Competency-Based Education: Development of the Entry-Level Pain Entrustable Professional Activities for Workplace-Based Assessment

Importance The physical therapy profession is being called to adopt a competency-based education (CBE) model, following the lead of other health professions. A key element of CBE is workplace-based assessment, in which clinicians evaluate learners’ readiness to perform essential clinical tasks through Entrustable Professional Activities (EPAs). Although a common set of EPAs exist for the profession, none currently guide assessment and learning in specialty areas like pain. Objective The objective of this study was to describe the development and initial validation of pain-specific Entrustable Professional Activities (Pain EPAs) designed to assess physical therapist clinical competency in managing pain within a CBE framework. Design This was a developmental study following published recommendations for EPA creation, including preparation, drafting, quality control, and curriculum alignment. Setting The study was conducted across 4 American universities. Participants Five American-based physical therapists collaborated on EPA development and gathered feedback from educators, clinicians, and an 8-person reactor panel. Intervention The intervention involved developing Pain EPAs through expert consensus and external review for alignment with competency frameworks. Main Outcome The main outcome was a set of Pain EPAs reviewed for clarity, observability, and assessability using the EQual rubric, with external feedback guiding their categorization. Results Twenty-one Pain EPAs were developed and aligned with pain competency frameworks, with feedback organizing them into 4 levels of increasing complexity and autonomy: generalist, pain-specific entry-level, specialty clinic entry-level, and advanced practice. Conclusions This study outlines a structured, replicable approach for developing EPAs aligned with CBE principles. The Pain EPAs provide an initial framework to assess readiness for autonomous pain management tasks. Further research is needed to establish their validity and support implementation in entry-level and post-professional training. Relevance The Pain EPAs support CBE workplace-based assessment in physical therapist education. This approach can be adapted for other specialty areas within physical therapist practice.