Entrustable Professional Activities (EPA) page
Entrustable Professional Activities (EPAs) are defined as a unit of professional practice (tasks or responsibilities) that a learner with sufficient competence is entrusted to perform without direct supervision. EPAs integrate multiple competencies and capture concrete tasks for daily clinical practice1. The EPAs reflect activities a first year resident is expected to perform without direct supervision (supervisor not in the room but available to provide assistance) on day 1 of residency2. The assessment in Phase 4 includes the following 14 EPAs, which have been linked to the appropriate CanMEDs roles and MD program objectives:
- EPA 1: Obtain a history and perform a physical examination adapted to the patient's clinical situation [AFMC]
- EPA 2: Formulate and justify a prioritized differential diagnosis. [AFMC]
- EPA 3: Formulate an initial plan of investigation based on the diagnostic hypotheses. [AFMC]
- EPA 4: Interpret and communicate results of common diagnostic and screening tests. [AFMC]
- EPA 5: Formulate, communicate and implement management plans. [AFMC]
- EPA 6: Present oral and written reports that document a clinical encounter. [AFMC]
- EPA 7: Provide and receive the handover in transitions of care. [AFMC]
- EPA 8: Recognize a patient requiring urgent or emergent care, provide initial management and seek help. [AFMC]
- EPA 9: Communicate in difficult situations. [AFMC]
- EPA 10: Participate in health quality improvement initiatives. [AFMC]
- EPA 11: Perform general procedures of a physician. [AFMC]
- EPA 12: Educate patients on disease management, health promotion and preventative medicine. [AFMC]
- EPA 13: Collaborate as a member of an interprofessional team. [AAMC]
- EPA 14: Incorporate relevant social determinants of health (SDoH) and cultural safety in relation to patient’s illness and management planning. [Memorial University]
AFMC: EPAs adapted from https://www.afmc.ca/web/en/faculties/entrustable-professional-activities
AAMC: EPa adapted from https://www.aamc.org/what-we-do/mission-areas/medical-education/cbme/core-epas/publications
Memorial University: EPA developed by Faculty of Medicine; pilot introduction for 2021-2022 academic year
Assessment of EPAs uses the concept of entrustment. A learner is either ready to be entrusted to perform a specific task (EPA) without direct supervision (“entrustable”) or not yet ready to do so (“pre-entrustable”). The above documents outline the entrustable and pre-entrustable behaviours for each EPA. Learners should review those descriptors as this may guide their learning. Becoming ready to be entrusted is a longitudinal process and takes time! It is expected that learners will not be assessed as “entrustable” for most EPAs within their first rotations of the Core Experiences course.
Refer to the Assessment during Core page for more information on assessment tools, workflow and progress monitoring.
The EPAs for each discipline are listed in the following documents:
EPAs for Anesthesia
EPAs for Emergency Medicine
EPAs for Internal Medicine
EPAs for Obstetrics and Gynecology
EPAs for Pediatrics
EPAs for Psychiatry
EPAs for Rural Family Medicine
EPAs for Surgery
Medical learners must be appropriately supervised at all times to ensure patient and learner safety. The level of responsibility delegated to learners must take into account their level of training, and the level of supervision must take into account their level of entrustability. Learners who do not feel competent to perform a particular activity must inform their preceptor(s).
More information regarding EPA assessment during Selectives/Electives is outlined in the appropriate Selectives/Electives document.
1Ten Cate O, Chen HC, Hoff RG, Peters H, Bok H, van der Schaaf M. Curriculum development for the workplace using Entrustable Professional Activities (EPAs): AMEE Guide No. 99. Med Teach. 2015;37(11):983-1002. doi: 10.3109/0142159X.2015.1060308. Epub 2015 Jul 14. PMID: 26172347.
2AFMC: Entrustable Professional Activities for the Transition from Medical School to Residency