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

Daniel S. Harrison, Erika J. Sigman, Judy H. Ch’ang, Aarti Sarwal, Abigale Celotto, Alexandra Malone, Ariel Nowicki, Ashley Martin, Bryan Boling, Christa O.Hana S. Nobleza, Christopher Reeves, David M. Greer, Diane McLaughlin, Elizabeth O.B. Woods, Emmaculate Fields, Erica Perets, Gemi E. Jannotta, Jennifer Mears, Kaitlyn Twomey, Kelly A. RathKelly Peronti, Krista M. Garner, Matthew B. Bevers, Nicholas A. Morris, Paola Martinez, Sahar Zafar, Sarah Livesay, Sarah Wahlster, Thomas Lawson, Catherine S.W. Albin

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)1032-1042
Number of pages11
JournalCritical care medicine
Volume52
Issue number7
DOIs
StatePublished - Jul 1 2024

Keywords

  • critical care
  • education
  • neurology
  • nurse practitioners
  • physician assistants

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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