Development and use of Observable Practice Activities (OPA) in graduate medical education (GME): A 10-year experience

Background Since the introduction of educational milestones by the Accreditation Council for Graduate Medical Education (ACGME), residency programs have sought to identify the optimal approach to assess progression through these milestones. Entrustable Professional Activities (EPA) and Observable Practice Activities (OPA) are tools that can be customized for each medical specialty and utilized to assess a learner’s advancement. An effective process for creating and implementing specialty-specific EPAs and their corresponding OPAs into the residency curriculum remains unclear. Objective The aim of this report is to present a 10-year experience in developing and using OPAs to assess residents’ performance and competence in Physical Medicine and Rehabilitation (PM&R). Methods A PM&R residency program developed 63 OPAs in 2014 and subsequently incorporated them into their curriculum in 2015. These have been in active use since then. Assessment of the tool’s effectiveness and ease of use were evaluated and monitored through annual surveys of residents and faculty. Generalizability was assessed by another PM&R residency program. Finally, the value of the process was evaluated when shared with the PM&R Residency and Fellowship Directors Council, a multi-specialty Competency Based Medical Education (CBME) round table, and in a CBME workshop of the American Board of PM&R (ABPMR). Results At the time of this report, 100% of residents, 65 total, have utilized the tool. The OPAs covered the core PM&R conditions, allowed residents real time monitoring of their progression through each domain, and were felt to be a valuable tool by faculty, residents, and education leaders. Conclusion OPAs can be crafted and effectively incorporated into a PM&R residency curriculum to assess resident progression through the ACGME milestones.