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Table 3 Levels of autonomy reported by graduates for various tasks (percentages and absolute numbers)

From: An analysis of core EPAs reveals a gap between curricular expectations and medical school graduates’ self-perceived level of competence

EPA

Task (nested EPA, key referring to numbering in PROFILES)

Visualization of resultsa

Level of autonomy (in %, n in brackets)

Key

Description

Indirect, reactive supervision

Direct, proactive supervision

Observe only

1

1

Take a patient’s medical history (persons of all ages)

+++++

99% (150)

1% (2)

0% (0)

2

2.1

Perform a physical examination in persons of all ages

+++++

95% (145)

5% (7)

0% (0)

 

2.2

Assess the cognitive and mental state of the patient including memory, perception, understanding, expression and affect

+++++

80% (122)

20% (30)

0% (0)

 

2.5

Use devices such as stethoscope, otoscope and ophthalmoscope

+++++

90% (137)

9% (14)

1% (1)

 

2.6

Explain physical examination maneuvers and obtain consent

+++++

90% (136)

9% (14)

1% (2)

 

2a

Assessment of a patient’s general condition and vital signs

+++++

91% (138)

8% (12)

1% (2)

 

2b

Assessment of a patient‘s nutritional status

++++

66% (100)

31% (47)

3% (5)

 

2c

Assessment of a patient’s attention, thought, perception, speech, affect and psychomotor skills

++++

61% (92)

38% (58)

1% (2)

 

2e

Assessment of skin, hair and nails, description of lesions

++++

61% (92)

38% (58)

1% (2)

 

2f

Palpation of lymph nodes

+++++

93% (141)

6% (10)

1% (1)

 

2j

Assessment of eye movements, recognition and description of nystagmus

++++

65% (99)

32% (49)

3% (4)

 

2n

Inspection and palpation of thyroid, carotid arteries

+++++

81% (123)

18% (28)

1% (1)

 

2o

Inspection and palpation of skeleton and joints

+++++

88% (134)

11% (16)

1% (2)

 

2p

Functional testing of joint mobility: shoulders, elbows, wrists, fingers, hips, knees and ankles

+++++

83% (126)

16% (25)

1% (1)

 

2q

Inspection, palpation, percussion and mobility of the spine

+++++

85% (129)

14% (21)

1% (2)

 

2r

Inspection and palpation of chest, percussion and auscultation of lungs

+++++

98% (149)

1% (2)

1% (1)

 

2 s

Palpation (apex beat/fremitus) and auscultation of heart; description of normal/abnormal heartbeat and murmurs

+++++

86% (130)

14% (22)

0% (0)

 

2 t

Palpation of pulse, testing for arterial insufficiency or bruits

+++++

87% (133)

12% (18)

1% (1)

 

2v

Assessment of venous system

++++

60% (91)

36% (55)

4% (6)

 

2w

Palpation, percussion and auscultation of abdomen, description of findings

+++++

97% (148)

2% (3)

1% (1)

 

2x

Inspection and palpation of groin/hernial orifices

+++

42% (64)

55% (83)

3% (5)

 

2dd

Perform a neurological examination

+++++

90% (137)

10% (15)

0% (0)

 

2ee

Assessment of coma (scale)

+++

56% (86)

39% (59)

5% (7)

3

3

Prioritize a differential diagnosis following a clinical encounter

++++

61% (93)

38% (57)

1% (2)

4

4

Recommend and interpret diagnostic and screening tests in common situations

++++

65% (99)

33% (50)

2% (3)

5

5a

Measuring and interpreting body temperature

+++++

97% (148)

2% (3)

1% (1)

 

5b

Intravenous, subcutaneous and intramuscular injection

+++

56% (85)

41% (62)

3% (5)

 

5c

Insertion of a peripheral intravenous line

+++

58% (88)

35% (54)

7% (10)

 

5c

Planning and managing parenteral administration of drugs

++

21% (32)

55% (83)

24% (37)

 

5f

Wound cleaning, application and removal of sutures

+++

43% (65)

47% (72)

10% (15)

 

5 g

Application of bandages and dressings

++

36% (54)

54% (82)

10% (16)

 

5o

Performance and interpretation of a urine stick test

++++

66% (101)

30% (45)

4% (6)

 

5q

Performance and interpretation of an ECG

+++

51% (78)

46% (70)

3% (4)

 

5r

Performance and interpretation of a pregnancy test

++++

74% (113)

21% (32)

5% (7)

6b

6a

Manage a patient with transient loss of consciousness, syncope, coma or seizures

+

18% (27)

66% (101)

16% (24)

 

6b

Manage a patient with severe hypotension or shock

+

7% (11)

57% (86)

36% (55)

 

6c

Manage a patient with acute chest pain

++

34% (52)

63% (95)

3% (5)

 

6d

Manage a patient with acute severe headache or meningism

++

25% (38)

65% (99)

10% (15)

 

6e

Manage a patient with acute abdominal pain

+++

45% (69)

52% (78)

3% (5)

 

6 h

Manage a patient with severe hypertension

+

17% (26)

71% (108)

12% (18)

 

6i

Manage a patient with uncomplicated trauma, such as a fall or minor traffic injury

++++

62% (94)

33% (51)

5% (7)

 

6 k

Manage a patient with severe acute blood loss

+

9% (13)

54% (82)

37% (57)

7

7

Develop a management plan; discuss orders and prescriptions in common situations

+++

50% (76)

45% (69)

5% (7)

8

8.1

Document and record the patient’s chart

+++++

86% (130)

13% (20)

1% (2)

 

8.3

Provide and incorporate a discharge document

++++

66% (100)

31% (48)

3% (4)

 

8.5

Provide an oral presentation of a patient encounter and situation

+++++

84% (127)

14% (22)

2% (3)

  1. All results are based on 152 cases
  2. a Visualization of proportion of respondents indicating requiring “indirect, reactive supervision” only: +++++ = 80–100%, ++++ = 60–79%, +++ = 40–59%, ++ = 20–39%, + = less than 20%
  3. b For EPA 6, the same three response levels were used as for the other EPAs even though PROFILES requires graduates to “autonomously and trustworthily manage [these situations] within the first 30 min” (p. 22) which refers to “distant supervision”