Entrustable professional activities: addressing confusions and controversies

In this chapter, we address common confusions and controversies with entrustable professional activities (EPAs). With an eye toward practicality, we seek to offer resolutions or advice for these controversies where possible. We detail the differences between competencies and EPAs and discuss how they are complimentary approaches to health professions education that employ different lenses (individuals for competencies, and activities for EPAs). We next detail how EPAs should not be treated as an ‘assessment tool’ but rather as an approach to education that facilitates a stepwise decrease in supervision within the philosophy of competency-based education. Many terms related to EPAs and entrustment are conflated or poorly understood. This chapter disentangles many of these terms, including entrustment, supervision, trustworthiness, competence, supervision, autonomy, and independent practice. With precise definitions for these terms, it becomes clear how entrustment decisions are a forward-looking decision for the future rather than a report of past performance or supervision provided. Finally, we explore how EPAs and entrustment can support time variability and also how approaches to entrustment vary between contexts and cultures.