Redesigned Entrustable Professional Activity (EPA) Assessments Reduce Grade Inflation in the Experiential Setting.

Abstract

Objective: This study aims to evaluate the impact of redesigning an Entrustable Professional Activities (EPA) assessment tool on the accuracy of student performance assessment within pharmacy education.

Methods: The study utilized retrospective programmatic data for students on clinical rotations over a three-year period and compared entrustment levels assigned by preceptors to suggested entrustment levels. This tool was redesigned to separate formative EPA feedback from final grade determination. Data was analyzed with Chi-Squared tests to look for trends in students ABOVE, AT, or BELOW the suggested entrustment levels. Additionally, to account for variation in inter-cohort variability, the relationship between students ABOVE suggested level of entrustment and post-graduate metrics was examined.

Results: After implementation of the revised tool, there was a significant decrease (3%) in students scoring ABOVE suggested entrustment levels and an increase in students scoring AT (1%) or BELOW (2%). Individual patient care settings also exhibited changes, with a decrease in grade inflation and an increase in accurate assessments. NAPLEX pass rates, residency match rates, and grade point average did not correlate with entrustment levels.

Discussion: The redesigned EPA assessment tool demonstrated a decrease in grade inflation resulting in more accurate assessments. The tool's focus on holistic grading and narrative descriptors contributed to a better alignment between preceptor assessment and school suggested achievement levels. This study suggests that EPA assessments in pharmacy education could benefit from a stronger emphasis on formative feedback and the use of holistic assessment methods for final grade determinations. The findings underscore the potential advantages of considering a separation between EPA scoring and final grades, prompting the academy to explore their assessment practices to better reflect student performance in clinical experiences.