This page details all the Entrustable Professional Activities (EPA) roles and responsibilities. There are many groups and individuals involved in the implementation, assessment and oversight of EPAs.
Entrustability Scale
The goal of prevocational training is to reach the required level of entrustability by the end of the year, therefore it is not necessary that entrustability is reached for every EPA during the year.
EPA assessors are asked to make a judgement on the degree of entrustment for each EPA assessment.
You can find the AMC’s three-point entrustability scale below. Please note that this scale is the only approved assessment scale.
Requires Direct Supervision
“I needed to help a lot or asked lots of extra questions”
Requires Proximal Supervision
“I needed to help a little bit or just clarified a few things”
Requires Minimal Supervision
“I didn’t need to help (even though I was observing and still expect the doctor to run cases by me)”
EPA Roles and Responsibilities
The Assessment Review Panel uses the end-of-term assessments, the EPA assessments and any other learning activities documented in Clinical Learning Australia (formally known as the AMC ePortfolio) to make a global judgement on the progress of the prevocational doctor. They will meet periodically during the year.
At the end of the year, the panel will make a recommendation on whether the prevocational doctor has met all the Prevocational Outcome Statements at the required standard.
Number:
- A minimum of 10 EPA assessments have been completed,
- One assessment of EPA 1 in each term and
- At least two assessments of EPAs 2-4.
How the Assessment Review Panel uses the EPAs:
- Contribution to global assessment and achieving outcomes
- A higher number of EPAs may be recommended as part of Improving Performance Plans
- Oversight of hospital unit variation to drive education of supervisors
The goal of prevocational training is to reach the required level of entrustability by the end of the year, therefore it is not necessary that entrustability is reached for every EPA during the year.
There is no requirement for a prevocational doctor to ‘pass’ a minimum number of EPA assessments.
The EPAs contribute evidence to the achievement of prevocational outcomes.
Interpretation of entrustability:
Entrustability is a new concept in medical education. There can be variations in the understanding of entrustability which the Assessment Review Panel will need to understand in the local context.
- Assessor variation can be minimised but not eliminated and the Assessment Review Panel should understand the perspective of their own assessors when interpreting EPA entrustability scales. For example, some assessors do not consider any PGY1 doctors to be independent because local guidance determines that all cases must be discussed.
1. Set local guidance for assessors and prevocational doctors.
- Who to approach to complete an EPA (Term Descriptions).
- Responsibility lines: prevocational doctor makes sure they happen, but unit/supervisors must make sure there is the opportunity for them to happen.
- Escalation lines (unit-central).
- Determination of non-medical professionals to act as assessors eg. Pharmicists, Nurses, Allied Health.
- Minimum number of EPAs expected to be completed per term/annum (health service specific).
- Ensure that IMGs are approved by their own IMG principal supervisor prior to undertaking an EPA assessment.
2. Training of Assessors:
- Utilise resources – online modules and training at meetings.
- Tracking and monitoring completion of training.
- Ad hoc/further training – on request or when need identified.
- Quarterly reporting to PMCV – Assessor completion rate by discipline and by role.
3. Oversight of EPAs
- Unit – Tracking of unit data for feedback to supervisors and unit on numbers and consistency (positive and negative).
- Prevocational doctor
- Contribution to ARP data in considering the achievement of outcomes for progression.
- Ensure that the EPAs are not all being done by Doctors in Training (i.e. Registrars).
- Provide unit leadership on process.
- Develop local situational guidance (eg. Sample EPA scenarios, expected level).
- Ensure EPA information is in Term Descriptions.
- Undertake at least one EPA per prevocational doctor per term (NB. If the Term Supervisor is not available (e.g. leave), then Primary Clinical Supervisor may be utilised).
- Embed EPAs within Beginning of Term Discussion – outlining opportunities and expectation
- Review term EPAs as part of Mid Term and End of Term Assessment:
- The Term Supervisor may recommend above minimum EPAs in order to achieve outcomes.
- The Term Supervisor may also identify that all EPAs have been completed by junior staff and recommended that this be addressed.
- Contact point with Medical Education Unit.
- Consider running unit based sample/calibration EPA to support unit consistency.
- Provide the opportunity for EPA completion and guidance on most appropriate time eg. Week 4.
- Complete the training.
- Assess EPAs (including form).
- Engage with Term Supervisor and the Medical Education Unit as needed.
- Contribute to future development within unit.
- Ultimate responsibility for EPA completion sits with the prevocational doctor.
- Engage in Beginning of Term discussion with Term Supervisor to understand process and timing of EPA plan.
- Act on EPA plan as provided by unit (e.g. Contact Term Supervisor in week 3).
- Escalate concerns to Term Supervisor or Medical Education Unit in appropriate timeframes (e.g. Difficulties in getting completed).
- Provide details to the next prevocational doctor through rover (or health service specific mechanism) –“I found these tasks to be good learning opportunities”.