Entrustable Professional Activities Defined
The Entrustable Professional Activities are tools for assessing competency attainment.
They are workplace tasks that a beginning intern should be able to perform. There are 14 Entrustable Professional Activities for a medical student:
- Gather a history and perform a physical examination
- Prioritize a differential diagnosis following a clinical encounter
- Recommend and interpret common diagnostic and screening tests
- Enter and discuss orders and prescriptions
- Document a clinical encounter in the patient record
- Provide an oral presentation of a clinical encounter
- Form clinical questions and retrieve evidence to advance patient care
- Give or receive a patient handover to transition care responsibility
- Collaborate as a member of an interprofessional team
- Recognize a patient requiring urgent or emergent care and initiate evaluation and management
- Obtain informed consent for tests and/or procedures
- Perform general procedures of a physician
- Identify system failures and contribute to a culture of safety and improvement
- Integrate Osteopathic Principles and Practice into clinical practice
“EPAs, first introduced by ten Cate in the Netherlands in 2005, are receiving increasing attention internationally as a framework for meaningful assessment of physician competence at both the UME and GME levels. As measureable units of observable work, EPAs describe important routine activities of a given specialist or subspecialist that require integration of competencies for safe and effective performance. …. The qualifier of “entrustable” aligns with the ultimate ability of an individual to perform the professional activity safely and effectively without supervision …. the AAMC has developed Core EPAs for Entering Residency. The Core EPAs for Entering Residency set the expectation that trainees should be able to perform 13 EPAs on Day 1 of residency without direct supervision….”
Building a Framework of Entrustable Professional Activities, Supported by Competencies and Milestones, to Bridge the Educational Continuum Carraccio, Carol MD, MA; Englander, Robert MD, MPH; Gilhooly, Joseph MD; Mink, Richard MD, MACM; Hofkosh, Dena MD, MEd; Barone, Michael A. MD; Holmboe, Eric S. MD
AACOM has further developed the 13 EPAs to integrate osteopathic principles and practice. TUCOM has integrated a 14th EPA which allows for distinctive osteopathic professional development. Both documents can be reviewed here: AACOM and TUCOM Core EPAs documentation.
Using the EPAs in Specialty Project Development and Assessment
Each student should make an attempt to select EPAs to practice during their specialty track. Most but not all EPAs require clinical activity with the ability for workplace assessment. Because of this not all students will use EPAs as part of their contract and project.
The extra effort to select, understand, practice and self-assess EPAs during the specialty track offers the student an opportunity to own their education and move towards success in their profession.
Self-Directed Student Learning
- EPAs allow a student to understand what is expected of them as they begin residency.
- EPAs allow a student to track their progress in core competencies
- EPAs allow a student a tool to improve their ability to practice medicine.
- EPAs are a foundational component of the language residency directors will recognize in reviewing the student MSPE
WHEN STUDENTS ASSESS THEIR IMPROVEMENT IN THE COMPETENCIES, THEY DEMONSTRATE IT BY DOCUMENTING IMPROVED ENTRUSTABILITY USING A SIMPLE RUBRIC.
Base your self-assessment on where you believe you are clinically rather than on what you are allowed to do without supervision.
After doing a self assessment, a student will strongly benefit from asking a faculty member, who can observe them in the workplace setting or even in a simulated setting to give them an objective assessment of entrustability.
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 –> 2a. “Let’s do this together.”
- 2b Supervisor in room ready to help–> 2b. “I’ll watch you.”
Level 3: Do with supervision on demand
- 3a Supervisor immediately available all findings checked –> 3a. “You go ahead, and I’ll double-check all of your findings.”
- 3b Supervisor immediately available key findings checked–> 3b. “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.
This rubric was adopted from that developed by: H. Carrie Chen, MD, MSEd, W.E. Sjoukje van den Broek, MD, and Olle ten Cate, PhD who published it in The Case for Use of Entrustable Professional Activities in Undergraduate Medical Education.
For more information contact your Clinical Distinction Advisor.