The Case for Use of Entrustable Professional Activities in Undergraduate Medical Education

Abstract

Many graduate medical education (GME) programs have started to consider and adopt entrustable professional activities (EPAs) in their competency frameworks. Do EPAs also have a place in undergraduate medical education (UME)? In this Perspective article, the authors discuss arguments in favor of the use of EPAs in UME. A competency framework that aligns UME and GME outcome expectations would allow for better integration across the educational continuum. The EPA approach would be consistent with what is known about progressive skill development. The key principles underlying EPAs, workplace learning and trust, are generalizable and would also be applicable to UME learners. Lastly, EPAs could increase transparency in the workplace regarding student abilities and help ensure safe and quality patient care. The authors also outline what UME EPAs might look like, suggesting core, specialty-specific, and elective EPAs related to core clinical residency entry expectations and learner interest. UME EPAs would be defined as essential health care activities with which one would expect to entrust a resident at the beginning of residency to perform without direct supervision. Finally, the authors recommend a refinement and expansion of the entrustment and supervision scale previously developed for GME to better incorporate the supervision expectations for UME learners. They suggest that EPAs could be operationalized for UME if UME-specific EPAs were developed and the entrustment scale were expanded.

Effectiveness of a rural longitudinal integrated clerkship in preparing medical students for internship

“…Through the extended association between clinician educator and student, medical students become trusted to take on more of the role of a practitioner, to 'act up' (Brennan et al, 2010), in a carefully supervised structure (Hirsh, Holmboe, & ten Cate, 2014), carrying out entrustable professional activities (Chen, van den Broek, & ten Cate, 2014;Englander & Carraccio, 2014;Teherani & Chen, 2014;Ten Cate, 2014a). Students form a professional identity through extended patient contact experiences that give them the ability to reason through medical problems while exploring their own feelings in a supportive environment (Konkin & Suddards, 2012).…”

Assessing the value of entrustment during high fidelity simulation – an innovation pilot

“…The literature highlights the importance of assessing when a learner can be entrusted to perform a particular curricula element unsupervised encompassing the domains of knowledge, skills and attitudes (1). Whilst the EPA discussion is currently focused on residency entry and the appropriate EPA choice, there has been interest about its potential in an undergraduate setting with the argument of assessing developmental progression and in enhancing the integration of classroom and workplace learning (2).…”

“…Both the pre teaching session and simulation scenarios had been reviewed by emergency physician doctors and simulation experts to ensure clinical accuracy. We recognize the use of different scales within the literature and chose to avoid over complex descriptors and whether learners could then be entrusted to supervise others with the focus predominantly on the supervisor's perspective (2). We were also assessing the learners as a group as opposed to individually in view of the simulation setting.…”

Core Entrustable Professional Activities for Entering Residency Pilot Group Update: Considerations for Medical Science Educators

“…Many of the core EPAs can be described as a collection of smaller components, or Bstepping stones,^that build to the ultimate task. Some of these components must be introduced and practiced at early stages of training, before the student is ready to participate in the direct care of patients [6].…”