Education Research: Entrustable Professional Activities for General Neurology Advanced Practice Providers: Results of a Modified Delphi Consensus Process

Abstract

BACKGROUND AND OBJECTIVES: A dedicated didactic framework, assessment strategy, and consensus expectations for advanced practice providers (APPs) entering general neurology practice for the first time have not been described. We aimed to define entrustable professional activities (EPAs) for general neurology APPs and to provide further validity evidence for the EPAs through application of the EQual rubric. METHODS: This was a modified Delphi consensus process. Panelists were leaders of neurology APP fellowship programs and other established experts in neurology APP education. The steering committee identified putative EPA topics. Panelists voted on a 5-point Likert scale how important it was that a new general neurology APP be able to perform specific activities with indirect supervision remotely available by the end of their on-the-job training. Panelists were allowed to propose modifications to putative EPAs and suggest new EPAs. After 3 rounds of voting, full EPA descriptions were drafted by the steering committee. Full EPA descriptions were sent to external experts in neurology APP education for assessment of their structure and quality. The steering committee met again to discuss feedback from the external experts and make adjustments as needed. The full EPA descriptions were sent to the Delphi panelists for a final round of voting. RESULTS: Of 35 experts invited to participate in the Delphi process, 30 agreed to serve as panelists, 16 of whom were program leaders in neurology APP fellowship programs. The steering committee proposed 13 core and 52 nested EPA topics and the panelists proposed 6 modifications and an additional 4 nested EPAs. After 3 rounds of voting, 13 core and 46 nested EPAs were retained and full EPA descriptions were authored. All EPA descriptions met the pre-specified cut score for quality and structure and were retained in a final Delphi round. Overall entrustment expectations did not differ between panelists who were fellowship program leaders and those who were not (5-point Likert median [interquartile range], 4 [4-5] vs 4 [4-5], p = 0.980, r = 0.005). DISCUSSION: These consensus EPAs may be applied for curricular development and assessment for new general neurology APPs. Entrustment expectations did not differ between those who were leaders in fellowship programs and those who were not.