Entrustable professional activities and entrustment decision making in health professions training
In the 1990s and early 21st century competency-based medical education (CBME) became embraced in several countries in frameworks such as CanMEDS or the ACGME competency framework for physician training. A need was felt to move from time-based to competency-based medical education. The 2010 Carnegie Report on reform in medical school and residency proposed to move away from fixed time and variable standards, to a fixed-standards-flexible-pathways model.
CBME also met with some critique in the literature, as competencies seemed remote from clinical practice. The wish to bridge this gap between well-elaborated competency frameworks and clinical practice in patient care led to entrustable professional activities (EPAs), units of professional practice that may be entrusted to learners once they have demonstrated to have mastered the competencies needed to perform patient care safely. General competencies (communication skills, professionalism and collaboration skills etc.) remain critically important and must be evaluated, but they serve to inform the key objectives of training: the professional activities.
EPAs also lead to a different view on workplace assessment of trainees. Central are Entrustment decisions (‘Can we trust the learner to work unsupervised?’), graded responsibility in patient care and adequate supervision.
An increasing number of medical schools and postgraduate medical specialty programs incorporate EPAs. In addition, nursing education, veterinary education, dental education, pharmacy education, physician assistant training and even teacher training are beginning to use the concept.
While this all happens quickly, there remains a need to address the validity of these new concepts and applications. The scholarly aspects of EPAs and entrustment decision making will be the focus of this presentation.