A Modified Delphi Consensus Approach to Define Entrustable Professional Activities for Neurocritical Care Advanced Practice Providers

Authors

Daniel S. Harrison, Department of Neurology, Brigham and Women's Hospital, Boston, MA.
Erika J. Sigman, Departments of Neurology and Neurosurgery, Emory University SOM, Atlanta, GA.
Judy H. Ch'ang, Department of Neurology, Weill Cornell Medicine, New York. NY.
Aarti Sarwal, Department of Neurology, Atrium Wake Forest School of Medicine, Winston-Salem. NC.
Abigale Celotto, Department of Neurology, University of Maryland Medical System, Baltimore, MD.
Alexandra Malone, Department of Anesthesiology, University of Kentucky, Lexington, KY.
Ariel Nowicki, Department of Neurology, Brigham and Women's Hospital, Boston, MA.
Ashley Martin, Department of Neurology, Emory University Hospital, Atlanta, GA.
Bryan Boling, Department of Anesthesiology, University of Kentucky, Lexington, KY.
Christa O'Hana Nobleza, Department of Neurology, University of Tennessee Health Science Center, Memphis, TN.
Christopher Reeves, Department of Nursing, Boston Children's Hospital, Boston, MA.
David M. Greer, Department of Neurology, Boston Medical Center, Boston, MA.
Diane McLaughlin, Department of Neurosurgery, Lyerly Neurosurgery, Jacksonville, FL.
Elizabeth O'B Woods, Department of Neurology, Massachusetts General Hospital, Boston, MA.
Emmaculate Fields, Department of Neurology, University of Oklahoma Health, Oklahoma City, OK.
Erica Perets, Department of Neurology, Grady Memorial Hospital, Atlanta, GA.
Gemi E. Jannotta, Department of Neurology, Harborview Medical Center, Seattle, WA.
Jennifer Mears, Department of Neurology, Weill Cornell Medicine, New York. NY.
Kaitlyn Twomey, Department of Neurology, Weill Cornell Medicine, New York. NY.
Kelly A. Rath, Department of Neurology & Rehabilitation Medicine, University of Cincinnati COM, Cincinnati, OH.
Kelly Peronti, Department of Neurology, Grady Memorial Hospital, Atlanta, GA.
Krista M. Garner, Department of Neurology, Emory University Hospital, Atlanta, GA.
Matthew B. Bevers, Department of Neurology, Brigham and Women's Hospital, Boston, MA.
Nicholas A. Morris, Department of Neurology, University of Maryland SOM, Baltimore, MD.
Paola Martinez, Department of Neurosurgery, University of Texas Health San Antonio, San Antonio, TX.
Sahar Zafar, Department of Neurology, Harvard Medical School, Boston, MA.
Sarah Livesay, Department of Neurology, Harborview Medical Center, Seattle, WA.
Sarah Wahlster, Department of Neurology, Harborview Medical Center, Seattle, WA.
Thomas Lawson, Department of Neurology, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH.
Catherine S. Albin, Departments of Neurology and Neurosurgery, Emory University SOM, Atlanta, GA.

Document Type

Article

Abstract

OBJECTIVES: To define consensus entrustable professional activities (EPAs) for neurocritical care (NCC) advanced practice providers (APPs), establish validity evidence for the EPAs, and evaluate factors that inform entrustment expectations of NCC APP supervisors. DESIGN: A three-round modified Delphi consensus process followed by application of the EQual rubric and assessment of generalizability by clinicians not affiliated with academic medical centers. SETTING: Electronic surveys. SUBJECTS: NCC APPs ( n = 18) and physicians ( n = 12) in the United States with experience in education scholarship or APP program leadership. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The steering committee generated an initial list of 61 possible EPAs. The panel proposed 30 additional EPAs. A total of 47 unique nested EPAs were retained by consensus opinion. The steering committee defined six core EPAs addressing medical knowledge, procedural competencies, and communication proficiency which encompassed the nested EPAs. All core EPAs were retained and subsequently met the previously described cut score for quality and structure using the EQual rubric. Most clinicians who were not affiliated with academic medical centers rated each of the six core EPAs as very important or mandatory. Entrustment expectations did not vary by prespecified groups. CONCLUSIONS: Expert consensus was used to create EPAs for NCC APPs that reached a predefined quality standard and were important to most clinicians in different practice settings. We did not identify variables that significantly predicted entrustment expectations. These EPAs may aid in curricular design for an EPA-based assessment of new NCC APPs and may inform the development of EPAs for APPs in other critical care subspecialties.

Medical Subject Headings

Humans; Delphi Technique; Critical Care (standards); Clinical Competence; Consensus; United States; Physician Assistants (education)

Publication Date

7-1-2024

Publication Title

Critical care medicine

E-ISSN

1530-0293

Volume

52

Issue

7

First Page

1032

Last Page

1042

PubMed ID

38488423

Digital Object Identifier (DOI)

10.1097/CCM.0000000000006260

Recommended Citation

Harrison, Daniel S.; Sigman, Erika J.; Ch'ang, Judy H.; Sarwal, Aarti; Celotto, Abigale; Malone, Alexandra; Nowicki, Ariel; Martin, Ashley; Boling, Bryan; Nobleza, Christa O'Hana; Reeves, Christopher; Greer, David M.; McLaughlin, Diane; Woods, Elizabeth O'B; Fields, Emmaculate; Perets, Erica; Jannotta, Gemi E.; Mears, Jennifer; Twomey, Kaitlyn; Rath, Kelly A.; Peronti, Kelly; Garner, Krista M.; Bevers, Matthew B.; Morris, Nicholas A.; Martinez, Paola; Zafar, Sahar; Livesay, Sarah; Wahlster, Sarah; Lawson, Thomas; and Albin, Catherine S., "A Modified Delphi Consensus Approach to Define Entrustable Professional Activities for Neurocritical Care Advanced Practice Providers" (2024). Neurology. 1944.
https://scholar.barrowneuro.org/neurology/1944