Fig. 1
Relationship between entrustable professional activities (EPAs), milestones, and microskills. The EPAs are professional activities that define a profession and are comprised of one or more competencies, within domains of competence, and their associated milestones for development. By increasing granularity, which affords more specificity for feedback and improvement goals, microskills are broken down into situational and context-specific behaviors. Successfully mastering a broader EPA requires an attainment of advanced-level developmental competence and the completion of many smaller microskills
Table 1
Microskill creation criteria. Each microskill was formed using the following criteria based on previously mentioned medical and negotiation theories of deliberate practice, coaching and formative feedback, as well as situated learning
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1. Action-based: Microskills are written in active voice with action-based language. This format allows the trainee to recognize and undertake the desired skill, as opposed to leaving it up to interpretation as to how they should meet a goal |
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2. Broadly-applicable yet narrowly-focused: Microskills are vague enough that they can apply to multiple types of patients (i.e., patients with different diseases) yet narrow enough so that the trainee can identify the context in which to employ the skill (i.e., assessments for existing patients, as opposed to a new patient) |
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3. Distilled into granular components: Microskills are distilled into the most discrete components possible. For milestones/EPAs that mention various activities (e.g., resuscitate, initiate stabilization of the acute patient), each skill required of the trainee to fulfill that task is identified separately |
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4. Organizationally designed according to the learner’s day: The microskills are organized into domains, developed from a user-centered design approach that mirror a trainee’s workday |
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5. Grounded in clinical and/or situational context: Grouping microskills according to the circumstance in which they are employed helps to frame most microskills within a situational context. Depending on the microskill, some are also framed within a clinical context (i.e., the medical circumstance in which an activity should be performed) |
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6. Easily observable: The microskills contain enough descriptive context so they may be readily observed by supervisors, senior residents, and others to allow for feedback targeting precise skills |
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7. Training-appropriate: Microskills can be created and tailored for any training level and any specialty. The current set of microskills are designed for a pediatrics intern on a hospital medicine rotation, with the assumption that the learner has a working knowledge of physical exam skills and patient presentations from their medical school experiences. However, microskills can be created for any level of training |