Integrating key concepts in workplace-based assessment: entrustable professional activities, programmatic assessment, and milestones

Despite their independent origins, entrustable professional activities, Milestones, and programmatic assessment are interconnected concepts within the domain of competency-based education. While some organizations prioritize the use of entrustable professional activities, others prefer using Milestones. Simultaneously, competency-based education in health professions has embraced programmatic assessment as a core concept. A question raised regularly is how the three relate and whether they can be used in combination when designing an assessment system. This chapter aims to offer definitions of the three concepts and explore their mutual reinforcement, benefiting the quality of health professions education and, ultimately, patient care. To facilitate health professions trainees’ progression along their educational path and enhance their autonomy through entrustment with specific clinical tasks, every curriculum needs a program of assessment. This chapter illustrates the alignment of the three concepts and provides practical examples on how they come together in a program of assessment. In summary, the seemingly distinct concepts share more common ground than previously acknowledged. By integrating the concepts, growth in context-dependent performance from novice to expert levels can be fostered, all while promoting learning in conjunction with high-stakes entrustment decision-making.