To assess the relationship between checklist-based performance in simulated neurologic emergencies and supervisor- and self-assessed entrustment among neurocritical care (NCC) advanced practice providers (APPs).
APPs are key contributors to NCC teams. Six core and 47 nested entrustable professional activities (EPAs) for NCC APP training have been developed. These could be leveraged for EPA-based assessment, however, are not supported by validity evidence in this context.
Two simulation scenarios were created to assess performance related to six core and 15 nested-EPAs. The simulations’ critical action checklists were iteratively developed based upon guideline recommendations and consensus opinion from five collaborating institutions. Prior to participation, NCC APPs self-assessed their entrustment on the core and nested EPAs (the “EPA Assessment Tool”). APP supervisors completed the same assessment. After completing a rater training exercise, study staff completed the critical action checklists for each participant.
22 NCC APPs from 4 institutions participated in the study. There was a moderate positive association between physician supervisor assessed entrustment and performance on the critical action checklist (r= 0.47). There was a very strong positive association between physician supervisor assessed entrustment and participant NCC experience (r= 0.84). There was fair agreement in 393 physician and self-assessed EPAs (kw= 0.39). Overall entrustment was similar when assessed by physician supervisors (4.13 +/- 0.72 [5-point entrustment scale mean +/- standard deviation]) and participants (4.11 +/- 0.60, p= 0.83). For the subset of participants who were additionally assessed by an APP supervisor, overall entrustment was also similar between self- and supervisor-assessment (4.04+/-0.59 vs 4.20+/-0.73, p= 0.39).