Table 2 Population, study type, aims, EPAs, mainly results and conclusions

S1

Qualitative study

To identify core procedural skills and areas of critical importance for the clinical practice of EM and to describe an EM procedure bootcamp.

EPA 10 from Association of American Medical College’s (AAMC) [22]: recognize a patient requiring urgent or emergent care and initiate evaluation and management.

All participants reported an increase of knowledge and confidence in the topics covered and overall satisfaction with the simulation experience.

To do a bootcamp using EPAs identifies educational gaps for graduating medical students. Gaps include procedural skills such as airway management, procedural sedation, pain management, care of wounds, suturing, and emergency ultrasound, as well as ED-specific skills related to patient reassessment, observation, and disposition.

S2

Qualitative study

To describe a new approach to develop EPAs in emergency medicine.

Managing adult patients with acute chest pain and Managing elderly patients following a fall

Describe a comprehensive five stage approach to develop two EPAs using depth focus groups and individual interviews.

The approach described in this paper was used successfully to develop two specialty-specific EPAs in emergency medicine along with a three level entrustment scale.

S3

Qualitative study

To recognize a septic patient with delirium who requires emergent care, and initiate the evaluation and management of a critically ill patient.

EPA 10 from AAMC [22]: recognize a patient requiring urgent or emergent care and initiate evaluation and management.

Students successfully completed each of the five critical actions without prompting. No specific areas of difficulty were identified during the debriefing following this session

Application of this simulated practice can more successfully prepare undergraduate students to perform more efficiently during their professional lives.

S4

Qualitative study

To recognize a severity of a patient with an ST segment elevation myocardial infarction, apply basic and advanced life support, and engage team members required for immediate response, continued decision making, and necessary follow-up to optimize patient outcomes

EPA 10 from AAMC [22]: recognize a patient requiring urgent or emergent care and initiate evaluation and management.

Authors describe the scenario and 3 comments from students who praised the simulation and debriefing.

It is expected that the model brought by the study will help the curricular construction of different centers and allow them to train qualified professionals who are aware of the most important practices to be adopted during their professional practice.

S5

Qualitative study

To describe the design of a multidisciplinary dedicated transitional year (DTY), a final year at Medical School, focused on the recognition and initial treatment of critically ill patients

Recognition and initial treatment of patients with vital instability, Evaluation of patients with respiratory insufficiency, and Evaluation of patients with circulatory insufficiency

The authors believe that theme-orientation and the learning objectives provide coherence in a year consisting of elective rotations. They said that the design and implementation of DTY has been a laborious, yet satisfactory, process. Considerable time and effort were required to collaboratively develop and describe the three EPAs, transcending traditional specialty boundaries, with faculty from five disciplines.

This multidisciplinary DTY using EPAs aims to final year’s medical students with profile-specific competence in acute care. It prepares for residency in a range of specialties.

S6

Qualitative study

To design realistics case-scenarios representing patients in need of emergent care

EPA 10 from AAMC [22]: recognize a patient requiring urgent or emergent care and initiate evaluation and management.

Authors developed 5 scenarios: (1) Chest pain: unstable atrial fibrillation (Afib); (2) Abdominal pain: ruptured ectopic pregnancy (REP); (3) Confusion and fever: sepsis (SEP); (4) Headache: subarachnoid hemorrhage (SAH); and (5) Trauma and shortness of breath: trauma-related tension pneumothorax (PTX).

Three critical actions were common across all of the cases: recognizing abnormal vital signs, asking for help when needed, and determining patient disposition. Almost 87% of the students were rated as having reached ad-hoc entrustment

High-fidelity simulation has shown promise in effectively assessing medical students’ ability to care for emergent patients.

S7

Analytic experimental study

To determine the effectiveness of an educational intervention in teaching fourth-year medical students how to use ultrasound measurements of the inferior vena cava (IVC) and echocardiography for volume assessment in patients presenting with shock.

EPA 10 from AAMC [22]: recognize a patient requiring urgent or emergent care and initiate evaluation and management.

The students’ knowledge increased significantly after the training and the satisfaction survey showed 97.6% of students felt the session was worthwhile, 96.4% would recommend it to other students, and 83.1% felt it taught new information

The educational intervention successfully improved knowledge regarding volume assessment using echocardiogram and ultrasound measurements of the inferior vena cava (IVC). Students highly appreciated the course and found it offered unique information not commonly covered in medical school. This curriculum aligns with the AAMC EPA 10, better preparing students to handle cases of hypotension and potentially enhancing the overall value of the medical school curriculum.

S8

Analytic observational cross-sectional study

To describe how the views of senior medical students at the time of the pre-internship transition compare with: (1) national guidelines; (2) resident expectations; and (3) institutional objectives.

EPAs from AAMC [22]: 1 (take a medical history), 2 (Assess the physical and mental status of the patient), 3 (Prioritize a differential diagnosis following a clinical encounter), 4 (Recommend and interpret diagnostic and screening tests in common situations), 5 (Perform general procedures) 7 (Develop a management plan; discuss orders and prescriptions in common situations’), 8 (document and present patient’s clinical encounter; perform handover),9 (Contribute to a culture of safety and improvement and 10 (recognize a patient requiring urgent or emergent care and initiate evaluation and management

Over 80% of students rated ‘managing time efficiently’ and ‘communicating around care transitions’ as very important pre-internship skills. Of the institutional objectives, 87% rated ‘recognising critically ill patients’ and ‘knowing when to ask for help’ as the most important pre-internship skills.

Although the emphasis on knowing when to ask for help and communication around care transitions differed somewhat across stakeholders, educational priorities were shared by students, residents, educators and institutional objectives.

S9

Qualitative study

To develop and provide a longitudinal curriculum for formative assessment of Entrustable Professional Activities (EPAs) in medical school, trough simulation and implement them in differents backgrounds

EPAs from AAMC [22]: 4 (Recommend and interpret diagnostic and screening tests in common situations), 7 (Develop a management plan; discuss orders and prescriptions in common situations’), 8 (document and present patient’s clinical encounter; perform handover), 9 (Contribute to a culture of safety and improvement and 10 (recognize a patient requiring urgent or emergent care and initiate evaluation and management)

Simulations were well-received by medical students. Feedback from students was overwhelmingly positive and highlighted the ability of a simulation setting to provide students with a safe environment to take a leading role in attempting to manage unstable patients, as well as simply providing an opportunity to translate what they learned in the classroom into actual practice Deliberate practice and longitudinal formative assessment were considered crucial for the effective development of core EPAs before making final entrustment decisions.

Simulations were an effective way to offer formative assessment of EPAs and were highly appreciated by medical students.

S10

Analytic observational cross-sectional study

To evaluate students’ self-perception on the EPAs using an online survey.

A list of 46 EPAs presented in Principal Relevant Objectives and Framework for Integrated Learning and Education in Switzerland (PROFILES) [23]

EPAs about EM analyzed in the article:

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

Manage a patient with severe hypotension or shock;

Manage a patient with acute chest pain;

Manage a patient with acute severe headache or meningism;

Manage a patient with acute abdominal pain;

Manage a patient with severe hypertension;

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

Manage a patient with severe acute blood loss.

There was a significant gap between the reality and the expectations from the students. The lowest levels of autonomy were reported for EPAs related to urgent and emergency care.

There was a notable difference between the expectations of curriculum developers and the skills perceived in students, particularly in practical skills and emergency situations.

S11

Analytic experimental study

To evaluate the performance of medical students before and after submission at a curriculum using EPAs

EPA 10 from AAMC [22]: recognize a patient requiring urgent or emergent care and initiate evaluation and management. Authors developed two simulated scenarios: chest pain/cardiac arrest and respiratory distress.

Mean scores from pretest to final posttest in the chest pain/cardiac arrest and respiratory distress cases significantly

A new directed curriculum of standardized simulation using EPAs was effective to improve performance of medical students.