Translating Competencies into Meaningful Clinical Activities. As medical education continues to evolve toward competency-based models, Entrustable Professional Activities (EPAs) are emerging as a powerful bridge between abstract competencies and real-world clinical practice. EPAs offer a practical and observable framework that supports learners’ development toward independent responsibility. But how do you actually design clear and effective EPAs? In this article, we’ll walk you through the essential elements of EPA design, using practical examples and best practices to help you get started.
What is an EPA?
An Entrustable Professional Activity (EPA) is a key task in professional practice that can be entrusted to a learner once sufficient competence has been demonstrated. Unlike traditional competencies, which are often abstract and difficult to assess in practice, EPAs are grounded in day-to-day clinical responsibilities. Think of them as the answer to the question: “What do I need to be able to trust this trainee to do unsupervised?”
A well-designed EPA allows educators to make meaningful decisions about learner readiness, while giving trainees a clear and structured path to independent practice.
Criteria for a Well-Designed EPA
A good EPA has four defining components. Let’s break them down.
1. Entrustability and Scope
The EPA must describe a task that is entrustable—something that a supervisor can realistically assign to a trainee for independent execution. It should be clearly defined and fall within the scope of real-world responsibilities. Avoid vague terms like “medical knowledge” or “professionalism”—these are competencies, not entrustable activities.
Instead, focus on specific tasks. For example:
Not good enough: “Demonstrate professionalism”
Well done: “Diagnose and treat a patient with asthma”
The scope should be broad enough to avoid micromanagement, yet narrow enough to remain meaningful and assessable.
2. Practical Situation
Each EPA should specify the context in which it applies. This ensures clarity and consistency during assessment. In our asthma example, this could be:
“Diagnosing and treating a patient with asthma in a primary care setting.”
This helps align expectations for both learners and assessors and ensures the EPA reflects actual clinical practice.
3. Required Knowledge, Skills, and Attitudes
Clearly listing what a learner needs to know and be able to do is essential for both teaching and assessment. These should be broken down as follows:
- Knowledge: The essential knowledge required to perform the EPA. e.g., Asthma pathophysiology, treatment guidelines, medication classes, patient education strategies.
- Skills:The essential skills that a learner should be able to perform to master this EPA. e.g., Taking patient history, performing physical exams, interpreting spirometry results, developing treatment plans.
- Attitudes: The attitudes that a learner should display while carrying out this EPA. e.g., Showing empathy, involving patients in decision-making, collaborating respectfully with colleagues.
This clarity helps structure feedback and guides the learner’s development.
4. Assessment Strategy
To ensure a structured and objective evaluation, each EPA should define how and with which tools progress will be assessed. Common tools include:
- Workplace-Based Assessments (WBA)
- Case-Based Discussions (CBD)
- Patient Simulations
- Patient Feedback Forms
These assessments—especially when used formatively—build the foundation for a summative entrustment decision made by multiple observers.
Example: EPA for Asthma Care
Let’s summarize the process with a practical example:
EPA Title: Diagnosing and treating a patient with asthma
Context: In a primary care setting
Knowledge:
- Pathophysiology of asthma
- National treatment guidelines
- Medication mechanisms and side effects
- Patient education approaches
Skills:
- History-taking and physical examination
- Spirometry interpretation
- Shared decision-making
- Treatment planning
Attitudes:
- Empathy and active listening
- Patient-centered care
- Respect for team collaboration
Assessment tools:
- Workplace-Based Assessments
- Patient simulations
- Case-Based Discussions
- Structured patient feedback
This structure ensures the EPA is observable, assessable, and grounded in real-world tasks—key traits of a strong educational framework.
Final Thoughts
Designing EPAs takes practice, collaboration, and a clear understanding of clinical responsibilities. When done right, EPAs can significantly improve the clarity, transparency, and effectiveness of medical training. They empower both educators and learners with a structured, practical way to translate competencies into daily practice. By clearly defining EPAs, you lay the foundation for better education, safer practice, and more confident healthcare professionals.
To help you get started, we’ve developed an EPA Worksheet—a practical tool that guides you through the steps of EPA design. You can download it here. Besides that, we have covered everything you need to know about EPAs in just 20 minutes in a webinar. You can watch this webinar here.
