Entrustable professional activities in health care education: a scoping review

Abstract

CONTEXT The shift in medical education from time-based learning to outcome-based learning has drawn much attention to entrustable professional activities (EPAs) as an ideal assessment framework to translate competencies into clinical practice. Given the relative novelty of EPAs, this review aims to highlight research gaps and explore and consolidate available evidence pertaining to the development and implementation of EPAs in health care.RESULTS Eighty articles were included in the review. All articles were published between 2010 and 2018. Three major themes and eight subthemes were generated: (i) development of EPAs (frameworks for EPA development and implementation, identifying core or specialtyspecific EPAs, and EPAs for faculty development), (ii) evaluation of EPAs and EPA entrustment factors (revised curriculum, entrustment decisions for professional activities, and feedback on implemented EPAs and the development process), and (iii) future directions and recommendations for EPAs (implementation of EPAs in undergraduate medical education and specific disciplines, and other criticisms and recommendations for EPAs).CONCLUSIONS Entrustable professional activities are an essential means to translate competencies into observable and measurable clinical practice. However, high-level evidencebased research on the efficacy, development and implementation of EPAs for specific target groups (i.e. undergraduates and staff) and geographical regions (i.e. Asia and Africa) is still lacking, which suggests a direction for future research.

Seeking trust in entrustment: shifting from the planning of entrustable professional activities to implementation

“…1 Fortunately, the general practice setting is well placed to educate our future doctors, especially in the areas of promoting patient-centred care, communication and clinical skills. 2,3 Demand for primary care health professionals is increasing as health care delivery shifts to general practice settings to achieve major advantages for patients and their families and economic benefits for patients and government . .…”

“…4,5 Students highly value general practitioners' (GPs') teaching roles and the individualised education, time and feedback they provide, 6 and most literature supports GPs as having personal qualities and attributes that make them good teachers. 2,3,7 However, it must be noted that GPs work in an evolving and unique environment and, thus, have unique training needs to support their educational role that may demand further innovation to support the professional identity development and practice of GPs as educators.…”

“…As defined by ten Cate, EPAs constitute the core activities of physicians' work that are observable and measurable and can be entrusted by a supervisor to a trainee with a certain amount of autonomy. 1 The scoping review by Shorey et al 2 on the use of EPAs in health care education identifies the many initiatives to develop EPAs and thereby confirms the widespread enthusiasm for this framework across the medical education continuum. This review 2 should prompt educators to step back and assess progress with this approach to assessment given that the time to shift from defining and planning EPAs to implementing them has come.…”

“…To represent the work of a profession, and enable assessment of learners' performance, it is important that a programme's EPAs be treated not as a list of titles, but, rather, as detailed descriptions of the knowledge, behaviours, attitudes and approaches to observation and assessment required by particular practitioners. 2,3 Implementation requires confronting the challenges involved in using entrustment, and ratings in general, as the basis for describing learner performance Entrustable professional activities define and elaborate professional activities, but entrustment ratings describe the performance. To fully understand this translation warrants the further exploration of questions regarding entrustment.…”

Development of an entrustable professional activities (EPAs) framework for small group facilitators through a participatory design approach

“…These practices provide rich evidence of how EPAs can be used in faculty training activities. However, there is a paucity of research on designing EPAs for specific teaching domains, such as small group teaching, bedside teaching, mentoring, and others [14,25].…”