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Quick Guide to Entrustable Professional Activities (EPAs)

What are EPAs?

A critical part of professional work that can be identified as a unit to be entrusted to a


trainee once sufficient competence has been reached. Ten Cate, 2005
Tasks of high importance for daily practice (core business), high risk or error prone tasks, or
tasks exemplary of a number of specific domains of competence (e.g. communication, medical
expertise, quality and safety).
The supervisor confirms when a trainee has reached the level where they can be trusted to
perform each activity without direct supervision.
A trainee should gain entrustment in performing these activities without direct supervision
before progression to subsequent stages of training.

Why use EPAs?

EPAs can be used to bridge the gap between the theory of competency-based medical
education and clinical practice.
EPAs address two of the main criticisms of competency-based medical education:
o That it results in an overload of atomistic competencies which are difficult to process and
almost impossible to assess.
o That assessments targeted at specific domains of competence (e.g. communication) do
not allow for the assessor to assess performance as it occurs in the real world given the
need to integrate the domains of learning when practicing the art of medicine.
EPAs translate learning outcomes and make them more manageable and meaningful in
terms of the tasks or activities that can be safely entrusted to someone who has demonstrated
the required ability.
Supervisors make entrustment decisions every day when working with trainees. EPAs:
o provide a mechanism for formalising this process
o promote direct observation of pre-determined EPAs rather than random aspects of
performance
o align what supervisors assess with what physicians actually do on a regular basis.
A number of medical education providers are using EPAs in their training programs, including
the Royal Australian and New Zealand College of Psychiatrists (RANZCP), the Royal College
of Physicians and Surgeons of Canada (RCPSC), and the USAs Accreditation Council for
Graduate Medical Education (ACGME).

Example EPA titles

Produce discharge summaries and organise appropriate transfer of care


Recognise, manage and appropriately escalate the care of a deteriorating patient
Gather a history and perform a physical examination

Curriculum@racp.edu.au