Entrustable professional activities in entry‐level health professional education: A scoping review

Abstract

Entrustable professional activities (EPAs) are a recent enhancement to competency‐based health professional education that describe the observable work done by a competent health professional. Through defining education outcomes in a work‐based context, EPAs offer potential to identify skill gaps in individual or student cohorts and focus improvements. Entrustable professional activities have been pioneered and gained rapid acceptance in postgraduate medical education; however, less is known about their application and use in undergraduate or entry‐level health professional education. The Joanna Briggs Institute scoping review methodology was used to explore how and in what context EPAs are being used in entry‐level health professional education. Databases searched include CINAHL, EMBASE, MEDLINE, Web of Science and PsycINFO. A total of 748 abstracts were returned after duplicates removed, and 127 full‐text articles were screened with 30 included for data extraction. Publications in this area have recently accelerated with disciplines of professions of medicine, pharmacy, dietetics and physician assistants reporting on EPA development, implementation and evaluation. EPA use has been reported in the United States, Canada, Europe Australia and Central America. Major motivation reported for EPA use is to improve patient safety by aligning performance and expectations and to improve student assessment. Several studies report on the use of EPAs to evaluate different curriculum models or identify curriculum gaps representing potential application in education research.

Entrustable Professional Activities in Clinical Education

“…This means that evidence, data collection, interaction with others, and indeed the integration of other theories or models may be used at any point in the action cycle. For instance, the frequently used Delphi consensus building approach 16 could be implemented for an action cycle phase. The outer action cycle begins at the base of the framework and rotates clockwise.…”

“…The primary drivers to incorporate EPAs that validate practitioner competencies are patient safety, patient-centered care, 9,16,17 and the optimization of the student experience to meet industry standards. A recent scoping review (N = 30) revealed that EPAs are used in the United States, Europe, Australia, and Central America in pharmacy, physician assistant, and dietitian programs as well as medical education programs.…”

“…28 Entrustable Professional Activities Assessment of competency performance can be challenging, with possible interassessor variations and performance inconsistency as well as the variety of settings in which competencies can be demonstrated. 16 Having explicit EPA directions for the context in which competencies are to be assessed, for example, common conditions or complex patient encounters, and within a specific population (child, adult, older adult), helps mitigate variances. When EPA activities have been assessed within diverse contexts and various condition complexities, summative entrustment decisions are reached.…”

“…A recent scoping review (N = 30) revealed that EPAs are used in the United States, Europe, Australia, and Central America in pharmacy, physician assistant, and dietitian programs as well as medical education programs. Their use has been reported as having high acceptability by academics, educators, supervisors, and preceptors, which accounts for their popularity 16…”

How can Entrustable Professional Activities serve the quality of health care provision through licensing and certification?

“…EPAs have enjoyed huge interest in all domains of health professions in many countries and constitute an important area of ongoing scholarly work. [1][2][3][4] In the literature, EPAs have been called objectives for education, a tool for assessment and sometimes even specific competencies. It is useful to reiterate here that each of these alone are not the best characterizations of EPAs.…”