facilitated by fellows with faculty mentorship.

IMPLEMENTATION AND EVALUATION
Sessions in the module ran concurrently with the general PCCM curriculum over several months of 1-2 sessions per week. (Table 1) Faculty and fellows were given learning objectives with key scientific papers, and relevant details of each ARDS case with discussion questions were sent ahead of time for the fellows to review.

A formal evaluation of the curriculum is currently in process. However, subjective feedback suggests fellows found this approach to be more helpful in integrating many different pieces into an overall approach in the management of ARDS. Determining the module’s impact on supporting fellows in achieving competency in this EPA will take several years. We will follow in-service testing scores while developing and implementing other tools to test trainee knowledge and track actual care delivered and patient outcomes of ARDS cases in our ICU.