Competency-Based Medical Education (CBME) is rapidly becoming the standard. You may have heard about EPAs, but how do they relate to CBME and what does their practical application look like?
What are EPAs?
Entrustable Professional Activities (EPAs) are an effective and proven assessment framework to translate competencies into daily healthcare practice.
The term EPA was first used in the context of medical education at the beginning of this millennium by renowned Dutch medical educator Professor Olle ten Cate. He introduced the concept as a framework that helps shape the professional development of trainees in a competency-based training environment.
Competencies refer to broad and overarching abilities that encompass various aspects of medical practice, combining knowledge, skills, and attitudes. They are useful to broadly describe professional standards. However, they do not necessarily indicate if a professional in training can apply these competencies in a practical healthcare situation.
It’s important to note that EPA’s do not aim to replace existing competency frameworks. Most healthcare educators are used to working with some kind of competency framework. Examples are the Canadian CanMEDS Physician Competency Framework (Frank et al. 2015), the Accreditation Council for Graduate Medical Education (ACGME) Core Competencies in the USA (Batalden et al. 2002), and the General Medical Council’s Tomorrow’s Doctors framework in the UK. A well-designed and implemented EPA can capture how future professionals will integrate relevant competencies coming from these frameworks into professional activities.
Since their introduction, EPAs have gained popularity in medical education programs worldwide, and are now even being applied in other disciplines such as nursing and dentistry. This illustrates the growing importance of practical assessments and recognizes the significance of professional activities in the training of future healthcare professionals across the board.
How EPAs Relate to Workplace-Based Assessments
Workplace-Based Assessments (WBAs) are a great way to ensure structured periodical assessment of EPAs. Ideally, a WBA is a short instrument that focuses on positive feedback and points for improvement. We’ve elaborated on the practical application of WBAs in a previous article.
The WBA takes a practical situation as a starting point, just like the EPA. Therefore, a WBA should naturally fit into one (or more) EPA context(s) and the EPA requirements can be used to make feedback more specific and actionable. A collection of WBAs together serves as evidence of the trainee’s effort and progress.
How to design good EPAs
To implement EPA-based education, program designers should define a set of EPAs that together cover the essence of their field. When defining an EPA, you should always be able to answer the question ‘Is it something that can be entrusted’. For example: ‘Medical Knowledge’ and ‘Professionality’ are not things that can be entrusted, but ‘Diagnosing and treating a patient with asthma’ is.
The purpose of EPAs is not to define each and every detail of the job as a checklist, but rather to give a representative overview of the responsibilities of the specialist. The coverage of an individual EPA should be broad enough that it does not lead to micromanagement and excessive administration, but narrow enough to be meaningful. For example, having a hundred EPAs for each type of patient is probably not feasible. However, if your only EPAs are ‘Performing surgery’ and ‘Making a treatment plan’, they are so broad that they can only truly be entrusted after finishing years of training. In our experience, the ideal number of EPAs for a medical specialty lies between ten and twenty.
Each EPA comes with a description that clearly defines the practical situation to which it applies. Furthermore, it should list the required knowledge, skills, and attitude and how the EPA should be assessed. Optionally, it could mention the phase of the curriculum in which the trainee is expected to have completed the EPA, but this should only be indicative.
Download the EPA Worksheet
We’ve developed a handy printable worksheet that helps you and your colleagues draft your first EPAs. Click the below button to download it from our website.
How an EPA Portfolio Can Boost Medical Education
To put EPA-based education into practice, it is essential to have a good overview of each trainee’s trajectory. This includes their past achievements, their current level of independence, and their future learning goals. Furthermore, there should be an easy way for trainees and trainers to perform Workplace-Based Assessments.
A good EPA portfolio app combines all these features to facilitate any EPA-based program and is a tremendous help in implementing and communicating this new way of learning. Find out how others have successfully implemented our EPA Portfolio app.
Learn More
Are you curious to find out how Reconcept EPA Portfolio can fit into your curriculum? Download our Information Package or schedule a live demo with us.