Building Entrustable Professional Activities In Residency Training: Peripheral Blood Smear And Body Fluid Analysis

Introduction/Objective Entrustable professional activities (EPAs) are defined as specialty-specific tasks representing a unit of professional practice that can be entrusted to unsupervised performance by a trainee following attainment of sufficient task-specific competence. EPAs and periodic competency assessments also provide a framework for evaluating relevant ACGME milestones. We describe our experience creating EPAs for peripheral blood smear (PBS) and body fluid (BF) analysis through which residents became qualified to act as laboratory testing personnel. Methods Training occurred during a 6 week “boot camp” for PGY2 and PGY4 residents in July-August 2018 and July-August 2019. Training for PBS included didactic lectures in automated hematology and RBC morphology (2 hr) and WBC and platelet morphology (2 hr); faculty-guided microscope reviews of RBC (2 hr) and WBC morphology (2 hr) using a training checklist; completion of RBC and WBC self-assessment quizzes; and a 40 question graded exam that covered cell identification, lab protocols, and case scenarios. Training for BF included didactic lectures (2 hr); faculty-guided microscope review of BF slides using a training checklist; completion of a BF self-assessment quiz; and a 40 question graded exam that covered cell identification, lab protocol, and case scenarios. Following successful completion of the graded exam residents were deemed competent to perform unsupervised review of cases initially flagged as abnormal by laboratory technologists; they were required to obtain attending review prior to release of results in defined situations. Formal competency assessments according to CLIA standards were done at 6 and 12 months after initial training. Impact on laboratory workflow and turnaround time was assessed before and after training. Conclusion We successfully created EPAs for PBS and BF analysis through which residents became qualified to act as laboratory testing personnel. There was no adverse impact on laboratory turnaroud time, and the number of PBS and BF cases requiring attending pathologist review decreased. Residents appreciated this tangible opportunity to gain graduated responsibility that prepared them for future practice. Periodic competency assessments provide an opportunity to evaluate relevant ACGME milestones. Our training and assessment program and EPAs can serve as a template for other residency programs.