Mar 28, 2019

Measuring Progress with Entrustable Professional Activities (EPAs)

EPA Chart

Written by: Dr. Janet Bodley, Associate Professor with the Department of Obstetrics and Gynaecology

With Competence-By-Design (CBD) implementation around the corner, we would like to introduce the concept of Entrustable Professional Activities (EPAs). These are key tasks that an individual resident can be trusted to perform without direct supervision, once sufficient competence has been demonstrated.

EPAs allow for authentic, work-based assessment that is targeted at the daily tasks of a physician. They were created by the ObGyn Royal College Subspecialty Committee as a focus for teaching and learning the abilities essential for each stage of the residents’ training.

It might help to visualize an EPA as a basket or a bundle. For each EPA there are various skills, also known as milestones, that are needed to perform that task. As an individual works towards entrustment, they will need to develop each of those milestones (see diagram below).

EPA Chart

There are EPAs associated with each stage in the Royal College competence continuum (e.g. Transition to Discipline, Foundations of Discipline, Core of Discipline, Transition to Practice) and, as a resident progresses through these stages, the EPA bundles become progressively more complex, reflecting the resident’s achievement of more sophisticated milestones.

Below are links to the two ObGyn Transition to Discipline (TTD) EPAs that incoming PGY1s will be focusing on during the first three blocks of residency:

ObGyn Transition to Discipline – EPA #1

ObGyn Transition to Discipline – EPA #2

EPAs and Residents

One of the key motivations for CBD has been encouraging greater agency and promoting lifelong learning. With EPAs, residents have the opportunity to better monitor their progress and solicit feedback from supervisors on areas where they may feel less confident.

EPAs are formative, low stakes assessments. Residents are encouraged to make the most of their time on rotation by asking supervisors for feedback whenever possible and not just when they feel they are entrustable in a given EPA. The program will be looking for multiple observations with progress over time (not perfection from the beginning).

EPAs and Supervisors

As supervisors, faculty will be observing residents perform an individual EPA multiple times and coaching them to improve their performance. Supervisors may initially refer to each of the milestones associated with an EPA to inform their feedback on specific elements of the task, but as they become familiar with the EPAs and milestones, they may find that they ‘unpack’ an EPA (i.e. look at all of the milestones) only to plan their teaching or to help a resident who is struggling to progress.

EPA Digital Tool

EPA progress will be tracked with a digital tool that is easy to use and permits supervisors to make rapid decisions about whether they can entrust a resident to perform a task independently. There will be more about entrustment scales and the digital tool at the CBD Development Day on April 12th and in the May ObGyn Newsletter.

More information about EPAs can be found here:

UofT PGME Resources:


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