Entrustable Professional Activities and Entrustment Decision Making: A Development and Research Agenda for the Next Decade

Abstract

To establish a research and development agenda for Entrustable Professional Activities (EPAs) for the coming decade, the authors, all active in this area of investigation, reviewed recent research papers, seeking recommendations for future research. They pooled their knowledge and experience to identify 3 levels of potential research and development: the micro level of learning and teaching; the meso level of institutions, programs, and specialty domains; and the macro level of regional, national, and international dynamics. Within these levels, the authors categorized their recommendations for research and development. The authors identified 14 discrete themes, each including multiple questions or issues for potential exploration, that range from foundational and conceptual to practical. Much research to date has focused on a variety of issues regarding development and early implementation of EPAs. Future research should focus on large-scale implementation of EPAs to support competency-based medical education (CBME) and on its consequences at the 3 levels. In addition, emerging from the implementation phase, the authors call for rigorous studies focusing on conceptual issues. These issues include the nature of entrustment decisions and their relationship with education and learner progress and the use of EPAs across boundaries of training phases, disciplines and professions, including continuing professional development. International studies evaluating the value of EPAs across countries are another important consideration. Future studies should also remain alert for unintended consequences of the use of EPAs. EPAs were conceptualized to support CBME in its endeavor to improve outcomes of education and patient care, prompting creation of this agenda.

Entrustable Professional Activities in Clinical Education

“…38 Initially, faculty can garner knowledge on the development of EPAs and milestones using a hands-on approach. 38 Content regarding trust and what that means between the student and the assessor (capability, agency, integrity, reliability, humility) 39 ; using EPAs as a basis for meaningful feedback; case-based discussions to support assessment decisions; and digital guidance should be included. The availability of education material using a variety of delivery methods detailing the EPA concept and the technology system is essential for success and sustainability.…”

Competency-Based Medical Training in Anesthesiology: Has It Delivered on the Promise of Better Education?

“…11 Furthermore, they can be scaffolded for demonstrable progression of increased resident autonomy and responsibility in patient care on the path to independent practice. 12…”

“…19 To allow competency committees to make summative decisions, a resident’s education portfolio should include workplace assessments completed by a variety of faculty across a wide breadth of clinical contexts. 12 Unfortunately, programs are struggling to use the assessment data received for these purposes. 20 In the absence of platforms to manage and interpret the realms of data, programs can be challenged to support the growth of their residents and to make confident valid decisions on readiness for practice.…”

Entrustable Professional Activities: Reflecting on Where We Are to Define a Path for the Next Decade

“…27 EPAs, as important contributors to curriculum, are also highlighted as a component of the research agenda by ten Cate et al, where they note the importance of "using EPAs across the educational continuum and into practice. " 20 We believe this topic deserves crucial focus given the current known limitations of training, which are further compounded by the explosion of knowledge and technology that abolishes any notion that structured learning ends with training. In the current world, EPAs provide a bridge across the abyss that exists in learning and assessment between training and practice and create an opportunity for such a structure.…”

“…Ensuring that EPAs are always aligned with these, practice analysis updates would provide a system of checks and balances to keep EPAs focused on what is important for the profession, achieving a feedback loop between assessing EPAs and using identified gaps to improve curriculum, as advocated by ten Cate and colleagues. 20 What Is Preposterous, Possible, and Plausible in the Next 10 Years?…”