AM Last Page

Definition and rationale. Entrustable professional activities (EPAs) are tasks or responsibilities that faculty entrust to a trainee to execute, unsupervised, once he or she has obtained adequate competence. EPAs are executable within a given time frame; observable and measurable; and suitable for focused entrustment decisions. 1 EPAs are units of work (e.g., anesthetic care of an uncomplicated patient), while competencies describe people's abilities (e.g., knowledge, professional attitude, communication skill). Units of work and abilities of persons can be viewed as two dimensions of a grid. Competencies remain theoretical if not grounded in practice. Consulting new ambulatory patients Providing first treatment of mild traumas Leading an inpatient ward Initiating cardio-pulmonary resuscitation Discussing medical errors with patients Multiple competencies are at stake with most activities. The dots show the most relevant competency-domains for each example EPA. EPAs link competencies to work. EPAs can serve as the primary focus of competency-based training: Supervisors can observe trainees executing an EPA, but through a lens of competencies. Supervision. Mastery of an EPA is marked by a formal entrustment decision for unsupervised practice. It is competency-based, rather than time-based, and different trainees in different settings reach a particular EPA at different times. Clinical oversight is sufficient once the entrustment decision is made, after an earlier decrease of supervision. Each level of supervision reflects different authorization to act. Level 4 is the privilege to work unsupervised and should be documented (e.g., as Statement of Awarded Responsibility STAR). 1. Observing the activity 2. Acting with direct supervision present in the room 3. Acting with supervision available within minutes 4. Acting unsupervised (i.e., under clinical oversight) 5. Providing supervision to juniors a. Title b. Description c. Link with the competency framework d. Required knowledge, skills and attitudes e. Information sources to assess progress f. Conditions for level 4 supervision g. Method to arrive at a justified entrustment decision for this EPA EPA design. EPAs should be chosen and elaborated carefully to create maximum clarity; they should refer to a " job to be done, " and they should not be too detailed. Clarity is served with a two page text. A title should be supplemented with a description of what is included and its limitations. The most relevant competencies (e.g., see grid above) should guide the entrustment decision process. Trainees should know what knowledge and skills are expected of them to be awarded a STAR, and specific information sources …