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 demonstrate 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).
Due to the lack of familiarity with the term ‘EPAs’ in the prevocational sphere, PMCV has introduced ‘Observed Practice’ as an interim term in place of ‘EPAs’.
The four EPAs are:
EPA 1 – Clinical assessment
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.
EPA 2 – Recognition and care of the acutely unwell patient
Recognize, assess, escalate appropriately and provide immediate management to deteriorating and acutely unwell patients.
EPA 3 – Prescribing
Appropriately prescribe therapies (drugs, fluids, blood products, inhalation therapies including oxygen) tailored to patients’ needs and conditions.
EPA 4 – Team communication
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 (one each term)
- Minimum of 2 assessments of EPA2, EPA3 and EPA4 across the year
EPA Assessors
To assess an EPA, Prevocational Supervisors will need to complete EPA training.
The AMC are in the process of developing an EPA training module.
EPAs can be assessed by specialists, registrars, nurses/nurse practitioners, pharmacists, or other health professionals. At least one EPA in each term must be assessed by a specialist or equivalent.
2024 PMCV Observed Practice Pilot
PMCV recognises 2024 as an opportunity for health services to commence engaging and familiarising prevocational supervisors and PGY1 doctors with EPAs in lead up to formal implementation in 2025.
The 2024 PMCV PGY1 Observed Practice Pilot aims to:
- Identify change management strategies to support the formal implementation in 2025.
- Identify additional resources that will support the formal implementation in 2025.
- Minimise the associated impact of formal implementation in 2025.
Health services may choose to participate in one of the three proposed studies, or alternatively a health service specific study can be submitted to PMCV for consideration.
Pilot 1: Longitudinal study on a small number of PGY1 doctors over the 3 terms
Pilot 2: Term EPA study by Clinical Unit
Pilot 3: Parent and Secondment Hospital Study
Pilot 4: Health Service Specific Study
Details of the proposed studies are outlined in the 2024 PMCV PGY1 Observed Practice Pilot document below.
A number of Victorian health services have opted into the pilot program for 2024. These include:
| Health services participating in the pilot |
|---|
| Barwon Health |
| Bendigo Health |
| Goulburn Valley Health |
| Mercy Health |
| Mildura Base Public Hospital |
| Monash Health |
| Northern Health |
| Royal Children’s Hospital |
| St Vincent’s Hospital Melbourne |
Health services participating in the pilot are required to complete this PMCV PGY1 Observed Practice Pilot Declaration which includes:
- Nominating a pilot lead within the organisation and
- Indicating which pilot is likely to be undertaken (see options under Pilot Participants).
Questions regarding the pilot should be directed to Maaki Dusanovic, PMCV Statewide Project Manager via NFPMT@pmcv.com.au
Additional Resources
| Resource | Author | Link |
|---|---|---|
| Presentation from NFPMT HS Lead Workshop | Dr Sheree Conroy | |
| Presentation- New Models of Medical Training: A Global Journey | Dr Jason Frank | |
| Crossing the Gap: Using Competency-Based Assessment to Determine Whether Learners Are Ready for the Undergraduate-to-Graduate Transition | Murray et al., 2018 | |
| Learning Curves in Health Professions Education | Pusic et al., 2015 | |
| The Ottawa Surgical Competency Operating Room Evaluation (O-SCORE): A Tool to Assess Surgical Competence | Gofton et al., 2012 | |
| How Do You Deliver a Good Obstetrician? Outcome-Based Evaluation of Medical Education | Asch et al., 2013 |
