Entrustable professional activities and entrustment decision-making for competency-based education in the health professions: an introduction

Since the turn of the millennium, competency-based education (CBE) has become a new standard for training in the health professions in many countries. Early work to operationalize CBE has included development of detailed frameworks of competencies that every physician should demonstrate. However, these models were criticized because they do not directly translate to everyday activities of practice. For that reason, entrustable professional activities (EPAs) were introduced in 2005. EPAs are units of professional practice that may be entrusted to trainees once they show the competencies needed to execute them without supervision. EPAs have become popular within competency-based programs in many countries, with numerous examples not only in medicine but in all health professions, including nursing, veterinary medicine, pharmacy, physical therapy, dentistry, and more. This chapter provides an overview of key foundational concepts related to EPAs. Beginning with a historical overview, the chapter provides a definition and rationale for EPAs. While competencies are qualities of individuals, EPAs are units of work. The two can be seen as dimensions of a matrix. Almost all activities in health care draw upon multiple, integrated competencies (communication and collaboration skill, professional behavior, content expertise, etc.). Next, entrustment decision-making as an approach to assessment is explained, as well as the associated framework of levels of supervision, ranging from ‘allowed to observe’ to ‘ready to be a supervisor.’ The chapter concludes with a summary of important considerations for building an EPA program.