Implementing Neurology EPAs in Singapore using the Consolidated Framework for Implementation Research (1186)

Objective: To describe implementation of Neurology Entrustable Professional Activities (EPAs) in Singapore. Background: Ministry of Health (MOH) Singapore intends to implement EPAs for workplace-based assessment of competency-based health professions education in Singapore. Neurology senior residency was selected to participate in the EPA pilot project in 2018. National-level implementation of EPAs has been sparsely described in the literature. We describe our experience in national-level Neurology EPA implementation using the Consolidated Framework for Implementation Research (CFIR) as an organizing framework. Design/Methods: CFIR describes 5 principal domains – Process, Intervention, Inner setting, Outer setting, Individuals. Implementation Processes included forming the SNEPA workgroup with educators from both Singapore neurology programs who were responsible for engagement, execution and evaluation of national EPA implementation. This workgroup defined EPAs as the Intervention, analysed extant evidence for neurology EPAs and EPA implementation, created 5 neurology EPAs using the Delphi method, and piloted them. We examined Inner Settings, harnessing existing residency systems and educator networks, and department culture. For Outer Settings, the Neurology Residency Advisory Committee, the Graduate Medical Education offices and MOH were key enablers. Individuals (faculty and SNEPA members) were engaged and met periodically to refine the EPAs. MOH-organized EPA workshops were organized to upskill general faculty, administrators and promote buy-in. To facilitate assessment implementation, a new electronic-assessment system (MedHub) was implemented with appropriate staff training. We are currently collecting results of EPA use for evaluation. Results: The CFIR framework guided the SNEPA Workgroup to systematically implement Neurology EPAs across Singapore, with 5 principal domains of focus, plus defined processes and subprocesses. This resulted in creation of 5 pilot EPAs, trained faculty and administrators familiar with EPAs, and an e-assessment system. Conclusions: Amongst many implementation science frameworks, we found the CFIR framework to be useful for EPA implementation in our Singapore context. Disclosure: Dr. Tan has nothing to disclose. Dr. Chan has nothing to disclose. Dr. Tan has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Novartis, Merck, UCB, Sanofi Genzyme and Eisai.