What is an Entrustable Professional Activity (EPA)?
Entrustable Professional Activities (EPAs) refer to tasks that a prevocational doctor would complete as a part of their daily work that are observed by an assessor who decides to what extent they would trust the prevocational doctor to have done it independently.
The benefit of EPAs is that the assessor does not have to consider a standard, but rather simply comments on what they saw. The assessor also provides feedback to the prevocational doctor on things they could consider doing differently next time.
The following are important points about Entrustable Professional Activities (EPAs) in the prevocational context:
- EPAs consider the multiple capabilities required by a prevocational doctor to complete a task at work.
- For example, when assessing a patient after a fall (the task or activity), the prevocational doctor must demonstrate skills in professionalism, communication and medical expertise (the outcomes and capabilities).
- An EPA is different to other assessment tools, like Workplace-based Assessments, which may consider individual outcomes rather than entrustability.
While PGY1 and PGY2 doctors will be assessed using the same EPAs, PGY2 doctors will be assessed to a higher level based on the complexity, responsibility, level of supervision and entrustability, as well as the context, of PGY2 doctors’ work.
The four EPAs are:
Conduct a clinical assessment of a patient incorporating history, examination, and formulation of a differential diagnosis and a management plan, including appropriate investigations.
Recognise, assess, escalate appropriately, and provide immediate management to deteriorating and acutely unwell patients.
Appropriately prescribe therapies (drugs, fluids, blood products, inhalational therapies including oxygen) tailored to patients’ needs and conditions, either in response to a request by the treating team or self-initialised.
Communicate about patient care, including accurate documentation and written and verbal information to facilitate high-quality care at transition points and referral.
How many EPAs need to be completed?
The AMC has determined that at least 10 EPAs must be assessed each year, with at least two occuring in each term.
EPA 1 (Clinical Assessment) should be assessed at least once a term, and EPAs 2-4 should be assessed two to three times throughout the year.
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There are many reasons to complete a higher number of EPAs, including:
- Individual health service education design facilitating more in recognition of value for learning.
- Prevocational doctor preference for learning in conjunction with their supervisor and/or ward consultant, or to build data points if independent entrustability has not yet been achieved for a particular EPA .
- Supervisor request – either for learning or to gain more feedback if independent entrustability has not yet been achieved for a particular EPA.
The EPAs are collated and used collectively to inform the progress of the prevocational doctor, with no one being considered more important than any others.
Who can assess an EPA?
All EPA assessors must complete mandatory training before they can assess an EPA. This training can be accessed via your health service’s Learning Management System.
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At least one EPA per term should be assessed by the Term Supervisor. In instances where the Term Supervisor is not available, the primary Clinical Supervisor can complete the EPA assessment.
Clinical assessors must be working as either at or above Registrar (PGY3+) level. The Term Supervisor should consider whether the Registrar is capable of undertaking EPA assessments in addition to their own training.
Other members of the health care team, such as a nurse or clinical pharmacist, might also conduct or contribute to an EPA assessment in a term, where the health service/supervisor deems this suitable.
EPA Training and Resources
Contact your health service’s Medical Education Unit to access the online EPA Training Module