Paul Barach

Paul is a Clinical Professor at Wayne State University School of Medicine, Children’s Hospital of Michigan, and is a practicing double board-certified physician-scientist in Anesthesiology and Critical care, from the Massachusetts General Hospital affiliated with Harvard Medical School.

Dr Barach is a leading health services and systems researcher and medical educator with an international reputation for his work investigating and contributing to systems improvement and quality outcomes. He has particular expertise in the culture and structure of acute settings, leadership, management and change in health sector organizations, quality and safety in health care, resilient health care, accreditation and surveying processes in international context and the restructuring of health services.

He is a formally trained health services researcher, with advanced post graduate training in quality improvement and lean techniques at Intermountain Healthcare, and in advanced medical education and assessment methods from the Harvard Medical School Josiah Macy Program. He has had additional training in epidemiology and statistics including both methodological as well as applied HTA research. Paul has taught and has deep experience developing processes, systems and content around systems improvement, population health, duty of care, quality improvement, human factors, patient safety and systems re-design to undergraduate/graduate and post graduate providers and managers for over 15 years in US, Europe, and Australasia.

Professor Barach is well known for bringing management and leadership concepts and evidence into the clinical arena and he has published extensively (more than 200 refereed contributions, and 300 total publications, 5 books) about organizational, social, human factors, and team approaches to care. He has presented at or chaired international and national conferences, workshops, symposia and meetings on more than 500 occasions, including over 60 keynote addresses and his work has been widely cited over 8000 times.

He is interested in the organization and delivery of healthcare services and in the development and application of strategies for improving healthcare quality and outcomes, guided by theories and insights from the fields of implementation science and healthcare quality improvement research. He is involved in a variety of efforts to further develop and strengthen the field of implementation science and to facilitate more effective collaborations between researchers and policy and practice leaders interested in improving healthcare delivery. Paul has advised the World Health Organization (WHO) and the World Bank and has served as a consultant on health care reform to governments in a number of countries focused on reducing burden of NCD’s working in Asia and Africa including targeted health systems strengthening and delivery of better clinical services. Paul and his team developed the first perioperative patient safety curriculum, internship simulation course and competency based quality improvement training programs and he helped develop the award winning Team STEPPS  team training program. He has worked with ACGME, NBME, ABMS, and was a board member of the NBME Innovation Board.

Presentation Title: Developing and Assessing Entrustable Professional Activities as the Basis for Assessment of Patient Safety Competencies

Abstract: Determining when residents are independently prepared to perform clinical care tasks safely is not easy or understood. Educators have struggled to identify robust ways to evaluate trainees and their preparedness to treat patients while unsupervised. However, efforts to implement competency-based medical education have been stymied by practical challenges and assessment questions. Competency-based assessment tools, while potentially psychometrically strong, can prompt narrow focus on aspects of individual competencies and improper implementation of assessment tools with inadequate faculty training limits the information gained. Entrustable professional activities (EPAs) are a novel method of operationalizing competencies and milestones in the context of actual clinical work.  An EPA reflects relevant competencies and milestones; requires skills, knowledge, and attitudes; addresses a professional task with a recognizable output; and can be observed and judged by an expert. Trust allows the trainee to experience increasing levels of participation and responsibility in the workplace in a way that builds competence for future practice. The breadth of knowledge and skills required to become a competent and safe physician, coupled with the busy workload confound this challenge. Notably, a technically proficient trainee may not have the clinical judgment to treat patients without supervision. This talk will review patient safety Milestones (discipline-specific developmental achievements toward competence), and their assessment, that ideally facilitates meaningful workplace-based assessment over time. We will review the factors affecting why and when supervisors trust residents to proceed without supervision.