Use of entrustable professional activities in pre-licensure health professions education

This chapter introduces how entrustable professional activities (EPAs) can be implemented in the pre-licensure stage of education (e.g., undergraduate health professions education), with a focus on how trainees can contribute to patient care in a legitimate participatory role prior to licensure. The relative freedom of trainees from workplace-based productivity provides pre-licensure training with a great deal of flexibility. Such flexibility allows creativity and different approaches to laying the canonical foundation for specific EPAs, preparing trainees for clinical training based on EPAs and entrustment, and establishing an appreciation for how entrustment represents an assurance of readiness for safe patient care rather than a grade. Educators can leverage the required knowledge, skills, and attitudes detailed in EPA descriptions to ensure that foundational science courses are preparing trainees for clinical care. The transition from canonical knowledge to more EPA-focused activities is ideally via a ‘Z-shaped’ curriculum. Factors of a trainee’s trustworthiness, which underlie entrustment in later clinical stages of training, can be explicitly introduced, explored, and strengthened in pre-workplace-based settings. Lastly, the chapter delineates how early pre-licensure workplace-based learning founded on EPAs provides opportunities to introduce contextual competencies, while advanced workplace-based education further refines practice with limited supervision, preparing trainees for the transition to additional post-licensure training or licensed practice.