Entrustable Professional Activities (EPAs) are an effective and proven assessment framework to translate competencies into daily healthcare practice. A core feature of EPAs is the Entrustable part. This entrustability is not an all-or-nothing qualification, but rather a growing level of independence. To make a trainee’s progress transparent, EPAs are evaluated using a scale of required supervision. But how do these supervision levels work?
In daily practice, trainers continually evaluate the level of supervision required by a trainee while performing certain EPAs. Their evaluation is shaped by observation and collaboration with the trainee. The supervision level required is formalized in the trainee’s portfolio. Ultimately, this summative assessment is based on trust, backed by observations by multiple staff members documented using formative assessments.
As the trainee follows their individual curriculum, they will progress through several levels of supervision, becoming increasingly independent. The end goal: performing the EPA independently.
After the trainee has completed the EPAs that together cover their specialisation, the program is finished and they can become a certified specialist.
Example case: 5 supervision levels of learning to ride a bike
Let’s make things a little more tangible, using an example that is near and dear to our Dutch roots: learning to ride a bike. Mastering an EPA in a medical setting is a lot more complex than learning to ride a bike. Still, the milestones to becoming skilled at either are very similar. Whether learning to ride a bike or learning to diagnose a patient, it is key to entrust trainees with an increasing amount of independence.
1. Observation
Watch and learn! You shouldn’t try to ride a bike if you’ve never seen anyone ride a bike. In this phase, you try to understand how it works and what it takes to control it.
2. Direct, Proactive Supervision
Got it? Now it’s time to give it a try. The first attempts can be a bit tricky. Fortunately, your experienced instructor will give you great advice along the way. They will help you stay balanced. They will stay close for as long as you need, right there to catch you if you should fall.
3. Reactive supervision
That’s it! Time to take off the training wheels. Clearly, you know how to handle yourself around a bike. Your instructor trusts that you can get around on your own in most cases, so they’re taking a step back. In this phase, you are really riding your bike on your own, but help is available on request. After your ride, you’ll want to discuss with your instructor how things went.
4. Supervision at a distance
Off you go! Both you and your instructor are confident that you can ride solo on any terrain. You are now entrusted with this skill. Of course, this doesn’t mean you can’t go on a bike ride together every once in a while, and you still have to know your own limits. And you will want to discuss your experiences with your instructor every now and then. Remember, there’s no shame in asking for a second opinion.
5. Supervision to others
So what’s next? You’ve become an expert at biking. You know about the challenges of riding in all kinds of weather. The world is your oyster, and you are now ready to guide others on this wonderful journey. At this point, you can step in and become an instructor to others.
Discover Reconcept EPA Portfolio
A successful EPA-based program requires a good overview of the trainee’s journey through the supervision levels of each EPA. Reconcept EPA Portfolio is our fully equipped platform to track and assess learning progress.
The platform was developed together with seasoned medical educators on the solid foundations of the EPA teaching method which originated in The Netherlands. Currently, over 80 teaching hospitals and 25,000 medical specialists and postgraduates use the app to support their learning journey.
We work together with teaching hospitals and institutions to prefill our platform with official EPAs and additional documentation to fully incorporate their specific program.
Find out more about how the features of our EPA Portfolio make practical training easy for both trainers and trainees.
- How to use EPAs in practice – 08-20-2024
- Workplace-Based Assessment in Today’s Medical Education – 08-01-2024
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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.