Optimizing Use of Entrustable Professional Activities (EPAs) for Trainee Success

Stay on the leading edge of learning and assessment best practices through these efficiencies in mapping Entrustable Professional Activities

The goal of graduate medical education (GME) is to advance learners after completion of medical school into the world of independent practice. While many medical education institutions’ assessment methods are competency- and milestone-based, faculty continue to face challenges in providing a comprehensive assessment, partially due to the lack of clinical context contained in the milestones.

We were privileged to hear from Dr. David Turner, Vice President for Competency-Based Medical Education at the American Board of Pediatrics (ABP), who shared how the ABP is transitioning to using Entrustable Professional Activities (EPAs) in pediatrics.

Read the summary below or watch the full webinar to learn more.

What are Entrustable Professional Activities?

Entrustable Professional Activities (EPAs) are observable activities that a trainee should be able to perform safely and effectively to meet the needs of their patients. In other words, EPAs integrate competencies and milestones into a patient-centered clinical context.

Having trouble envisioning what that means for educators? Dr. Turner shared a great example.

Picture a teenager learning to drive a car. There are several competencies necessary to independently drive a car, like using the gas or brake pedals while driving. These competencies are important to the overall activity of driving a car, and there are milestones toward each of those competencies. As the teenager advances, the process becomes smoother. Yet, you could have someone that performs well at using the brake but is still not a very good driver because they are not able to incorporate all the competencies in the situational context of driving. In this case the critical activity (i.e., EPA) is the ability to drive the car safely.

In graduate medical education (GME), it is crucial that a trainee progresses to the point that they are ready to perform these larger activities without supervision (like a teenager driving a car). In addition to facilitating assessment of numerous specific competencies, EPAs are also helpful in developing patient-centered learning experiences for physicians.

How do EPAs benefit graduate medical education?

1. Entrustable Professional Activities integrate milestones to provide data for assessment decisions. By using EPAs to assess learners, suggested milestone ratings can be easily auto-populated, combined with EPAs, and used as part of the assessment in decision-making during Clinical Competency Meetings. Ultimately, EPAs simplify data collection for program administrators and leadership and give more context in identifying areas for improvement when reviewing a resident or fellow’s progress.
2. Assessment is intuitive, growth-focused, and flexible. Entrustment decisions are made based on the level of supervision needed, creating a very intuitive approach to assessment. Faculty can easily identify the level of needed supervision per activity. If a learner is not ready for unsupervised practice, faculty can begin asking the right questions – based on data – and use a growth-focused improvement plan to help learners in a formative way.
3. Programs are empowered to fill gaps in training through education design using EPAs. Research shows that there are several areas (such as behavioral and mental health) in which graduating pediatric residents are not prepared for unsupervised practice, highlighting gaps to be addressed at the programmatic and individual levels. By using EPAs, these gaps can be identified and addressed.
4. Entrustable Professional Activities focus on activities important to achieve optimal patient outcomes. This patient-centered approach allows programs to achieve their mission of improving health within their specialty.
5. GME institutions and programs can more nimbly address emerging topics and challenges. Throughout the COVID-19 pandemic, training was disrupted, and programs struggled to determine whether trainees were ready to advance. EPAs help programs in identifying performance or curricular gaps and address them early on, enabling them to improve the quality of their programs while assessing educational outcomes.
6. The EPA process is future-focused. Entrustment and mastery are earned over time, and this doesn’t end when residency or fellowship training ends. When thinking about certification and the life-long learning process, EPAs can help create a smooth continuum in supporting physicians as they move from a training environment to board certification.

How can MedHub support Entrustable Professional Activities?

1. Milestone management. Rather than building them yourself, you can import EPAs just like you would sub-competencies. You can tag questions to EPAs and link EPAs to sub-competencies to lay the groundwork for use in your institution.
2. Evaluations. Map evaluations and simplify evaluation forms by tagging EPAs (as well as sub-competencies) within your evaluations.
3. Milestones summary. With milestones tagged to EPAs, you can see the longitudinal progress of the EPAs (along with sub-competency information) for each resident, track their supervision level needs, and have additional valuable data to use during CCC meetings.

MedHub residency management software puts valuable resident progress information at your fingertips with the ability to map and track milestones, sub-competencies, and EPAs. MedHub can help incorporate EPAs into your training program assessments to keep you on the leading edge of medical education and most importantly, improve learning outcomes.

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