Understanding entrustable professional activities

Residency Program Insider, February 24, 2020

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Editor’s Note: The following is an excerpt fromThe Complete Guide to Continuous GME Accreditation. For more information about this book, click here.

The idea of entrustable professional activities (EPA) is a very general concept and one that is often confusing for program directors. Olle ten Cate, PhD, and Fedde Scheele, PhD, who are generally credited with this concept, define EPAs as “those professional activities that together constitute the mass of critical elements that operationally define a profession,” and these activities “should only be entrusted upon a competent enough professional” (ten Cate et al., 2007). EPAs are routine activities of a physician that educators and the general public should reasonably expect a resident to be able to perform without supervision at the completion of their training. According to ten Cate and Scheele, other conditions of EPAs include:

  • Being part of essential professional work
  • Requiring adequate knowledge, skills, and attitudes
  • Leading to recognized output of professional labor
  • Being confined to qualified personnel
  • Being independently executable within a given time frame
  • Being observable and measurable
  • Reflecting one or more core competencies (ten Cate et al., 2007)

Core competencies, subcompetencies, and Milestones for a particular specialty should ideally be linked to an EPA for that specialty. For example, one would expect that a general pediatrician completing his or her residency training should be competently able to provide care for a well newborn (an EPA). In order to provide the care of a well newborn, that pediatrician must:

  • Perform an accurate physical exam to detect congenital abnormalities, a pediatric subcompetency under the core competency of patient care
  • Use their interpersonal communication skills to provide anticipatory guidance to the family
  • Potentially arrange home phototherapy and use their knowledge of community resources to provide this to their patient, a systems-based practice subcompetency

A pediatric trainee must reach a certain level of competence along the Mile-stone continuum to provide care for a well newborn without supervision.

Ten Cate, O., & Scheele, F. (2007). Competency-based postgraduate training: Can we bridge the gap between theory and clinical practice? Academic Medicine, 82, 542–547.


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