One of the key changes of the revised NFPMT is the transition to a competency-based medical education model and the introduction of Entrustable Professional Activities (EPAs).
EPAs are core clinical activities that integrate the knowledge, skills, and attributes performed by prevocational doctors during their day-to-day clinical work. The clinical activity (the EPA) is observed and evaluated using an ‘entrustment scale’ describing the degree of supervisor input required to execute the activity to standard. As EPAs are linked to daily work, they can be readily observed by senior medical staff, day–to–day supervisors such as registrars, and potentially other health professionals (e.g. pharmacists for the prescribing EPA).
EPAs allow you as a Prevocational Doctor to take control of your prevocational training through self-assessment, requesting assessments and obtaining feedback from your EPA assessors. This will provide a framework for navigating difficult conversations and assist in identifying strengths and areas for improvement.
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 and communication with the patient and their family or carers.
Recognize, assess, escalate appropriately and provide immediate management to deteriorating and acutely unwell patients.
Appropriately prescribe therapies (drugs, fluids, blood products, inhalation therapies including oxygen) tailored to patients’ needs and conditions.
Communicate about patient care, including accurate documentation and written and verbal information to facilitate high-quality care at transition points and referral.
EPA Requirements
Prevocational doctors must complete a minimum of 10 EPA assessments each year.
This includes:
- Minimum of 2 EPAs each term
- Minimum of 4 assessments of EPA1
- EPA1 must be assessed at least once per term
- Complete at least one of EPA 2, 3 or 4
- Each of EPA 2-4 must be assessed at least two times throughout the year
Remember it is your responsibility to ensure that you complete the minimum amount of EPA assessments.
EPA Assessors
At least one EPA each term must be assessed by a specialist or equivalent.
The other EPAs can be assessed by other practitioners as appropriate if they have completed EPA assessor training, including other consultants, registrars, pharmacists, and nurse/nurse practitioners. For example, a pharmacist could assess EPA 3 and provide feedback.
Frequently Asked Questions
EPAs
Can EPAs be undertaken in a simulation setting?
No. The EPA assessment is based on interaction with a real patient for whom the prevocational doctor played an active role in delivering care.
Can I get the registrar to complete all the EPAs?
No, at least one EPA per term must be completed by the Term Supervisor (or Primary Clinical Supervisor if not available)
What if my hospital wants me to complete more than 10 EPAs per year?
In recognition of the value of feedback, some hospitals will expect a higher number of EPAs. They may set this as a local requirement beyond the minimum of the AMC
Who can view each EPA?
User access is determined by the AMC.
The term supervisor will have access to the prevocational doctor’s assessments during the term and the Director of Clinical Training, Medical Education Unit, Assessment Review Panel and the prevocational doctors will have access to all assessments during the year.
Can you ‘set up’ an EPA with a specific patient?
This would involve thinking ahead – ‘Mrs X would be a good patient to assess, so I will ask the doctor to see them’
In planning patients, bias is introduced – the PD may select a patient they perceive to be ‘easy’ or even have seen before or the assessor may judge incorrectly.
You MAY choose to say – ‘I would like you to take the lead in assessing the fourth patient on our ward round this morning’
Do I have to watch the prevocational doctor interacting with the patient?
Feedback will be of highest value when it follows the SMART principles (specific, measurable, achievable, reliant, timebound). This is easiest when an interaction was viewed.
Can you retrospectively make something an EPA?
No – the PD should know ahead of time that this is the case being used as their EPA.
Can EPAs be undertaken during a service rotation?
An EPA can be undertaken during a service rotation, provided the assessor has completed training. However, these may not contribute to the annual tally as there is usually not a Term Supervisor to tie these into the Term Assessments.