Entrustable Professional Activities are a key feature of Specialty Track Clinical Distinction courses, however, they should inform all clinical training and are a useful measure for students and faculty of student progress in competency development.
Entrustable Professional Activities are skills, tasks and knowledge a medical student must be facile with to be a successful resident. The tasks are unique to medical training but foundational. If a student is entrustable, in one or more of these activities, it means they have grown in the core comptencies and are moving towards residency readiness.
Doing any one of these tasks once isn’t enough to verify entrustability because of the broad nature of medical work. For example, taking a history and physical, the first EPA is something a medical student might be able to do well in the setting of an adult well visit and yet struggle in the face of a pediatric patient or an emergency setting. Determining entrustability requires multiple workplace assessments of each of these 14 tasks.
Clinical Distinction is adult-centered learning and the student is asked to assess their level of entrustability before and after their course. This practice is one that can be carried into all of their clinical training – both the self- assessment process and understanding the level of entrustability they have reached.
Clinical Distinction also asks faculty members to evaluate the student based on workplace assessment of the EPAs. To facilitate the determination of level of entrustability the following intuitive rubric is used by both students and faculty:
Level 1: Not allowed to do the EPA
- 1a Not allowed to observe –> “Please wait here and do some reading.”
- 1b Allowed to observe–> “Watch me do this.”
Level 2: Do with full direct supervision
- 2a Coactivity with supervisor –> “Let’s do this together.”
- 2b Supervisor in room ready to help–> “I’ll watch you.”
Level 3: Do with supervision on demand
- 3a Supervisor immediately available all findings checked –> “You go ahead, and I’ll double-check all of your findings.”
- 3b Supervisor immediately available key findings checked–> “You go ahead, and I’ll double-check key findings.”
- 3c Supervisor distantly available (phone) findings reviewed –> ( in most instances, a student must be licensed (intern), for a supervisor to allow this level of supervision, therefore most students can only reach this stage hypothetically.
AAMC and AACOM describe 13 EPAs. AACOM has included osteopathic components into the 13 EPAs originally described by AAMC. TUCOM has added a 14th distinctly osteopathic EPA and published an article on it. Here are some interesting documents to review: