Documenting what residents learned by teaching children to waltz is not yet as simple as 1, 2, 3 but perhaps it just became easier.—C. Andrew Aligne, MD, MPH
American Board of Pediatrics; Accreditation Council for Graduate Medical Education. The Pediatrics Milestone Project. January 2012. Available at: https://www.abp.org/abpwebsite/publicat/milestones.pdf. Accessed February 12, 2012.
A Focus on Social Determinants of Health: Aligning Training With Population Needs
Academic Pediatric Association; American Academy of Pediatrics; APA Task Force on Child Poverty. A strategic road-map. Available at: http://www.academicpeds.org/public_policy/pdf/APA_Task_Force_Strategic_Road_Mapver3.pdf. Accessed November 11, 2013.
Defining Assessment and Management of Social Determinants of Health as an EPA
Association of Pediatric Program Directors. Important points about “Entrustable Professional Activities (EPAs).” Available at: https://www.appd.org/home/PDF/Newborn_EPA_mapped_to_MilestonesVignettes_for_APPDmembers.pdf. Accessed September 20, 2013.
Development of an EPA on Assessing and Managing the Social Determinants of Health
Accreditation Council for Graduate Medical Education. ACGME program requirements for graduate medical education in pediatrics. September 30, 2012. Available at: http://www.acgme.org/acgmeweb/Portals/0/PFAssets/2013-PR-FAQ-PIF/320_pediatrics_07012013.pdf. Accessed November 11, 2013.
American Board of Pediatrics; Accreditation Council for Graduate Medical Education. The Pediatrics Milestone Project. January 2012. Available at: https://www.abp.org/abpwebsite/publicat/milestones.pdf. Accessed February 12, 2012.
- •Develop and carry out management plans (patient care ACGME competency domain).
- •Humanism (professionalism).
- •Cultural competence (professionalism).
- •Participate in the education of patients, families, students, residents, and other health professionals (practice-based learning and improvement).
- •Advocate for quality patient care and optimal care systems (systems-based practice).
- •Know how to advocate for the promotion of health and the prevention of disease and injury in populations (systems-based practice).
- •Communicate effectively with patients, families, and the public across a broad range of socioeconomic and cultural backgrounds (interpersonal and communication skills).
- •Demonstrate sufficient knowledge of the basic and clinically supportive sciences appropriate to pediatrics (medical knowledge).
- •Demonstrate trustworthiness that makes colleagues feel secure when one is responsible for the care of patients (personal and professional development).
EPA Title | Assess and Manage the SDH |
---|---|
Justification | According to the 2011 US Census Bureau, the poverty rate in the United States is 15%, accounting for 46.2 million people. The most severely affected group is female-led households with children. No region of the country is unaffected, and affected families are from all racial backgrounds and live in metropolitan, suburban, and rural areas. 7 The recent research on impacts of the SDH in this population is staggering. Thus, the prevalence and importance of SDH makes it vital to assess and manage them as a routine part of health care, and to ensure the development of the skills to assess and manage them is an explicitly defined educational outcome based on the needs of the population. |
Description of the activity (functions/specific activities required) | Patient-level activities: The provider addresses the social determinants of the patient currently being seen in the office. Clinic-level activities: The provider recognizes that many patients seen in the clinic/office have similar social determinants and incorporates resources for providers into the electronic medical record. Community-level activities: The provider recognizes the importance of addressing social determinants in his or her community and engages local community agencies by participating in health fairs and volunteering at the local school. Population-level activities: The provider recognizes the prevalence of social determinants in his or her community as well as the need to address, intervene, and evaluate population-based outcomes. He or she establishes a partnership with a local community agency to address some of these unmet needs and evaluates processes and outcomes for patients and for the population as a whole. |
Link to ACGME competency domains | Patient care. Medical knowledge. Practice-based learning and improvement. Interpersonal and communication skills. Professionalism (including pediatric-defined area subcompetencies for personal and professional development 3 , American Board of Pediatrics; Accreditation Council for Graduate Medical Education. The Pediatrics Milestone Project. January 2012. Available at: https://www.abp.org/abpwebsite/publicat/milestones.pdf. Accessed February 12, 2012. 4 ).Systems-based practice. |
Required knowledge, skills, and attitudes | Defined by the content of the 9 pediatric milestone subcompetencies chosen as critical to this area: Develop and carry out management plans (patient care ACGME competency domain). Humanism (professionalism). Cultural competence (professionalism). Participate in the education of patients, families, students, residents, and other health professionals (practice-based learning and improvement). Advocate for quality patient care and optimal care systems (systems-based practice). Know how to advocate for the promotion of health and the prevention of disease and injury in populations (systems-based practice). Communicate effectively with patients, families, and the public, as appropriate, across a broad range of socioeconomic and cultural backgrounds (interpersonal and communication skills). Demonstrate sufficient knowledge of the basic and clinically supportive sciences appropriate to pediatrics (medical knowledge). Demonstrate trustworthiness that makes colleagues feel secure when one is responsible for the care of patients (personal and professional development). |
Sources of information to track developmental progress during training | Assessment data from advocacy rotation and/or longitudinal advocacy projects, ambulatory clinic or community health center, ED, inpatient, and other patient care–focused educational experiences. Feedback from parent surveys during clinical visits. Critical review and evaluation of advocacy projects. Critical review and evaluation of community and volunteer experiences. Critical review and evaluation of scholarly activity in the area of SDH and vulnerable populations |
Estimated levels for entrustment decisions | Entrustment for unsupervised practice: Level 3. Entrustment to supervise others: Level 4 |
Basis for formal entrustment decisions | The study of milestones and subsequently developed EPAs is in its infancy. It is difficult to determine the number and mix of evaluation metrics (eg, direct observations, parent feedback, community experiences, advocacy projects) that will be required to formally assess entrustment decisions for assessment and management of SDH. |
Association of Pediatric Program Directors. Important points about “Entrustable Professional Activities (EPAs).” Available at: https://www.appd.org/home/PDF/Newborn_EPA_mapped_to_MilestonesVignettes_for_APPDmembers.pdf. Accessed September 20, 2013.
Social Determinants of Health EPA: A Strategy to Ensure Educational Outcomes
Conclusion
Academic Pediatric Association; American Academy of Pediatrics; APA Task Force on Child Poverty. A strategic road-map. Available at: http://www.academicpeds.org/public_policy/pdf/APA_Task_Force_Strategic_Road_Mapver3.pdf. Accessed November 11, 2013.
Supplementary Data
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References
- Pediatrics in the community: integrating community pediatrics into residency training.Pediatr Rev. 2010; 31: 159-160
- The pediatrics milestones: conceptual framework, guiding principles, and approach to development.J Grad Med Educ. 2010; 2: 410-418
American Board of Pediatrics; Accreditation Council for Graduate Medical Education. The Pediatrics Milestone Project. January 2012. Available at: https://www.abp.org/abpwebsite/publicat/milestones.pdf. Accessed February 12, 2012.
- The assessment of professional competence: developments, research and practical implications.Adv Health Sci Educ. 1996; 1: 41-67
- Health professionals for a new century: transforming education to strengthen health systems in an interdependent world.Lancet. 2010; 376: 1923-1958
- Competency-based postgraduate training: can we bridge the gap between theory and clinical practice? [viewpoint].Acad Med. 2007; 82: 542-547
- Pediatrics in the community: the Beacon Burners Running Program: empowering kids to run round and round without reinventing the wheel.Pediatr Rev. 2008; 29: 249-250
- Food insecurity is associated with adverse health outcomes among human infants and toddlers.J Nutr. 2004; 134: 1432-1438
- Health of homeless children and housed, poor children.Pediatrics. 1990; 86: 858-866
- US housing insecurity and the health of very young children.Am J Public Health. 2011; 101: 1508-1514
- Determinants of health and service use patterns in homeless and low-income housed children.Pediatrics. 1998; 102: 554-562
- Housing and health: time again for public health action.Am J Public Health. 2002; 92: 758-768
- Medical–legal partnerships: transforming primary care by addressing the legal needs of vulnerable populations.Health Aff (Millwood). 2010; 29: 1697-1705
- Inner-city asthma.Immunol Allergy Clin North Am. 2002; 22: 737-752
- Intelligence quotient scores of 4-year-old children: social–environmental risk factors.Pediatrics. 1987; 79: 343-350
Academic Pediatric Association; American Academy of Pediatrics; APA Task Force on Child Poverty. A strategic road-map. Available at: http://www.academicpeds.org/public_policy/pdf/APA_Task_Force_Strategic_Road_Mapver3.pdf. Accessed November 11, 2013.
Association of Pediatric Program Directors. Important points about “Entrustable Professional Activities (EPAs).” Available at: https://www.appd.org/home/PDF/Newborn_EPA_mapped_to_MilestonesVignettes_for_APPDmembers.pdf. Accessed September 20, 2013.
- Nuts and bolts of entrustable professional activities.J Grad Med Educ. 2013; 5: 157-158
- Toward a common taxonomy of competency domains for the health professions and competencies for physicians.Acad Med. 2013; 88: 1088-1094
Accreditation Council for Graduate Medical Education. ACGME program requirements for graduate medical education in pediatrics. September 30, 2012. Available at: http://www.acgme.org/acgmeweb/Portals/0/PFAssets/2013-PR-FAQ-PIF/320_pediatrics_07012013.pdf. Accessed November 11, 2013.
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The authors declare that they have no conflict of interest.