APPs are key contributors to NCC teams. Six core and 47 nested entrustable professional activities (EPAs) for NCC APP training have been developed. These could be leveraged for EPA-based assessment, however, are not supported by validity evidence in this context.

To assess the relationship between checklist-based performance in simulated neurologic emergencies and supervisor- and self-assessed entrustment among neurocritical care (NCC) advanced practice providers (APPs).

Two simulation scenarios were created to assess performance related to six core and 15 nested-EPAs. The simulations’ critical action checklists were iteratively developed based upon guideline recommendations and consensus opinion from five collaborating institutions. Prior to participation, NCC APPs self-assessed their entrustment on the core and nested EPAs (the “EPA Assessment Tool”). APP supervisors completed the same assessment. After completing a rater training exercise, study staff completed the critical action checklists for each participant.

22 NCC APPs from 4 institutions participated in the study. There was a moderate positive association between physician supervisor assessed entrustment and performance on the critical action checklist (r= 0.47). There was a very strong positive association between physician supervisor assessed entrustment and participant NCC experience (r= 0.84). There was fair agreement in 393 physician and self-assessed EPAs (k_w= 0.39). Overall entrustment was similar when assessed by physician supervisors (4.13 +/- 0.72 [5-point entrustment scale mean +/- standard deviation]) and participants (4.11 +/- 0.60, p= 0.83). For the subset of participants who were additionally assessed by an APP supervisor, overall entrustment was also similar between self- and supervisor-assessment (4.04+/-0.59 vs 4.20+/-0.73, p= 0.39).