Twelve tips for the implementation of EPAs for assessment and entrustment decisions

Abstract

The concept of entrustable professional activities (EPAs) reframes the approach to assessment in competency-based medical education. Key to this concept is the linking of assessment to decision making about entrusting learners with clinical responsibilities. Based on recent literature and the authors' experiences with implementing EPAs, this article provides practical recommendations for how to implement EPAs for assessment and entrustment decisions in the workplace. Tips for supervising clinicians include talking to learners about trust, using EPA descriptions to guide learning and teaching, providing learners with greater ad hoc responsibilities, using EPAs to identify/create opportunities for assessment and feedback, including case-based discussions and acknowledging gut feelings about learner readiness for more autonomy. Tips for curriculum leaders entail enabling the trust development, applying trust decisions at all levels of the supervision scale, employing all available information sources for entrustment, empowering learner ownership of the assessment process and using technology for learner tracking and program evaluation.

Twelve tips for teaching twelve transferable skills

“…Different abilities will be required at different points in education and training, and some skills will need to be revisited spirally (e.g. to build entrustability; Peters et al, 2017). Thus, it is important to align provision of teaching and assessment to points of transition; surveying pre-existing skills at entry (McLean et al, 2011) and providing appropriate orientation and induction.…”

“…This may be facilitated by including various opportunities to involve expert staff, peers, patients or other members of the public; particularly if developing an entrustable framework (e.g. trust when supervised directly, indirectly, unsupervised, to supervise, or to assess others; Peters et al, 2017). In any case, there needs to be appropriate mechanisms to flag additional opportunities for developing transferable skills and to provide support where needed.…”

Entrustable Professional Activities in final year undergraduate medical training – advancement of the final year training logbook in Germany

“…In addition, there is the possibility of defining less comprehensive EPAs for the study phase prior to the FY, that build on and complement one another (“nested EPA”), which then lead to the less extensive “core EPAs” in the FY [11]. Thus, the SWG FY-Logbook deliberately took a different path than other current national and international initiatives that try to embed EPAs in medical school [9], [10], [11], [16], [18], [31]. In this way, a new approach to training in the FY, with a stronger professional orientation and with the integration of the students into a team of employees from the various health professions, was to be achieved.…”

“…Experiences with EPAs in Germany are limited to a few individual medical schools [7], [14], [15], [16], while comprehensive approaches over all medical schools are missing. The FY seems to be particularly suitable for implementing the EPA concept, as according to the medical licensure law (ÄApprO) and the learning objectives for the FY in the NKLM, students are supposed to “deepen and extend the knowledge, skills and abilities acquired earlier in their studies”.…”

“…doctor’s letter/report). A larger percentage of the entrustment decisions is based on continuous supervision in a professional environment and a smaller percentage on additional structured observations in practice [16], [18]. The act of entrustment always involves a certain degree of subjectivity between the teaching doctor and the trainee [23].…”