Development of Entrustable Professional Activities in Adult Nephrology Fellowship Training

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Background: Entrustable Professional Activities (EPAs) are units of observable work that a competent healthcare professional does in everyday practice. EPAs explicitly build on the principles of competency-based training and assessment and serve as means to translate competencies into clinical practice. To our knowledge there are no established EPAs for US nephrology training programs. We aim to develop a list of EPAs that represent the scope of nephrology practice. Methods: An initial list of EPAs was developed and refined by the research group using a modified Delphi method. The panel (study participants) included 9 nephrologists (8 faculty, 1 fellow). Responses were given on a 5-point Likert scale and agreement was reached if (A) and (B) were met: (A) mean ≥4 with a SD<1; (B) >75% of respondents rated the item ≥4. After agreement EPAs that scored poorly were excluded from the next Delphi round. The panel provided additional comments and feedback on which EPAs to prioritize and how to proceed with implementation. Results: Our research group (4 attendings, 1 researcher, 2 fellows) met 3 times and developed an initial list of 25 EPAs covering 10 fields in everyday nephrology practice. After 3 Delphi rounds and revisions, 22 remaining items were established as final EPAs. These EPAs will be linked to target competencies and will serve as a list of training goals to be reached by renal fellows during the implementation and evaluation phase of the study. All panel members had prior experience with clinical work and renal fellowship training (Table). Most members believed that renal fellows should have increased exposure to chronic kidney disease and dialysis clinics, should use lay medical terminology, and should treat patients holistically. Conclusion: Graduating renal fellows must be prepared to meet specific standards, including cultural competence, safety, leadership, and professional development. The EPAs represent the scope of nephrology practice and will facilitate future educational research and curriculum development. Participants’ Characteristics (n=9) - Age (mean ±SD) 47.2 (±8.7) Females (%) 44.4 Attendings (%) 88.9 Years of clinical experience (academic and/or private) (mean ±SD) 13.7 (±9.97) Fellows (%) 11.1

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