Entrustment decision making in EPA-based curricula

Presented by Olle ten Cate, PhD on September 22, 2016 at 12:00 pm

Assessment of clinical competence is an ongoing topic of debate among medical educators. Competency-based medical education intends to train and assess residents and students who meet predefined standards. The quest for psychometrically valid assessments, i.e. sound measurement of trainee competencies, to provide sufficient certainty to the public that all those who complete undergraduate medical education are ready for residency, and all those who complete graduate medical education are ready for unsupervised practice, has not yet yielded a gold standard for evaluation. A new concept in workplace training and assessment is Entrustable Professional Activities (EPAs), units of professional practice that learners may execute without supervision once they have satisfactorily demonstrated to possess the relevant competence in postgraduate specialty training, or indirect supervision in undergraduate medical education. EPA-based curricula with entrustment decisions provide a conceptual change in perspective on both the standards for competence and their evaluation among trainees. This presentation will focus on entrustable professional activities for curriculum development and assessment, the concept of entrustment as part of assessment and entrustability scales that use levels of supervision as anchor points. The connection with milestones will be highlighted. While EPA-based assessment is new and there is yet limited experience with EPA-based curricula, there are a number of arguments to guide a development in that direction.