A Modified Delphi Consensus Approach to Define Entrustable Professional Activities for Neurocritical Care Advanced Practice Providers
Daniel Harrison1, Erika Sigman2, Judy Ch'ang3, Aarti Sarwal4, Abigale Celotto5, Alexandra Malone6, Ariel Nowicki7, Ashley Martin2, Bryan Boling6, Christa O'hana Nobleza8, Christopher Reeves9, David Greer10, Diane McLaughlin11, Elizabeth Woods12, Emmaculate Fields13, Erica Perets14, Gemi Jannotta15, Jennifer Mears16, Kaitlyn Twomey17, Kelly Rath18, Kelly Peronti14, Krista Garner2, Matthew Bevers7, Nicholas Morris19, Paola Martinez20, Sahar Zafar12, Sarah Livesay21, Sarah Wahlster22, Thomas Lawson23, Casey Albin24
1Neurology, Mass General Brigham, 2Emory University, 3Weill Cornell, 4Atrium Wake Forest School of Medicine, 5University of Maryland Medical System, 6University of Kentucky, 7Brigham and Women's Hospital, 8University of Tennessee Health Science Center, 9Boston Children's Hospital, 10Boston University School of Medicine, 11Lyerly Neurosurgery, 12Massachusetts General Hospital, 13The University of Oklahoma Health Sciences Center, 14Grady Memorial Hospital, 15Harborview Medical Center, 16Weill Cornell Medicine, 17New York Presbyterian Hospital, 18University of Cincinnati Medical Center, 19University of Maryland Medical Center, 20University of Texas Health Science Center, 21Rush University, 22University of Washington, 23The Ohio State University Wexner Medical Center and James Cancer Hospital, 24Emory Healthcare
Objective:
To define consensus entrustable professional activities (EPAs) for neurocritical care APPs.
Background:
Advanced practice providers (APPs) are essential members of neurocritical care teams. As neurologic education in APP degree programs is limited, significant on-the-job training is required for new neurocritical care APPs. Curricula for onboarding neurocritical care APPs have been developed; however, methods for evaluating readiness to deliver care without direct supervision are not available.
Design/Methods:
The steering committee developed a list of possible EPAs from Emergency Neurological Life Support course topics, the Neurocritical Care Society’s APP orientation course, and internal APP onboarding resources. We used a modified Delphi approach to generate consensus amongst neurocritical care APP leaders and expert neurointensivist medical educators. Panelists were encouraged to add additional EPAs. Items reaching 80% consensus after 2 rounds of voting were retained. The quality and structure of core EPAs were evaluated using the EQual rubric. We additionally performed an exploratory analysis of variations in entrustment expectations based on provider type, years of experience, and years of APP presence on unit.
Results:
The panel included 18 APPs and 12 neurointensivists from 16 institutions across the United States. 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. The steering committee defined 6 core EPAs encompassing the nested EPAs, all of which were retained after 1 round of voting. Entrustment expectations did not vary by the specified groups.
Conclusions:
Expert consensus was used to create EPAs for neurocritical care APPs. We did not identify variables that significantly predicted entrustment expectations. These EPAs will be a valuable tool in the design of educational interventions for and assessment of new neurocritical care APPs. This list could be adapted for other groups of learners and trainees in the neurologic ICU.